After the letter’s appearance in the Times the issue was raised in Parliament, where Conservative leader David Cameron challenged Gordon Brown to reveal where the funding for the Personal Care at Home Bill will come from.  Mr Brown responded by accusing Mr Cameron of taking a ‘u turn on policy ‘– a reference to the fact that the Tories had previously pledged their support to funding free care.  It was then revealed that the three main parties had been meeting privately in December 2009 to try to establish common ground for progressing social care reform.  They had reached agreement in a number of key areas, but negotiations broke down when the Conservative Shadow Health Secretary refused to accept a compulsory inheritance levy of up to £20,000 as a funding option.  There were also disagreements over the reform of certain disability benefits.

Matters came to a head when a recent article in the Guardian newspaper indicated that Labour may be in favour of pursuing the inheritance levy option.  The Conservatives immediately responded by calling the levy a ‘death tax’ and circulating a poster showing a gravestone with the accompanying words ‘RIP off’.  This move has been roundly condemned for further reducing a serious matter to political point-scoring.   The MPs’ behaviour prompted a consortium of 18 charities to write their own letter to the Times, in which they call for the three main parties to put stop squabbling and focus on creating realistic, costed proposals for the future funding of elderly care.

Health secretary Andy Burnham then invited ministers, care providers, local authorities and charities to attend an emergency debate in mid February to try and put negotiations back on track.  However, the Shadow Health Minister, Andrew Lansley, refused to attend unless the compulsory inheritance levy was removed as a possible funding option.  Mr Lansley stated that the levy is unfair on people who decide to care for their relatives at home instead of moving them to a care home and that it is ‘…at odds with the wider structure of social care reform’. Mr Burnham refused to discount the levy, although he stressed that a variety of compulsory and voluntary options were all open to discussion; he denied Mr Lansley’s accusation that Labour has already secretly made its mind up to implement the ‘death tax.’ Mr Burnham also said that the £20,000 levy would be the maximum payable and the levy would be means-tested.  The conference went ahead without the Conservative party being represented.  Negotiations are currently underway for another conference to take place, to be organised by the consortium of charities, which the Conservative party is expected to attend.

You can read more about the social care debate and related issues by following the below links to selected news articles:

http://www.timesonline.co.uk/tol/news/politics/article7021299.ece

http://news.bbc.co.uk/1/hi/uk/8507521.stm

http://www.guardian.co.uk/society/2010/feb/14/tories-accused-over-elderly-care

http://news.bbc.co.uk/1/hi/health/8523836.stm

Experts have warned that the current government figures for free care fail to take into account either an increase in demand with time, or the effect of people who previously chose to pay for private care switching to free care because they now qualify for it (a situation described by the Guardian as ‘redistributing to the rich’).  Whilst challenging the Personal Care at Home bill in the House of Lords, former health minister Lord Warner warned that when Scotland began offering free personal care in 2003, the costs doubled within four years and the number of claimants went up by 36%.  Although the bill survived the challenge, more and more organisations are now backing the view originally put forward in the Green Paper that individuals must share the cost of care with government funding.

Other concerns around the Personal Care at Home bill centre around how it will be decided which people have ‘critical’ care needs and will therefore receive funding.  How will needs be assessed as ‘critical’ and what help will be available for those whose needs are severe, but not ‘critical’?  This is made more complex by the fact that currently, local authorities all interpret care needs differently.  Some authorities currently classify ‘critical’ care needs together with the lower category of ‘substantial’.  With councils also offering different care services at different prices, there is a risk that many people will miss out on funding due to a ‘postcode lottery’ – as was the case when continuing care eligibility criteria were first introduced in 1995.

• Make sure the existing End of Life Care Strategy is fully implemented over the coming years.
• Commit to making end of life care a political priority by establishing a Cabinet Committee.
• Implement an out of hours service so that dying people have access to specialist palliative care services and nursing around the clock.
• Train all health and social care staff in the principles and application of end of life care.
• Raise awareness of the Dying Matters coalition, which encourages people to express their wishes and priorities around palliative care.

NCPC chief executive Eve Richardson comments: ‘Bad end of life care should now be regarded as completely unacceptable, in the same way as any other failure of care. We believe that everyone has the right to access high-quality palliative care services and be able to exercise choice about their place of care at the end of their life. The momentum must continue.’

The social care charging measure will have to receive royal approval before it can be passed as law.

Wales has launched a consultation process on the future of its social services. The consultation will be managed by a new body, set up in December 2009, called the Independent Commission on Social Services. The Commission’s role is to investigate and report back on how the Welsh Assembly Government should reshape social care and social services in Wales over the next 10 years. Its work will take place within the context of the recent Welsh Green Paper on the future of social care funding, ‘Paying for care’.

At present, social care costs Wales £1.2 billion per year, with services provided to 150,000 people by 70,000 staff. The Commission will look at improving the current system in four key areas:

• Best practice, training and development for staff
• Consolidating the existing services by bringing together all the individuals and organisations that contribute
• Joint working with other services, e.g. the NHS
• How to meet the social care needs of the Welsh population in the best and most effective way.

The Commission is urging carers, service users and the public to submit feedback on how the above areas of social care can be improved through a ‘Call for Evidence’ process. You can find out more about this at the Welsh government website. Submissions should be returned by 26 February 2010. The Commission will report back its findings and recommendations to the Assembly in November.

posted by Cheselden Continuing Care at
08:21

Health secretary Andy Burnham has made the second Parliamentary reading of Labour’s Personal Care at Home bill, which proposes providing free home care to all elderly people that require it. As was the case with the first reading, charities have questioned how the £670 cost of funding the care will be met, with Age Concern commenting that the care sector has been left ‘in the dark about its future funding’ and that ‘…people reliant on care services can only fear the worst. Their spokesperson added that: ‘Spending from the health budget should be re-prioritised to provide additional funding for the care system.’ The Alzheimer’s Society warned that people with dementia are still not receiving enough funding and commented ‘These measures will not completely fix a social care system that is failing hundreds of thousands of people with dementia.’ Concerns have also been raised by charities and politicians that the Government’s aim of enabling an extra 400,000 people to be cared for at home ignores the needs of those that will still need to live in care homes.

posted by Cheselden Continuing Care at
08:12

The Care Quality Commission (CQC), the new regulatory body for social care in England, has published a damning report on its recent investigation into the quality of the country’s care homes. A sixth of all homes inspected were found to be providing substandard care to more than 80,000 elderly people. And the eight local authorities that provide the worst care were named and shamed in the report. The CQC has pledged that it will be ‘persistent’ in forcing these councils to improve and in stopping them placing large numbers of residents in homes that have received poor ratings. However, the Local Government Association hit back by blaming the CQC for not providing enough information about care standards and urged the CQC to ‘…urgently address homes they know or find to be failing, in order to deliver the quality of accommodation that everyone expects to live in.’

Despite 4,000 of the 24,000 homes and care agencies inspected being given a ‘poor’ rating in the report, the CQC states that there has been a ‘steady improvement’ in care standards since the last review was published in 2003. However, CQC chief executive Cynthia Bower admits: ‘I am concerned that many care homes and agencies have more to do to deliver the quality of care expected of them.’

Report statistics include:

• 24,000 care homes and agencies provide over 450,000 registered care places in England
• Around 10,400 places are in the 4,000 homes and agencies that have been rated as ‘poor’
• Another 71,500 places are in the 3,500 homes and agencies that are considered to be ‘adequate’
• The remaining homes have been rated as ‘good’ or ‘excellent’
• 30% of care homes fail to meet CQC minimum standards on dealing with residents’ medication
• 29% are failing to meet staff supervision standards
• Almost 10% are not treating residents with enough dignity.

The Conservative and Liberal Democrat parties were quick to criticise the report’s findings with shadow care minister Stephen O’Brien commenting: ‘This report exposes just how far we have to go to improve care for the elderly. We need a Government that will be tougher on quality, and tougher on unscrupulous care home owners.’

posted by Cheselden Continuing Care at
01:08

The Care and Social Services Inspectorate for Wales (CSSIW) has published its annual report on the Welsh social care service. Although it acknowledges that service levels are improving, the report criticises the variations between Welsh regions in both quality of care and access to services. The CSSIW reports that service users are becoming increasingly involved in decisions about their care and, on the whole, are being treated with dignity. However, it urges local authorities to move more quickly to modernise services despite shrinking budgets. CSSIW chief inspector Imelda Richardson described on BBC Radio Wales how councils will benefit from ‘…better partnership arrangements with other authorities who are doing well, learning from those who are doing well so that you’re able to refocus, redesign your own services and also listening to what people themselves want because often they want quite simple services and not complex ones.’ The Care Forum for Wales has welcomed the report’s recommendations, calling them ‘…a challenge that all parties responsible for social services and social care must sign up to and face together.’ The report can be read in full at the Welsh Assembly Government website.

posted by Cheselden Continuing Care at
01:04

The Times has revealed that Gordon Brown’s recent pledge to provide free social care to England’s 400,000 neediest people will come at the expense of vital funding into diseases such as dementia. Questions were raised over how the Government will pay the £670 million bill for providing the free care as soon as the Prime Minister made his announcement. And now the Times has discovered that £60 million of NHS money, earmarked for research and development, will now be diverted into the social care funding pot. The former health minister Lord Warner has called for more information to be made available on exactly which research budgets will be diverted from the NHS into social care. However, research funding for conditions such as Alzheimer’s has already fallen by 7% in 2009 – despite repeated appeals from experts and charities that a huge increase in funding is needed if the UK is to cope with the rising number of dementia patients. At present, there are around 700,000 people with dementia in the UK and this figure is expected to double by 2025, with an estimated cost to the NHS of £1.7 billion per year. Current health minister Phil Hope has denied that the reduced investment in dementia funding represents a cut down on dementia research, arguing that many proposals for funding in 2009 have been turned down as they were not up to the required standard. But the Alzheimer’s Research Trust responded angrily to these claims, stating that: ‘The Department of Health claimed it will find £60 million for care from its research budget and in the same week said its dementia research spending has fallen. This smacks of the sort of short-termism that is causing us to sleepwalk into a dementia crisis. The Government needs to significantly increase its funding for research and it must do it now.’

The Government has also been roundly criticised by opposing parties for making false promises about social care and dementia funding in an attempt to win over voters in next year’s general election.

posted by Cheselden Continuing Care at
01:01

Wales has launched a consultation period on the reform of its social care structure and funding system. Entitled ‘Paying for Care’, the consultation Green Paper can be downloaded or read from a new, dedicated website www.payingforcareinwales.net. The website will be kept updated with the latest developments in and responses to the consultation process as well as information about how to get involved and have your say. The consultation will run until 28 February 2010.

A selection of initial responses to the Green Paper:

‘This cloned version of the UK government’s Green Paper offers no specifically Welsh solutions. The only thing that is clear is that the Assembly Government has no clue on how to deal with the looming funding crisis in social care.’

Peter Black, Welsh Liberal Democrat health spokesman

‘The care and support system in Wales is in need of a radical overhaul and it is under-funded and overstretched. The system is also overly complicated and unfair and it penalises savers, even those with modest assets. We need to identify what people should expect from care and support services, in terms of when they should be eligible, how much support they should receive and the quality of that service. We believe the fairest way to achieve this is by sharing the costs across society as whole. We conducted research this year which showed that 80% of people of all ages across Wales feel that care and support for older people should be free at the point of use and paid for through taxation. If taxation is being ruled out as an option then we must explore alternatives that will balance the responsibility of paying for care between individuals and the state so that everyone receives care when they need it.’

Victoria Lloyd, Age Concern Cymru and Help the Aged in Wales

‘It is clear that the current system for the provision of care and support is widely accepted as being outdated and in many cases grossly unfair. However, Saga’s research shows that there is no one size fits all solution with all of the proposals receiving a decidedly cool reception amongst over 50s. While many support the abolition of the postcode lottery in care provision and funding, many are still concerned that these proposals do not protect the family home as accommodation and food costs are still going to have to be met by the family.’

Emma Soames, Saga

‘Older people need a system that is fairer, more consistent and which addresses the longer-term financial issues as well. We need to listen to what people say as part of this consultation and look at what consensus comes through and take steps forward as this result. We have some concerns as a commission about proposals around future claims, claimants for Attendance Allowance which we think needs to stay as a benefit which benefits a lot of older people directly so we need to get involved in Wales in the UK consultation as well.’

Sarah Stone, Deputy Older People’s Commissioner for Wales

posted by Cheselden Continuing Care at
10:02

The Healthcare Inspectorate Wales (HIW) and the Care and Social Services Inspectorate Wales (CSSIW) have published a review of the impact of the National Service Framework (NSF) for older people in Wales, launched in 2006. The review is taking part in two phases over a two year period so that sufficient coverage is given to the complex and diverse range of services that the NSF offers. The first phase, published in autumn 2009, focuses on three core themes of dignity in care, nutrition and integrated services. The HIW and CSSIW gathered information from the review through talking to service users and their carers at regional conferences, inviting responses via their websites, setting up an advisory board and holding meetings with regional forums. Key findings within the review include:

• 93% of care homes have shown that they are meeting the requirements for providing dignity in care
• 46% of care homes reported staff training issues when dealing with dementia patients
• Most care homes and hospitals are not yet giving enough priority to patients’ nutritional requirements, although some positive initiatives have been identified
• Some health and social care services are found to be working well together, but community partnership agreements are not always specific to older people
• Older people with dementia were identified as the most vulnerable group amongst the older population and increased focus will be given to their needs in Phase 2 of the review.

Click here to read or download the Phase 1 review document from the HIW website.

posted by Cheselden Continuing Care at
09:56

As the consultation period for the English social care Green Paper ends, Wales is launching its own consultation process into the future of the country’s social care services and funding structure. The Welsh Green Paper, entitled ‘Paying for care in Wales: creating a fair and sustainable system’, is divided into two parts: the shape of the new social care system and the way in which it will be funded. As the Welsh healthcare system is devolved, they are free to develop their own social care system and, to an extent, decide how it will be funded. However, the country’s welfare and benefits system is still controlled by the UK Government. This means that any changes that are made to English benefits as part of England’s new ‘National Care Service’, such as the proposed abolition of Attendance Allowance, must be implemented in Wales also. It is therefore crucial that the new Welsh social care system is structured in such a way as to remain fair and viable in the light of any enforced changes to the benefits system. Wales also needs to decide if far-reaching English decisions and recommendations, such as Gordon Brown’s pledge to make personal care free to everyone aged over 65 who needs it, are suitable for introduction in Wales, or whether things should be done differently.

The Welsh Green Paper puts forward the same three proposals to fund social care services in future:

• Partnership – the state and the individual both contribute a proportion towards the cost of care, with the Government ‘topping up’ contributions for the less well-off.
• Insurance – people make voluntary payments into private or state-run insurance schemes to guarantee that future care costs will be met.
• Comprehensive – compulsory, lump sum payments into state-run insurance schemes for those who can afford it, to be made on retirement.

Deputy Minister Gwenda Thomas commented on the Green Paper’s publication and the launch of the consultation period: ‘This is a vitally important issue for all of us in Wales and it is essential that we get as wide a debate as possible going on in our homes and communities. I would encourage everybody to read and respond to this Green Paper, so that our discussions with the UK Government are as informed as possible.’ She added that it is ‘…widely acknowledged’ that the current funding system is ‘complicated, unfair and unsustainable in the long term.’

For more information about the consultation process, find out how to respond and to download the Green Paper and supporting documents, please visit the new, dedicated website www.payingforcareinwales.net. The consultation period runs until 28 February 2010.

posted by Cheselden Continuing Care at
10:10

Welsh Assembly Minister Peter Black has called on the Welsh First Minister to push back the 4 December deadline for patients and families to put in claims for continuing care funding that pre-date April 2003. Mr Black maintains that more time is needed to publicise the deadline and make sure that anyone who is entitled to claim is made aware of their rights before it is too late. His own investigations have revealed that local health boards are not doing enough to publicise the deadline and where they are doing so, the materials used are too technical and not sufficiently clear. He comments: ‘While I understand the need for a deadline for claims, such a deadline must be communicated to everyone in a way in which they can understand. Many people are not aware of the fact that they may be eligible to claim…(and) there is still confusion on how this deadline should be advertised… things need to be clear. I do not want to see anyone miss out on the compensation that they may be entitled to…This can only be achieved through a sustained advertising campaign and information in accessible language, not civil service speak.’ In response, Rhodri Morgan, First Minister, stated that he did not feel that the deadline was being inadequately communicated. At the time of writing, the existing deadline remains in force.

If you or a relative feel that you may be entitled to retrospective funding from the Welsh NHS for care fees pre-dating April 2003, please contact Cheselden immediately so that we can review your case. Please complete our initial questionnaire with the basic facts of your case or call us on 0845 659 1558.

For more information about Peter Black and to read about his stance on continuing care funding and the forthcoming reform of the Welsh social care system, please visit his website.

posted by Cheselden Continuing Care at
10:02

The Welsh Assembly has held a debate on the introduction of the social care charging measure, which aims to introduce maximum weekly charges for domiciliary care across the country and eradicate inconsistencies and unfairness. During the debate, Members called on the Assembly to approve the new measures in principle and it was agreed that a legislation committee will examine the proposals in more detail. Deputy Minister Gwenda Thomas spoke in favour of the new measures which she believes will make home care charges easier to people to understand and for local authorities to administer as well as fairer for everyone. A maximum weekly charge of £50 is proposed, with local authorities having the discretion to set their own fees provided they do not exceed that amount. Although this will lead to an element of consistency, the scheme has been opposed by some on the basis that weekly fees could potentially increase significantly for people that currently pay less than £50 per week, particularly if councils choose to interpret the £50 fee as a ‘standard’ rather than a maximum charge.

posted by Cheselden Continuing Care at
09:59

Deputy Welsh Assembly Minister Gwenda Thomas has announced that a Green Paper will shortly be published proposing new ways of funding social care in Wales. Writing in Wales Online, Ms Thomas explains how the Green Paper will bring together ideas and opinions put forward in a national debate on paying for social care that she launched in 2008, as well as the findings of an Advisory Group that she set up to examine the issues in greater detail. The next stage of the consultation process will be launched on Monday 16th November with the publication of the Green Paper and the launch of a new website, www.payingforcareinwales.net, which will give further information and explain how to respond to the proposals put forward in the Paper. The Paper itself will have similar content to the English version published in July and will propose the same three options for funding social care in future: partnership, insurance and comprehensive. However, it is up to the Welsh Assembly to decide how social care is actually provided and funded in Wales. As with the English Green Paper, the Welsh version will not just focus on the needs of elderly people but will also consider how younger disabled people will be supported. A review of the benefits system and how it will fit within the redesigned social care system will also be included. The consultation period on the Green Paper’s proposals will run until 28th February 2010 and Ms Thomas is encouraging as many people as possible to get involved in the debate about how Wales’ social care system will be reshaped and funded.

posted by Cheselden Continuing Care at
17:44

The Care & Support Alliance, a group of charities which have joined forces to protect public interests during the reform of the English social care system, has criticised the Government for withholding financial modelling data that underpins the proposals put forward in July’s Green Paper. With the Big Care Debate on the verge of closure (16 November), the publication of the figures has now been delayed until 2010 – causing concern within the Alliance that the various funding options put forward in the Paper are not actually sustainable. Doubt has also been cast on the reasons given for general taxation being excluded as a means of funding the new ‘National Care Service’. The Care & Support Alliance comments on the delay: ‘How we fund the growing demand for better care is critical to all our futures. But we are expected to decide on funding options without the facts and figures they are presumably based on. Ministers want us to accept the “mathematics” underpinning the Green Paper but don’t seem to trust the figures sufficiently to publish them. People rightly want to know how much they may have to pay for care in the future.’ The Alliance now plans to request the financial modelling data through the Freedom of Information system.

posted by Cheselden Continuing Care at
17:42

The Learning Disability Coalition (LDC), a group of 15 charities that campaigns for the rights of adults with physical and mental disabilities, has warned that the proposed National Care Service focuses too much on caring for the elderly at the expense of younger adults with life-long disabilities. The LDC argues that, as the proportion of adults with learning disabilities is rising sharply, the Government needs to give more attention to meeting the spiralling costs of their care. Funding for these adults is particularly vulnerable because so much of it comes from local government and community budgets which are likely to be hit hard by forthcoming cuts in public spending. John Smithies, spokesperson for the Down’s Syndrome Association, comments: ‘The government recognises the demographic argument but hasn’t met the increased need by providing additional funding…The green paper addresses chiefly the elderly, not those who are younger.’ Phil Hope, minister for health, disagreed, stating that younger adults are a priority and that the Green Paper addresses the social care needs of all adults, regardless of age. He added: ‘We have increased investment in local council services by 39% since 1997, and this will rise to 45% by 2010-11. We’ve put £520m into making social care services more tailored to individuals’ needs. We’re also helping to improve healthcare for all people with learning disabilities by offering annual checks through the NHS.’

The ‘Big Care Debate’ on the proposals put forward in July’s Green Paper on social care ends on 13 November 2009. Anyone still wishing to give feedback on the Paper can do so online at www.careandsupport.direct.gov.uk.

posted by Cheselden Continuing Care at
17:22

A report on the public awareness of personal budgets for social care, commissioned by two independent healthcare providers, has revealed some worrying statistics, including:

• 80% of social care service users do not understand the personal budget system
• 92% of older people and 62% of everyone surveyed knew nothing about personal budgets at all.

With 20,000 people already receiving personal budgets and a third of all service users expected to be managing their own care funds by 2011, the figures have understandably caused concern. And because personal budgets allow social care service uses to spend their care funding as they wish, the report’s authors have also warned local authorities to prepare for a sharp increase in demand for services such as personal assistants, day centre care and education services. Report author Jamie Bartlett commented: ‘The transition to personal budgets will revolutionise health and social care, but local authorities do have their work cut out. More than ever before, providers and local authorities need to be ready to respond to the new types of demands that consumers will ask of them.’

posted by Cheselden Continuing Care at
17:16

Speaking at the national children and adult services conference, Andy Burnham has pledged that age discrimination in the NHS and social care services will become illegal by 2012. The health secretary’s announcement was made after research commissioned by the Government revealed that older people are receiving a lower standard of treatment from the NHS and social services than younger people. In particular, the care given to elderly stroke patients and older people suffering from mental health problems was singled out as markedly worse than the care received by younger patients. A survey undertaken as part of the research revealed that 50% of doctors that care for older people consider the NHS to be ‘institutionally ageist.’ Mr Burnham commented on the research and on the 2012 deadline to bring in the new legislation: ‘The age discrimination ban in the Equality Bill should apply for health and social care across England, Wales and Scotland at the same time as other sectors – in 2012. Meeting that deadline is ambitious, but achievable – and it’s vital if a central tenet of the national care service, the pursuit of fairness and equity, is to be upheld.’ A spokesperson for the NHS recognised that attitudes towards older people need to change, but that this change has to be echoed in the wider community as ‘…the NHS does not exist in isolation.’

Mr Burnham also told the conference how the forthcoming National Care Service, that will integrate the funding and running of health and social care services, will eradicate the current problems faced by the elderly where ‘…people play a random game of chance – with their financial wellbeing as the stake.’

posted by Cheselden Continuing Care at
18:02

Health Secretary Andy Burnham has announced that the DLA benefit will not now be abolished to help fund the forthcoming ‘National Care Service’ that is outlined in July’s Green Paper. The news will come as a relief to the 2.5 million disabled adults aged under 65 that currently claim the benefit. Plans put forward in the Green Paper had proposed scrapping DLA, which is not means-tested, and replacing it with a social care fund that would be based around a recipient’s ability to pay for care. Conservative MPs reacted to Labour’s change of heart by challenging the Government’s ability to plug a funding gap of £4.6 billion for the National Care Service, which could have been at least partly filled by the abolition of DLA. But Mr Burnham commented: ‘We are looking at how we can make this benefit more progressive, so that the money works harder for those in greatest need. The important principle is that nobody who is receiving disability benefits will lose out from the reforms.’

Although the future of DLA is now secure, Attendance Allowance (AA), which is a similar benefit for adults aged over 65 may still be abolished. Also not means-tested, AA is paid out to 1.6 million adults per year at a cost of £4.4 billion. A petition protesting against the scrapping of both DLA and AA has been signed by more than 18,000 people so far and is open until 1 December 2009.

posted by Cheselden Continuing Care at
17:54

The Care Council for Wales has launched a brand new website which provides comprehensive information for social care service uses, social workers and students. Available in both English and Welsh, the site has been designed to be clear, concise and easy to navigate so that visitors can quickly find the information that they are looking for. As well as providing information and up to date news on social care developments and events, the site’s ‘Your voice’ section invites service users, carers and the public to get involved with the Care Council and provide feedback on its services. Visit the new website at www.ccwales.org.uk

posted by Cheselden Continuing Care at
13:52

Public sector union Unison has voiced concerns that the widespread introduction of personal budgets for social care will leave vulnerable people open to abuse. The Department of Health wants personal budgets, which give people a set amount of money to spend as they wish on their social care needs, to be available to all adults by 2011. This means that many people will end up employing their own care staff, rather than care being arranged and funded by social services. Unison’s Helga Pile comments on the new system: ‘Whilst (it) will work really well for some people, others need good reliable care, not cash. Social workers fear this will result in an increase in the number of safeguarding vulnerable adult cases.’ The charity Action on Elder Abuse agrees, citing the case of Irene Simons who was robbed of around £150,000 by a home carer that she employed using her personal care budget. However, the Government has recently upgraded its ‘vetting and barring’ legislation which aims to prevent unsuitable people working with vulnerable children and adults, and people with personal budgets will be able to vet potential carers through the scheme. The Department of Health has instructed councils to be alert to any individuals that may be at risk but defends its decision to introduce personal budgets, commenting: ‘Safeguarding people in vulnerable situations remains a priority but must be balanced with the genuinely transformational opportunities presented by direct payments.’

In related news, Action on Elder Abuse has also reported that it receives around 18,000 calls per year from older people that have suffered some form of abuse, mostly in their own homes. The 18,000 calls are described as ‘…merely the tip of the iceberg’ and the problem is expected to get worse as the elderly population increases.

posted by Cheselden Continuing Care at
13:46

Thousand of vulnerable elderly people will benefit from new safeguards that have been introduced to protect them from abuse by health or social care staff. The Independent Safeguarding Authority (ISA) has tightened up its existing rules so that it must now be informed about any employee working in the health, social care or education sectors may have harmed a child or vulnerable adult, or where there it is considered that there is a risk of harm. The ISA will then give each case detailed consideration under the Vetting and Barring Scheme, to decide if the employee in question should be barred from working with vulnerable children or adults in future. The ISA has been given new powers to extend the scope of any bar that it is put in place whilst the Government has also introduced new criminal penalties for employees that have been found to abuse people in their care. ISA Chair, Sir Roger Singleton, comments: ‘Today is the first major step in enhancing safeguarding to vulnerable groups, since the creation of the ISA. It brings with it a new era, where – under the Vetting and Barring Scheme – we are strengthening information sharing with employers and regulatory bodies to reduce the opportunities for unsuitable people having access to children and vulnerable adults.’

posted by Cheselden Continuing Care at
11:40

In July’s Green Paper on the future of the social care system and its funding, one of the ideas put forward was the abolition of certain disability benefits and the re-routing of the resulting funds into social care provision. The benefits in question are Attendance Allowance (AA) and Disability Living Allowance (DLA) which are currently available to anyone with a certain level of disability that affects their mobility, regardless of means. The proposed changes have led to concerns being raised by a number of charities and organisations that campaign for the rights of elderly and disabled people. They argue that by replacing these benefits with means-tested social care support, many people that currently receive AA and DLA will lose a significant proportion of their income because they will not qualify for the new type of support. An official petition has now been set up to appeal to the Government ‘…to recognise the vital support that Attendance Allowance (AA) and Disability Living Allowance (DLA) provide to disabled people, and to ensure that these benefits are secured and are not removed as part of any future reform of the social care system in England.’ You can sign the petition by clicking here. It will remain open until 7 December 2009.

posted by Cheselden Continuing Care at
11:28

Stephen Burke, chief executive of the charity Counsel + Care has urged the Conservative party to consider their stance on the future shape and funding of the social care system. Writing for the Guardian, Mr Burke anticipates a Conservative victory in 2010’s general election and asks how they are preparing themselves to take over the work done so far by Labour on its National Care Service. When Labour’s Green Paper was published in July 2009, launching the nationwide Big Care Debate, the Conservatives responded by criticising Labour for its delayed action on reforming social care rather than countering the ideas put forward in the Green Paper with concrete plans of their own. With the Conservative party conference looming, Mr Burke suggests that social care should feature strongly on its agenda – especially given that almost half of people that will turn out to vote next year are aged over 60 and so will be among those most affected by changes to the current system. He reiterates that the main issues to be tackled are the inconsistencies and unfairness that dog the current system along with the key problem of deciding how social care should be funded in future. The article closes with a call for ‘a groundswell of public support’ for social care reform which will ensure that any future government is forced to face up to its responsibilities.

posted by Cheselden Continuing Care at
14:55

The Social Care Charging Measure, soon to be introduced in Wales, has led to concerns that home care costs will rise rather than fall for some residents. 14,000 people in Wales currently pay for home care charges. The Measure aims to combat the existing postcode lottery whereby people in different areas of Wales pay ‘wildly differing’ weekly rates for home care – ranging from just £16.20 to as much as £200. The new legislation will introduce a maximum weekly rate which is yet to be confirmed. The Coalition for Charging Cymru, which opposes any charge for home care services, is concerned that the new maximum rate will be seen by service providers as a ‘basic or standard charge’ and that the weekly charge for many people will increase. Rhian Davies, who leads the Coalition, comments: ‘The Social Care Charging Measure is definitely needed and long overdue, but getting the detail right is crucial. The effectiveness of the measure, and any potential benefits to people who use home care services will all depend on how this measure is applied…There must not be a situation where people are worse off because of the…maximum charge and having to pay more for their care.’

posted by Cheselden Continuing Care at
20:36

Further to the publication of the Government Green Paper on the reform of social care, ‘Shaping the future of care together’, the Government reports that the consultation process – otherwise known as the Big Care Debate – is going well. The aim was to spark a nationwide debate on the future of adult social care services and how they are funded. The large amount of publicity that the Green Paper has received in local and national media, as well as health and social care-specific publications and websites, has brought the issues at hand to the attention of the general public, who are taking the opportunity to air their views. Since the Big Care Debate was announced in June, its official website, www.careandsupport.gov.uk, has received over 3,000 responses to the ideas put forward in the Green Paper. A nationwide road show is also underway which is enabling members of the public to access information about the proposed changes, put their opinions across and ask questions. Road show events are running until mid October, with all dates available on the official website.

A key area of the debate so far is the benefits question, with many respondents stating their concern about the proposed abolition of disability-related benefits such as Attendance Allowance (AA). This issue has also drawn strong responses from a number of charities that campaign for the rights of disabled people, such as the RNIB which claims that many sight-impaired people will lose out if AA is replaced with a means-tested social care benefit, for which many are unlikely to qualify. Commenting on the website’s blog, the Government responds to this by stating its commitment to ensuring that disabled people end up receiving the same level of benefits under the new system as they do now. It goes on to say that a new system is needed for older adults to remove the inconsistency, confusion and unfairness that result from the existing, fragmented social care and disability benefit systems for the elderly.

posted by Cheselden Continuing Care at
10:29

Northamptonshire County Council has agreed to provide £1.3 million of funding to help improve the county’s adult social care services. The money will be spent on eight new projects that aim to prevent problems or intervene at an early stage. Five more projects will be funded by the Northamptonshire Invest to Save programme which was awarded by the Government two years ago. These will cover wide-ranging social care issues such as dementia, mental health and visual impairment. It is hoped that all the projects will contribute to the council’s long-term aims of saving money and improving the quality of life for service users through earlier prevention and tackling of social care issues. Councillor Robin Brown comments: ‘By focusing on prevention and early intervention, we will be able to rely far less on admitting people to residential or nursing care but promote the independence, health and well-being of adults with social care needs living in Northamptonshire.’

posted by Cheselden Continuing Care at
13:11

The charity Royal National Institute for the Blind (RNIB) is gearing up to challenge the proposal put forward in the recent social care Green Paper to abolish the Attendance Allowance (AA) benefit. The charity fears that the move, which would redirect the monies saved from scrapping the benefit into other areas of social care funding, would leave many of the UK’s 53,000 visually-impaired people with no state support. Head of campaigns Steve Winyard has urged blind and partially-sighted people, as well as local organisations that support and represent them, to get involved in the Green Paper consultation process so that they can give their views on the proposed changes. In the meantime, RNIB is developing a report that will prove the importance of AA and demonstrate why it should remain, which will be used to lobby the national Government. Mr Winyard described the AA as ‘a beautiful example of an individual budget’ due to the flexible way that it can be spent by benefit recipients to meet their precise needs.

posted by Cheselden Continuing Care at
13:09

The Lancashire Telegraph reports that in a controversial move, health and social care budgets are likely to be merged in the borough of Blackburn and Darwen. Councillors have voted in favour of a new body, Care Trust Plus, which will manage the £300 million combined budget (£50 million from the council and £250 million from the NHS). It is hoped that the innovative new system will make it easier for residents to access health and social care services and that the current poor health statistics in the borough will improve. Before Care Trust Plus can take over, however, the plans still need to be approved by NHS North West and ultimately by health secretary Andy Burnham. If they are approved, a 15 man Care Trust Plus board which will include NHS representatives and lay people will meet monthly to discuss how the health and social care budget should be spent. Concerns have been raised by the scheme’s opponents that by giving the new body budgetary control, voters will lose their influence over how health and social care services are run in the borough. There are also worries that the combined budget will result in money that should be used for social services will be re-directed into the NHS. However, executive member for adult social services David Foster has stated that there will be ‘adequate safeguards’ in place to stop this happening.

In other Blackburn and Darwen news, three sites have been identified for the building of new extra care housing in the borough. The council plans to build three retirement villages offering sheltered housing for around 600 people in total as well as new facilities such as cinemas and pubs. Blackburn and Darwen Council will work on the project in partnership with the NHS. Councillor David Foster comments: ‘What we are trying to do is give greater choice for older people in terms of housing and accommodation. Traditionally people have had to go into residential care homes and there isn’t much option. We are trying to develop extra care schemes which allow people independence.’

posted by Cheselden Continuing Care at
13:07

On 5 August, the Guardian newspaper held a roundtable, sponsored by the Department of Health, to allow disabled people and the organisations that represent their rights to discuss the recently-published Green Paper on social care. Overall, the participants voiced their support for the introduction of a new social care service that is presented in the Paper, entitled ‘Shaping the future of care together.’ But they felt that the scope of the paper focused too much on caring for elderly people at the expense of younger disabled adults. Issues discussed at the roundtable included:

• The language used in the Green Paper, which some felt was patronising to disabled people and younger adults. Terms such as ‘national care service’ and being ‘looked after’ were seen as contrary to the outlook of most young disabled adults who want to be independent and included in society.
• A concern that the Paper implies through its tone that the cost of funding care for younger adults is a burden rather than an investment.
• The Government’s encouragement of people to participate in the Big Care Debate was seen as an opportunity to effect cultural change and to get the rights of disabled people to be reflected in mainstream Government policy.
• The roundtable liked the idea that, further to a single needs assessment, their care package would be ‘portable’ and they would be entitled to the same level of care funding wherever they lived in England. However, it was noted that the Paper did not refer to any specific services that an individual could expect to receive from the national care service. Participants also pointed out flaws in both of the proposed methods for setting funding levels – locally and nationally – and expressed concerns that adopting either method would not eradicate the current ‘postcode lottery’ of care funding and standards.
• Although the roundtable was told that the Government does not intend to abolish the Disability Living Allowance (DLA), some people were worried about the intention to re-allocate funds from Attendance Allowance (AA), a similar mobility benefit for those aged 65+. However, others considered that funds currently spent on AA might be better spent elsewhere.

To read the full article about the roundtable discussion, visit the Guardian’s website.

posted by Cheselden Continuing Care at
14:13

Birmingham City Council’s attempt to modernize its adult social care services has hit problems due to a serious lack of cash. The Council wants to change the current system where it is responsible for providing all services to a new commissioning system where services are outsourced to independent and voluntary providers. But a combination of over-spending and unexpected costs has caused the already slow-moving transformation scheme to grind to a halt – prompting fears that a promised rise in care standards and increased breadth of choice will not happen. The steady growth of the city’s elderly population is further complicating matters, with independent research suggesting that the Council needs to find an extra £300 million of funding if it is to meet demand for older people’s services over the next ten years. The new system was set to achieve this by allocating care budgets depending on an individual’s assessed needs and directing them to appropriate providers in the independent and voluntary sectors. However, financial pressure on social services budgets is now likely to wipe out these savings. A further reason for the scheme’s slow progress is that there are not enough of care providers to meet demand. Senior city councilor Len Clark comments on the situation: ‘The pressures on budgets are more than offsetting any cashable benefits that may derive from business transformation. If we allow people to exercise choice because we have given them individual budgets but then there are no providers there for them to choose from, we risk putting people in worse circumstances than they are in now.’

posted by Cheselden Continuing Care at
13:53

Care Forum Wales has described how social care standards in Wales have improved since devolution took place ten years ago. The Care Forum was established in 1993 in anticipation of devolution and by 1999 had already laid the groundwork for the successful partnership now enjoyed by the independent care sector and the Welsh Assembly government. Mario Kreft, honorary chief executive of Care Fourm Wales believes that this partnership along with the increased focus on the precise needs of Welsh people has resulted in higher standards of social care across the country. He explains: ‘…we have a different slant to rest of the UK – and social care is all the better for our uniquely Welsh approach. We were the first in the world to have an Older Person’s Commissioner.’ The Assembly is currently working on a 10 year strategy to map out the future of social care services in Wales and independent care providers are expected to play a central part in the new agenda.

posted by Cheselden Continuing Care at
13:52

Charities campaigning for the rights of elderly and disabled people have raised concerns about the proposed scrapping of the Attendance Allowance (AA) benefit to help fund the reformed adult social care system. The plans are outlined in the Green Paper published on 14 July which states: ‘In developing the new system we think that there is a case for drawing some funding streams together to enable us to deliver the new and better care and support system we want to create. We think we should consider integrating some elements of disability benefits, for example attendance allowance, to create a new offer for individuals with care needs.’ AA has been targeted as it is a non means tested benefit that is provided on the grounds of an individual’s disability and not their availability to pay for care. AA is designed to help disabled people to meet the extra costs associated with limited mobility, such as adapting their homes or buying a wheelchair. The Green Paper proposes to replace its universal availability with a discretionary social care grant that would be means-tested by local authorities. However, the new system would not convey the advantages that are associated with qualifying for AA such as increased access to other benefits (such as council tax benefit) and a higher allowance rate for carers. Many older disabled people would be likely to end up worse off under the new system. The RNIB has expressed concern that many of its clients who rely on AA would not qualify for any funding at all as their needs are often classed as low or moderate. Michelle Mitchell of Age Concern and Help the Aged added that AA is vital to help people stay independent and in their own homes rather than needing residential or hospital care, commenting: ‘That extra bit of help may help prevent or delay the need for more formal care.’

posted by Cheselden Continuing Care at
13:15

Further to the publication of the social care Green Paper, the House of Commons has set up a select committee to investigate ways that residential and domiciliary care will be provided and funded in future. It will also look at how social care services can be personalised, so that individuals have greater control over the care that they receive, for example, in the form of care budgets that they can spend as they wish. The committee is inviting social care organisations and experts to submit written evidence to the committee on how they think these services should work and be funded. The deadline for submission is 1 October 2009. The committee also intends to hold a series of consultation meetings, with the dates still to be confirmed. To find out more, visit Parliament’s Health Committee website.

posted by Cheselden Continuing Care at
13:42

In response to the recent Green Paper, the University of Leeds and the Bow Group have published new research which demonstrates the benefits of introducing telecare to the social care system. Telecare involves remotely monitoring an individual’s condition so that changes are picked up and treatment administered at the earliest possible stage. It has been proven to help prevent unnecessary hospital admissions, enable earlier discharge and significantly save on care resources and costs. Patients also benefit by being able to stay in their own homes for longer, rather than having to move into residential care, as they have the reassurance of being constantly monitored. The Telecare system consists of wireless sensors which communicate with a base unit that is linked to a 24 hour monitoring and response centre. As well as changes in health conditions, the sensors can also pick up on risks such as falls, fire, gas leaks and security – helping to prevent accident or injury. The behaviour and movements of dementia patients can be monitored to ensure that they do not do anything or go anywhere that might endanger them or others. Telecare fits in with the Government’s commitment to providing more people with care in their own homes, greater independence and dignity, and increased choice over how their care is delivered. Unpaid carers, usually family members, will benefit greatly from the increased support that can be provided as well as the lower costs involved. Professor Sue Yeandle of the University of Leeds urged that the Government acts on its research and makes funding available for the widespread implementation of telecare. She comments: ‘This research evidence clearly demonstrates that telecare is already making an impressive impact in helping sick, disabled and older people remain at home for longer, supporting unpaid carers and saving money in the health and social care system. Progress is being held back because of a lack of investment, low awareness among health and social care staff and access which is limited by eligibility criteria.’ You download Professor Yeandle’s research report by clicking here.

In related news, the technology trade association Intellect has launched a project called ‘Fitting IT all together’ which sets out the technology industry’s view on health and social care, and which calls for more openness and transparency, a roadmap to support joined-up working, and earlier engagement with industry. You can read or download the ‘Fitting IT all together’ paper at Intellect’s website.

posted by Cheselden Continuing Care at
13:39

Reactions continue to the Government Green Paper on the reform of adult social care services and funding, published on 14 July. A number of organisations have highlighted flaws in the thinking behind the Paper, or have exposed gaps and omissions in the document’s scope. Some of the key points that have been made are described below.

No reference to NHS continuing healthcare

Although NHS continuing healthcare is, by definition, a healthcare issue and not a social care one, concerns have been raised that the new social care funding system could result in some people having to pay for care who would, at present, receive free care from the NHS. Changes in the way that people are assessed and in the way that health and social care services interact that are outlined in the Paper could affect an individual’s entitlement to receive free care on the grounds of having a health condition. The Green Paper does not mention continuing care per se, but some people are worried by what they have read ‘between the lines’ – including the Chief Executive of the Royal College of Nursing, Dr Peter Carter. He comments: ‘The NHS is responsible for funding the nursing care of patients who have health needs, regardless of whether they are in hospital, a care home or their own home. We would fiercely oppose a system where responsibility for meeting the costs of nursing care was shifted onto the patient and subject to means-testing when it should be free on the NHS. We will be looking at the detail of the paper to see what could be included in the care package.’

No provision for accommodation costs

The Paper states that the funding options presented are only designed to cover the costs of ‘basic care’ and that accommodation costs such as rent or mortgage payments and care home fees will not be Government-funded, except in the case of people with extremely limited means. Despite this admission, numerous organisations and publications have pointed out that each of the proposed funding options – partnership, insurance and comprehensive – will involve most individuals paying out substantial sums of money to ensure they receive care when they need it. However, on top of this, they will still need to pay for their accommodation costs, which in the case of care homes, can be as much as or more than the cost of care itself. Many people would still need to sell their homes to pay for residential care – something the Government claims it wants to stamp out. The insurance funding option in particular, which involves paying out a lump sum of up to £20,000, has received criticism for this reason. The organisation Private Healthcare UK describes it as ‘like buying a new car and finding you then had to buy an engine, seats and four wheels.’ It also points out a second flaw in the insurance proposal – existing schemes of this type are very unpopular and only two insurance providers currently offer them.

No help for people who are struggling with care costs now

As our Managing Director, Colin Ball, comments in Cheselden’s official response to the Green Paper: ‘(It) ignores the fact that there are a significant number of chronically ill people paying for care that are “in the system” right now. These people’s assets and life savings are being stolen to pay for care they should be receiving free from the NHS.’ Any funding reforms that are implemented as a result of the Green Paper will not come into force until 2014 at the earliest – meaning that there is no help available for the many people that are struggling with the cost of care at the present time, or who develop a need for care in the next five years. By then it is estimated that a further 400,000 people will require social care.

No provision for younger adults

A number of have raised concerns that all three of the Paper’s funding options are focused on the needs of elderly people, with those of younger disabled adults given scant consideration. The Government’s intention to fund basic care for everyone who needs it by abolishing Attendance Allowance – worth £3.7 billion – is seen as inadequate by Mencap’s chief executive Mark Goldring. He comments: ‘If Attendance Allowance is all they have to redistribute, that can’t cover a quarter of the costs of those who don’t get support at the moment and also pay for an extension of social care for those who are under 65.’ Leonard Cheshire spokesman Guy Parckar added: ‘More money is needed in the system. It’s something that’s so central that you need to fund it from taxation and national insurance.’ A group of charities campaigning for the rights of disabled adults and their carers has submitted a joint open letter to the Guardian on the subject – click here to read the letter and here for the related Guardian article.

Paper’s proposals will not abolish means-testing or ‘postcode lottery’

There have been angry reactions from several quarters to the Paper’s stated intentions to both remove means-testing from the social care funding system and to abolish the current ‘postcode lottery’ of care provision and standards. Central to the paper is the ethos that the Government will pay for a set proportion of basic care for everyone in England, regardless of their financial means. The individual is then responsible for funding the remainder through one of the three proposed options of partnership, insurance and comprehensive. However, the Paper states on several occasions that those people who have very low incomes will have all their care funded by the state – including accommodation costs (see above). This cannot happen without means-testing, so it can only be concluded that a means-testing element will be included in whatever funding system is eventually introduced for social care. Colin Ball comments in Cheselden’s official response to the Paper: ‘The Government claims to want to end means-testing for care fees, and yet it proposes that those on lower incomes will still have their full care costs covered. It suggests a sliding scale of individual contribution according to ability to pay. That is contradictory to the proposal of “ending means-testing”’. This issue has angered many people who feel that is unfair that those who have saved all their lives are then forced to use their assets to pay for care, whilst those who have not been as frugal are rewarded with free care.

Regarding the ‘postcode lottery’ issue, the Paper describes two options for setting and allocating funding levels – nationally by the Government or locally by councils. In both cases the Paper refers to varying levels of funding according to geographical location, because of local differences in the types of care needed and the costs involved. This has attracted criticism because the references are at odds with the Paper’s stated intention that in future, access to social care services and funding will be fair and consistent for everyone. The references to differing levels of funding and care availability could be said to perpetuate the ‘postcode lottery’ rather than abolish it. Says Colin: ‘Much more needs to be done if (the Government’s) aims of a “fair and consistent social care system for all” stand a chance of being met.’

You can read full and abridged versions of the Green Paper at the Government’s Care and Support website or a summary on Cheselden’s website.

posted by Cheselden Continuing Care at
13:32

The Conservative and Liberal Democrat parties along with campaign groups have attacked Labour further to the publication of its long-awaited Green Paper on the reform of adult social care, published on 14 July. Labour has been accused of sidelining the issue for 12 years and then raising it shortly before a General Election is due to occur (2010) which means that any reforms that are approved will be delayed or may never happen. It was also pointed out that the proposals covered in the Paper are for long-term reform only and do nothing to help those that are struggling with the costs of care at the present time. On Labour’s current timescale, the first of any implemented reforms would not take effect for another five years – leaving those who are already retired or are about to retire with little hope of being able to benefit from them. Dot Gibson of the National Pensioners Convention commented: ‘The fact that it has taken 12 years for the Government to come up with any proposals – with the prospect of up to another five years before any legislation, is a terrible betrayal of Britain’s pensioners and their families. In the meantime, the system continues to crumble and older people continue to receive a second-class service.’

Shadow Health Secretary Andrew Lansley was also critical of the fact that the Green Paper is merely a consultation document and that no costs were presented for the options detailed within it, commenting: ‘We don’t need to start another debate. One debate always seems to roll into another with this Government. We need a decision, and we need serious, costed proposals to be the basis of that decision.’ If elected, the Conservatives have their own plans to overhaul long-term care funding and have stated their aim to stop people being forced to sell their homes to pay for care.

posted by Cheselden Continuing Care at
13:07

Carers and their patients who attended an area committee meeting in Upminster, Essex have told social services managers that better communication is key to providing them with improved support services. During the meeting, residents listened to a presentation on forthcoming changes to the social care system and also heard about the ‘Support the Carers’ initiative. With a rising elderly population, Upminster has to act now to ensure that adequate care and support systems are put in place in good time. Ideas discussed after the presentation included issuing personal alarms that could notify a local care centre if a patient needed urgent help and a voice alarm to alert dementia sufferers if they do something or go somewhere that could put them in danger. However, residents were quick to point out that gadgets such as these could only help people if they are told about them, and also that social care information in general needs to become clearer and easier to find. One area highlighted was a lack of information or support about their ongoing care for patients that are discharged from hospital. Bob Morgan, representing social services at the meeting, admitted that the local hospital has been experiencing problems but stated that there are plans to improve communications on adult social care both within the hospital and online. You can read more about the Upminster meeting at the Romford Recorder’s website.

posted by Cheselden Continuing Care at
12:42

The Government has published its long-awaited Green Paper on the reform of the adult social care system in England. Entitled ‘Shaping the future of care together’, the Paper was published on 14 July 2009. It marks the start of a four month consultation process during which the Government aims to get as much input as possible from the general public on how the social care system should be structured, operated and funded in future. The Paper is introduced by the Prime Minister, who summarises the Government’s aims for reform: ‘As a country we need a new National Care Service that is fairer, simpler and more affordable for everyone – a service underpinned by national rights and entitlements but also personalised to individual needs, where everyone can get the best possible care whatever their particular circumstances and where carers themselves also receive the support they need.’

Why the system needs to change

• The current means-testing system is widely considered to be unfair with some people being forced to spend their life savings and sell their houses to pay for care, whilst others who have never worked or not bothered to save receive free support.
• Britain’s ageing population means that by 2026 there will be more than 1.7 million more people needing care in England alone. The working-age population is shrinking in proportion to the growth of the retired-age population and an intolerable burden will fall on taxpayers as well as the state if the current system is not reformed.
• There is a ‘postcode lottery’ of care in England, with both the quality and quantity of care varying dramatically in different areas of the country. There needs to be more consistency to ensure a fair system and equal access to services for everyone.
• Existing resources are sometimes being inefficiently or poorly used, for example by duplication of services. And increasingly, local authorities can only afford to fund care for people who are the least well-off or who have the highest level of need – leaving many people who need support without any funding help.

A National Care Service – the future of social care in England

The concept of a National Care Service is defined as a social care system that is fair, simple and affordable. Likely to comprise some of the most fundamental reforms ever made to the care and support system, the new Service will provide support for disabled adults of all ages as well as elderly people. The Green Paper outlines six expectations that people have from a National Care Service:

1. Prevention services – to provide care and support early enough to stop higher levels of care being required later on
2. National assessment – to ensure that everyone’s needs are assessed in the same way, no matter where they live
3. A joined-up service – enabling health and social services to work along the benefits agency and housing services to provide a co-ordinated, comprehensive support service that is not duplicated
4. Information and advice – access for all to information on how the care system works and what can be expected from it
5. Personalised care and support – giving people more control over their care and an increased say in how their personal care budget is spent
6. Fair funding – ensuring that money is spent wisely and entitling everyone to some level of funding from the state.

It describes three key changes that need to take place to enable the National Care Service to work as planned:

1. More joined-up working between the NHS and the new National Care Service (comprising health and social services, the benefits agency and housing services) to reduce costs and improve outcomes
2. Local authorities to provide a wider range of services in care and support that are appropriate to the needs of residents in their area
3. Better quality amongst the care workforce and greater innovation in the ways that care is provided, for example, telecare.

Who should fund the National Care Service and who should qualify for help?

In 2008, the Government undertook a six month engagement programme to gather the public’s thoughts on social care funding reform. The programme’s findings form the basis of the Green Paper. One of the key areas that the programme looked at was who should be responsible for funding social care and how it should be decided that a person qualifies for funding.

Most people considered that funding responsibility should be shared in some way between individuals and the state, although some felt that care costs should always be borne by the state and some that an individual should be wholly responsible for funding their own care.

The following options were considered for deciding a person’s eligibility for funding resources:

• Where a person lives. Although many people thought that local authorities should be allowed a degree of flexibility as to whose care they will fund, it was also considered that basing eligibility for care wholly on where a person lives is not fair.
• When people develop a need for care and support. Opinion was divided as to whether less funding should be made available for older people, who have had the chance to anticipate and save for their care needs, and more funding given to younger disabled people who have not had the chance to save.
• A person’s ability to pay. Again people differed in their opinions, although it was generally considered that the state should fund the full cost of care for those with very limited resources. However, it was seen as unfair that those who could afford to pay for their own care should have to lose all their assets and savings before receiving any help from the state.

Funding options

The Green Paper makes it clear that simply redistributing or streamlining the current public spend on social care will not solve the problems caused by England’s ageing population and the spiralling costs of care. Society as a whole must be prepared to spend more on funding social care for others as well as themselves.

There are also the issues of fairness and consistency to address. The new system must be:

• Fair to everyone
• Easy to understand
• Affordable to all, regardless of their income
• Universal so that everyone who needs help with care costs gets it
• Personalised and flexible to enable people to live their lives the way they want.

The Paper examines five possible funding options for adult social care. Two of these – full funding by the individual and full funding by taxation – have been immediately ruled out as they are deemed to be unfair. The remaining three options are:

1. Partnership. Everyone receives a set proportion of their care costs from the state, say a third. They pay the rest themselves. Those with lower incomes would receive additional support. The scheme would work for people of all ages. However, people who end up having to pay very high care costs or need to live in a care home for a long time will still have to pay very large sums of money for care and may need to sell their homes or use their savings to do so.
2. Insurance. Again, everyone gets a proportion of their care costs met by the state. The remainder would be covered by a voluntary insurance policy, which could be offered by a private provider or operated by the Government. People could pay in instalments or in a lump sum before or after retirement, or after death. The full cost of their care would then be covered if needed. The scheme would work for people over retirement age and would enable people to keep their home and bequeath their other assets and savings to their children.
3. Comprehensive. Similar to the insurance scheme but compulsory rather than voluntary, this would work for people over retirement age. People would be required to pay premiums into a state-run insurance scheme or to make a lump sum payment of up to £20,000, which would guarantee free basic care for the rest of their lives. The amount an individual pays would depend on their financial circumstances. Again, the person’s home and other assets would be protected. This scheme would work alongside a free care and support system for people of working age.

It is likely that the funding method that is eventually chosen will in some way combine elements of at least two of these options. The Government considers that, as well as people being cared for, carers will benefit from the new funding system because the assessment process will be made simpler and more people will get access to funding.

Funding restrictions

The Green Paper points out that the proposed state funding will only cover a proportion of an individual’s basic care and support needs, i.e. the care that they have been assessed as needing. If someone wants additional care on top of basic care, they will have to fund it themselves. Neither will the state will contribute towards accommodation costs such as mortgage payments and care home accommodation fees, except for people that are on very low incomes. However, the Government does intend to introduce measures to help people meet these costs, such as deferred payments for accommodation in a care home, where the cost is recovered from the resident’s estate after their death.

Eradicating the ‘postcode lottery’

An important part of the new social care system will be to ensure that everyone in England can access high quality care wherever they live. People should not have to worry about not being able to access the same care services in a new area if they want to move house. However, it is also important to retain a degree of flexibility so that local authorities can tailor their services according to the needs of their local population. For example, a rural population with a high proportion of elderly people will need different types and levels of care services from an urban population that mostly comprises people of working age. The Green Paper aims to gather people’s opinions on two possible ways that the new social care system could be operated:

1. A part-national, part-local system. Under this system, the Government would decide what proportion of a person’s care it will fund. But local authorities would be able to decide how much an individual will actually receive, depending on local circumstances. This would reflect the fact that the costs of care and the requirements of individuals vary across the country. It would also allow local authorities the flexibility to develop new and innovative kinds of care and support. However, the downside is that where a person lives would still dictate the level of care funding available.
2. A fully national system. This would involve the Government deciding on the exact amount of funding that each person is entitled to. Funding amounts might be the same for every local authority or could still vary by locality. Local authorities would have no say in how much care funding an individual could receive and it would be hard for them to tailor their care budget to an individual’s circumstances. This system would also mean that all care would have to be funded by national taxation, unlike the current system where local authorities can top up their care funding from council tax funds if they wish.

Under either system, local authorities would still be responsible for all aspects of delivering and developing social care and support services.

Have your say on the future of adult social care in England

Consultation on the Green Paper is open until 13 November 2009. During this time, the Government will be running a series of events for stakeholders and members of the public where these issues can be discussed in detail. If you would like to get involved in these events, you can find out more at the Care and Support website. You can also download the full Green Paper from the website as well as a shorter version that summarises the main issues.

To read Cheselden’s reaction to the Green Paper, click here.

posted by Cheselden Continuing Care at
11:57

A device that helps care home residents with dementia to keep track of their own clothing has won an award at the Health and Social Care Awards held on 8 July. Designed for and used by Nottingham City Council, the ‘Stay Put’ radio frequency identification button attaches discreetly to a person’s clothes and enables them to identify their own garments so that they do not mistakenly take another resident’s clothes. The Stay Put device won the Innovation in Technology award for helping dementia sufferers maintain their independence and dignity. It is used in all five specialist dementia care units in Nottingham after being introduced in October 2008. It is available to people visiting the units for short term or respite care as well to long-stay residents. As well as helping to keep residents’ clothing separate, Stay Put also records details of an individual’s skin-related issues and allergies which staff need to be aware of when laundering clothes. Nottingham city councillor Eugene Campbell commented on the device’s success: ‘I’m thrilled Nottingham City Council has won this prestigious award for what is a simple idea that new technology allows us to put in place. It can save problems and upset and give our care staff more time to spend caring for residents…The buttons store specific requirements, ensuring individual needs are met discreetly and efficiently.’

In related news, Sir Michael Parkinson has spoken on GMTV about the People’s Award for Dignity in Care that he presented at the Health and Social Care Awards on 8 July. Sir Michael, who has been NHS Dignity Ambassador since May 2008, works to promote the rights of older people to be treated in the same way as younger generations. He supports the Dignity in Care campaign which has appointed 7,000 Dignity Champions across the health and social care sectors, all of whom are committed to improve the way in which older people are treated in hospitals, care homes and in their own homes.

posted by Cheselden Continuing Care at
16:32