Who’s seeing the wood from the trees in social care?

We’re at a potential turning point for social care in England. Potential, I say, because despite all the efforts of Andrew Dilnot, the long grass is still a distinct option for his proposals to make social care fairer. At the moment, the support you get depends on where you live and how much money you have, leaving many families in the position of losing almost everything they have to pay for the care they need.

The hoo-ha around the curiously named Health and Social Care Bill (curious because it isn’t about social care at all) has distracted us all from the wicked issue of how on earth we make sure older and disabled people’s care can be paid for. We all have a stake in this. As a person with no kids, I need to know that if I develop dementia like two of my grandparents, someone somewhere will be there to enable me to have some dignity and quality of life.

The thing that interests me is that the reason the Health Bill is now in such trouble is that after many months of polite muttering, the health professions have started to throw their prescription pads out of the pram .

The question is, who will throw their toys out of the pram for social care? Who has the influence to make sure we get a better deal for the service users and carers of today and tomorrow? As a sector we are disparate and comparatively low status. We have none of the trappings of power of the medical profession or the hospitals that people will march in the streets to defend. We have no easy solutions that don’t involve more funding for services,  and it’s easy to put us in the too hard basket.

I’ve been lucky enough to take part in a programme organised by the National Skills Academy for Social Care. It’s bringing together  people who work across social care  - local authority commissioners and managers as well as charities, to give us the skills to shape the sector for the future. Although in our day jobs, we are often on different sides of the fence, here we’ve found that what connects us is much greater.  We all work here because we believe in fairness, human dignity, and a society which enables people to live decent lives. It’s easy to get distracted in the next task- next task -next task rush of our lives and jobs. But social care deserves and needs so more than that.

Standing together with users and carers, we individually and collectively need to make change happen in the best way we can – it is all our responsibility . We can sit back passively wringing our hands, but then nothing will happen and we will be as much to blame as the Government. We need to  work together, push ourselves to have the tricky conversations which might tip the balance for change, understand where to use our energy to make most difference,  and do things differently from the  stereotypical patterns we have fallen into.  I, for my part, can make sure I use my skills to put carers’ issues at the heart of the agenda. I can do that  more by listening and  developing real connected partnerships so that we can stand strong together when the going gets tough, than by posturing or point scoring.

We’re meeting today in Hertfordshire and outside our meeting room  the spring snowdrops offer  a promise  of hope for the year ahead. Here, in the short time we can spend together in the calm and quiet of the forest ,  I hope we  are all starting to see the wood from the trees.

For more information on The National Skills Academy for Social Care visit
http://www.nsasocialcare.co.uk/

For information on the Care and Support Alliance’ s End the Care Crisis Mass Lobby on 6 March http://careandsupportalliance.wordpress.com/end-the-care-crisis-lobby-2012/

Capping it off – the hidden hole in new carers benefits

As a Scot working south of the Border in health and care policy, it’s not often I get to work on something that affects my friends up north  just as much as my neighbours and colleagues down here in the green and pleasant  land.  It’s sad but true that when I do work on a “reserved” issue (i.e. something which the Westminster parliament keeps power over) then it’s never good news because it’s always about cutting welfare benefits.  I should probably say “reforming” rather than “cutting”  of course, but from my experience, it’s  not often  about more money going in and very often more money being taken away.

You might have heard  last year that  Government said they’d leave Carers Allowance alone, for the time being at least . Well this was good news. Of course, it’s nothing like enough money. £58.45 a week (the amount for 2012/13) is not exactly a king’s ransom for people who are providing 35 plus hours of caring a week. But still it’s better than nothing.  And in general the new Universal Credit should be beneficial to carers who are on lower incomes, because instead of losing all your Carers Allowance if you go over  the £100 earnings threshold, there will be a taper – as the amount you earn goes up, the amount of benefit goes down. Less of a cliff edge has got to be a good thing.

But one thing seems to have been overlooked. Have you heard about the benefit cap? It’s been in the news quite a bit recently. Basically the Government is saying that there should be a limit on how much any one family can get from the state in benefits – £500 a week for families. Sounds like a lot, but  especially in the south east, you don’t get a lot for that for example if you have kids and need a three or four bedroom place to live. It won’t apply if you have a council house, but I seem to remember we sold most of them.

The cap won’t apply to carers who live with someone on Personal Independence Payment (PIP)  or one or two other benefits which are exempt. However, there are carers who don’t live with the person they care for. If, for example, you care for your sister who has  multiple sclerosis who lives in the next street.  Then, in order to mimic work patterns, your benefits could be capped as we are all supposed to be better off in work than out of it and if you want more money than this you better get out and earn it.  So, if you live in private rented accommodation, you might find your housing benefit reduced… meaning you can’t afford the rent and  have to move… meaning who cares for your sister in the next street?

The Government knows about this but it’s just not a big enough issue for them to want to fix it seems. I think it’s a massive issue. The very fact that the cap is there to “make work pay” and encourage people to go to work,  and it can possibly be applied to this group of people who are fully occupied in  difficult caring roles  and therefore saving the state millions of pounds a year, is pretty insulting.  What about making caring pay? Anyone feel a letter to an MP coming on?

Stuck in the Health and Social Care Bill tea party

Not long ago I did a conference presentation on the Health and Social Care Bill. To make an after-lunch slot a little less soporific I dusted off my White Rabbit and gave the whole session an Alice and Wonderland theme. Curiouser and curiouser, I said, and 3 months on, we’re still stuck. Not going forwards, no going back.  Round and round, consultation after consultation, debate after debate, and still no sign of the tea party being over.  Another cream bun anyone?

Whatever your take on the Health and Social Care Bill, I think the one thing we can all be sure of is that the hiatus that’s occurred within NHS structures isn’t helping anyone.  Don’t get me wrong, we shouldn’t plough ahead with proposals which are likely to make things worse rather than better. Personally I think tweaking the old system with better clinical involvement would have done the job. It wasn’t perfect but it did work. Instead,  what has happened is that  in advance of decisions being made, the system has effectively been dismantled and elements of the new one put in place, with no legislative mandate to do so. Maybe I’m old fashioned but I kinda think you should wait till Parliament has made the decision before you implement it.

I’ve got no problem with involving GPs more in commissioning. Some of my friends are GPs even. But they don’t always have carers right at the top of their agenda. That’s why the Government has worked with us, the Royal College of GPs and Carers UK on a programme to ensure GPs are more carer aware.* Across the country,  Carers Centres and Crossroads schemes work extensively with GPs in their areas, constantly  reinforcing the message about supporting carers.  All GPs need to do is think carer – identify and refer.  But often the carer is sitting there, right in front of them, struggling,  and still it doesn’t occur to them that they could be the lifeline to support.

The other worry I have is that in the shift from the  old NHS structures to the new ones, and the inevitable change in commissioners and staff, all the progress we’ve made on making sure support for carers is prioritised might be lost. The Government has listened to us on this issue, and so have many Primary Care Trust and local authority commissioners, but it’s still not enough and we don’t need any backsliding.

Who knows what’s going to happen now, with more and more health professions rattling their stethoscopes , it could be a while before we know the final shape of the new NHS.  It could get curiouser yet. However, for carers and those they care for, life goes on regardless, whatever the commissioning structures turn out to be.  If we need to start the debate on why we need to support carers all over again, we will. We just shouldn’t have to.

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PS: If you read my blog 2 weeks ago, you’ll see that a carer asked that I mention the Carers Ambassador programme  in England where carers can get involved in their local area  raising awareness of  carers issues. If you’d like to find out more about this, contact the project manager Michael on michael.shann@carersuk.org

Young carers wiped off the map of financial support

If you were anything like me when I was a teenager, then you’ll have thought it was pretty tough. Pressure all round – to be the same as your friends and fit in, to try to look good despite the spots, to succeed in exams, and all the hormones and other challenges that go with growing up and finding your place in the world.

To be honest I had it pretty easy. Young carers have got all this plus their caring responsibilities – perhaps looking after a mum or dad with a mental health problem, or a health condition like MS or cancer or a sibling with a disability, or looking after the other kids and the house because mum or dad aren’t able to. We know that one of the main caring roles young carers take on is emotional support – extremely demanding on a young person not yet sure of their emotions themselves . Although many young carers can and do succeed despite the difficulties, many others lose out on school, miss opportunities to develop friendships, miss chances to take part in activities which others take for granted.

Education Maintenance Allowance was one benefit that really helped young carers. For those young carers that bit of cash helped them stay at school and gave them a chance. That money wasn’t an extra luxury – it was money which formed an essential part of their family income. We know, because we asked them. EMA was quietly whipped away in England and Wales with no consultation, in the early days of the Coalition Government ( it still remains in Scotland). The Government said it was ineffective. I don’t know how they came to this conclusion seeing as they didn’t really ask.

Today Barnardo’s have published a reporting looking at the impact of the replacement 16-19 Bursary, which some young people can get, but misses out many thousands of young carers who previously would have qualified for EMA. The term they use is “disastrous”. One young carer called Foram who looks after her mother with bipolar disorder is in desperate straits:

Foram frequently misses meals or alternates eating with her sister who is in the year above her. They are putting their own health at risk to hide the financial situation from their mother. Not surprisingly, Foram is suffering from depression and anxiety herself.

The poorest students are being failed and young carers, in particular, miss out and may have to drop out of school. And of course young carers in full time education can’t get Carers Allowance either.

I wonder how anyone thinks a young carer is supposed to survive let alone flourish when they’re wiped off the map of financial support. Barnardo’s suggest all 16-19s in full time education who used to be on free school meals should get the bursary – that would pick up young carers on low incomes and would cost less than EMA did. To give young carers a chance at a future, that sounds cheap to me.

Barnardo’s report “Staying the course” is at http://www.barnardos.org.uk/stayingthecourse.pdf