Should Dilnot recommend compulsory care insurance?

The Dilnot Commission will report next week on how social care in England should be funded. Currently, if you have assets, including property, worth over £23,500 you will likely pay for social services or residential care. This means a lot of people pay for all of their care whilst some pay for none of their care.

Dilnot is charged with finding a system that will create a “fairer” system that will also encourage people to save for care that they may need. The focus will be on encouraging people to purchase insurance to cover future care costs.

The choice comes down to a voluntary insurance scheme or one where everybody has to purchase care insurance – just like all car drivers must purchase car insurance. Or there could be a voluntary scheme where people are automatically enrolled into it but can opt out.

Politicians will then be left to choose, if they choose to do anything. But what hasn’t appeared in the debate so far, is the role of genetics.

Having a certain genetic profile can make it more likely (but not certain) that you suffer conditions such as Huntingdon’s disease or Alzheimer’s. However, your behaviour can also reduce the likelihood of these so knowing your genetic profile could encourage you to change behaviour and reduce the chance of having various conditions.

Knowing can also help you and your family prepare, which is what one person felt when faced with this experience who I was talking to recently. And genetic profiling will become much more common in the future as costs rapidly decrease.

The impact of this on a care insurance market are obvious. In a voluntary insurance scheme, if you don’t have to share your genetic profile with insurance companies, those most at risk of ill health will take insurance but companies won’t know who has the greater risk so all prices will go up, fewer people will take insurance and insurance companies will leave the market. And in a voluntary system where you do have to tell the insurance company, there could be lots of people who will be refused insurance. They will be discriminated against because of their genetic profile.

However, in a compulsory insurance model where you don’t have to tell insurance companies, people will still be able to know their genetic profile and plan for the future but without fear of discrimination, and insurance companies could spread the risk and costs amongst a greater number of people.

Interestingly in 2003, the Department of Health declared: “As our understanding of genetics advances, the case for private health insurance as an alternative to our universal tax financed NHS diminishes”. It may be the same should apply to social care as well.

Value is not in the money but its greater impact

Robert Kennedy once said that economics often counts the wrong things meaning that we fail to understand the true value of some things, like the health of our children.

Regarding the value of public and charitable services, Social Return on Investment (SROI) analysis is designed to overcome this problem. For instance, when calculating the value of what a Carers’ Centre does you include the benefits to the wellbeing of the carer and the cared-for, and effects on other services that may otherwise have been needed.

The value is not just what was spent but the impact of what was done with that money.

Today, The Princess Royal Trust for Carers published a SROI analysis on five Carers’ Centres. It finds that for £5m invested per annum, the total value produced is at least £73m p/a. Carers maintain better health; the cared-for remains living at home; and young carers are more likely to end up in education, employment or training.

Based on this calculation, the total value produced by all 144 Carers’ Centres in the UK is £814m p/a, from just £57m worth of funding. Much of this is derived from the savings on health and social services created by Carers’ Centres helping carers maintain their own health and ability to care at home. But we are also talking about the value to people’s lives.

During the launch, after discussions about probabilities, financial costs and methodology, the real value of Carers’ Centre became clear when Jim got up to speak. He is a carer supported by Carers in Hertfordshire and told his story of caring for his wife.

We need to show the evidence of our work and how we use donations and public money to greatest effect. This report does this. But we must also remember that behind the figures are carers called Jim, or Karen, or Samuel, or James. Real people whose lives can be changed forever if we give them the support they need and deserve. The report shows that we do this to great effect given the funding. But we must be given the funding.

Take care

Gordon

Prime Minister celebrates Carers Week

Note: The following post is from Beryl Cross, Head of Operations at The Princess Royal Trust for Carers

The Prime Minister hosted a reception for about 150 carers at 10 Downing Street yesterday to celebrate Carers’ Week. I was there with carers and staff from our Carers’ Centres. You had to be very brave to fight through the melee to get to the Prime Minister, or in Louise’s case perhaps have someone like me to push you in the back to make you do so.

Louise is a young carers who is supported by our Bromley Carers’ Centre, and she gave David Cameron a letter she had written explaining her experience and ideas for supporting young carers.  Moira Fraser, our Director of Policy, was also straight in there, highlighting to David Cameron the need for government to take action on getting NHS money for carers breaks delivered to carers and raising our Give Carers a Break campaign. And it seemed to work as in his speech later in the evening the Prime Minister said the government should “follow through” on getting Primary Care Trusts to use that breaks money for carers.

He also made reference to his own experience as a carer for his son and he gave “a huge thank you” to the carers there for what they do. There were many other Ministers there including Nick Clegg MP, Paul Burstow MP (Minister for Care Services) and Steve Webb MP (Minister for Pensions), plus Tony Baldry MP co-chair the Parliamentary Group on Carers and other MPs who have supported carers in Parliament. They also recognised the massive contribution made by carers.

Jack Dromey MP also asked the Prime Minister about carers during Prime Minister’s Questions yesterday to which the PM responded:

“Everyone in the House should welcome the fact that it is carers week. I will be having a reception in No. 10 tonight to celebrate carers week with many people who take part and who are carers. This Government are putting in £400 million to give carers more breaks and £800 million specifically to make sure that those looking after disabled children get regular breaks.”

Thanks

Beryl

Carers show the true face of caring

A few years ago, Karen gave up work to care for her husband full time. She wanted to work part-time and care but her

employer was not willing to consider reduced hours. Plus, health and social services calculated that it would cost £160k p/a to provide a care package to meet all of his needs. The cheaper option was to leave the care to her and provide £5k worth of support.

Karen’s husband has a degenerative condition which does not directly cause early death. She pointed out that he could live for another 28 years but that there would be no chance she could carry on that long. She feels that she is being run into the ground and exists to provide care.

For about 90 minutes today, Karen shared her story with Rory Stewart MP, Peter Aldous MP, Laura Sandys MP, Cathy Jamieson MP, Andrew Bridgen MP, Stephen Mosley MP, Jonathan Lord MP and Tracey Couch MP.

James (aged 19) and Samuel (aged 15) were also there speaking to these MPs. Both care for their mothers and have done so for many years. Their message was simple:

• GPs need to think about who is looking after their patient at home
• schools have to realise that pupils can be young carers which affects their school work
• local young carers’ projects can provide vital support

These were young men who were speaking matter of factly about what they do, the impact on their own lives and what more should be done. It always strikes me how mature young carers can be when discussing their situation. Afterwards, we walked around London to see Buckingham Palace and Trafalgar Square, and they  talked about their interests and futures. This should be a time of choices for both.

Karen didn’t seem to have many choices; the map for her life had already been drawn. Her story illustrates why many carers feel taken advantage of and taken for granted.

The galling thing is that Karen could be considered a lucky carer as she might get a personal budget of £500 this year as a result of the Government’s £400m injection into the NHS for carers. Very few carers get a personal budget (fewer than 50,000 in 08/09) and if they do it is usually for approximately £250. So Karen could nearly consider herself a model of how the extra money is providing extra support. But as she pointed out, her £500 will still only provide one hour off every fortnight.

This is not the change that carers need. This can only just be the start or we will leave James and Samuel with no choices, and no chance.

Take care

Gordon

PS: Carers need continued support. Don’t forget to tune-in to BBC Lifeline’s appeal for carers on BBC One on June 19th at 4:45 pm (if you are in Scotland, Wales, Northern Ireland) and 5:15 (if in Scotland). Please do spread the word.

Ready for Carers Week 2011

Carers Week 2011 will be the largest awareness raising week in the UK and it begins on Monday 13^th June. Over 1500 organisations including Carers’ Centres and Crossroads Care schemes, other charities, local councils, GP surgeries, hospitals and private sector companies will be holding events throughout the week.

My week begins with an event with MPs and carers on Monday, which will be something akin to speed dating. Numerous carers will be sat at various tables and MPs will come in and speak to each one, moving around the tables giving them a chance to hear and discuss what it’s like to be a carer.

The aim is to show MPs the range of people that caring can affect and the different issues involved. So there will be young carers there, older carers, carers who combine work and care, people who care for people who have mental health problems, or learning disabilities, or physical disabilities. I’ll blog on Monday night to let you know how it goes.

On Wednesday, Sheila Gilmore MP is holding a debate in Parliament on carers and the effects of spending cuts on them and there will also be a reception for carers at 10 Downing Street hosted by the Prime Minister, David Cameron MP. We will have a guest blogger reporting back on that one.

Fast forwarding to Sunday 19^th June, The Princess Royal Trust for Carers will be featured on the BBC Lifeline Appeal on BBC One at 4.55pm. Do tune in and tell friends and family about it – we hope it will raise the profile of carers and also where carers can get help.

You can find out what events are happening in your local area at the Carers Week website and do post comments letting us know if you are involved in holding events for Carers Week. If you are, good luck!

Take care

Gordon

PS: Carers need continued support. Don’t forget to tune-in to BBC Lifeline’s appeal for carers on BBC One on June 19th at 4:45 pm (if you are in Scotland, Wales, Northern Ireland) and 5:15 (if in Scotland). Please do spread the word.

Carers do meet the social care needs

You may have seen media reports last week about 800,000 people not getting help with social care. This was based on an Age UK report that estimated there were 2 million older people in England with care related needs and 800,000 of these were not getting formal support from public or private agencies.

The widespread media reports implied that there were 800,000 people whose needs were not being met and levels of ‘unmet’ need is a cause for concern amongst politicians and decision makers. Of course, one of the biggest worries has been that if people are not being supported by councils or other agencies, then how do you know how many of them are there? This is a problem facing the Dilnot Commission which is considering the future funding of social care in England.

The answer of course lies with carers. Because we survey who is providing care, then you can work out how many people have care and support needs.

Going from the census 2001 and last year’s household survey, there are approximately 4.8m people providing care in England. The household survey found 37% were sole carers and 63% were sharing it with another person. This would equal approximately 3.2m people with care and support needs being supported by carers in England alone. Plus, there would be adults being cared for by young carers that were underestimated in the census and not covered by the household survey.

It is not that needs are going unmet, they are being met, just not by people who are paid to do so. The vast majority of need is being met by carers. They are the ones who are there when social services or private care agencies are not.

When we launched our Give Carers a Break campaign, Peter Hay, President of Association of Directors of Adult Social Services addressed the politicians and carers involved. He said that because it is carers who are the first ones providing care and we rely on them so much, then the NHS’s £400m for carers has to be spent on carers and prioritised first ahead of other needs.

Take care

Gordon

PS: Carers need continued support. Don’t forget to tune-in to BBC Lifeline’s appeal for carers on BBC One on June 19th at 4:45 pm (if you are in Scotland, Wales, Northern Ireland) and 5:15 (if in Scotland). Please do spread the word.