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What price would you pay for care and support?

Janet Jackson and Luther Vandross have a lot to answer for, as their duet “The best things in life are free” has seeped into the nation’s consciousness. We’ll grab whatever is going free, without thinking about the real cost.

My girlfriend recently upbraided me for using the small shampoo bottle in the hotel room. But why? It was free. But using it forces it to be replaced meaning more small plastic bottles which costs the environment.

As individuals in a society, we need to stop ignoring the costs attached to our choices because even if it is not us who pays for it directly, we will in some way.

The Government’s White Paper was launched with their main message that “everyone who needs care when they are old or disabled will get it for free”. Really? Just like that? Of course not, this will cost money meaning somebody needs to pay for it.

Free residential care for people after two years? Wow, have the Government persuaded nursing homes to stop charging? Err, no. And even if they did, there would still be a cost to the nursing home, which might be partly borne by their low paid staff. And so on.

The idea of paying for something from your estate (death tax…) seems abhorrent to many. But would you rather pay it when you are alive? Labour’s proposals will cost money but the fact is that there are millions of people who are already doing that and sometimes paying much more than what these proposals would cost.

Likewise, the Conservative offer of paying £8k at 65 to cover all residential care fees prompts many to splutter at the suggestion of finding £8k. But again, there are already many people spending more than that on care, and some of them are having to sell homes to do so. And those that cannot afford the £8k would not be asked to pay for their social care in the first place.

The upsurge in media and public interest in social care has been accompanied with alarm at the costs of the proposals. What has been forgotten is that there are already many people paying thousands and thousands of pounds, and then also suffering emotional costs because the current system inadequately supports carers and people receiving care.

Even if you read this thinking “I wont need care at home or in residential care so why should I pay?” – think about your mother, father, husband or wife. It is likely that at least one of them will need care. What price would you pay to ensure they get the care and support they need? I would sell my house, raid my pension, use all of my savings but the point is that a good system would mean I wouldn’t have to.

Take care,

Gordon

The Princess Royal Trust for Carers comment on the proposed National Care Service

And for those real gluttons for punishment among you, feel free to read my summary of the main proposals in the White Paper.

April 1, 2010 Posted by | Social Care | , , , , | 4 Comments

Big Care Debate = Big Government Confusion

By nature, I’m an optimistic kind of person that likes to believe the best in people. Sometimes, it works out for the best, but you can also be left shaking your head in disbelief. Which is what I’m doing regarding disability benefits and the Green Paper. To the many carers who have commented on this, I apologise.

The links below show that the Secretary of State and a Minister in the Lords appeared to be avoiding ruling out rolling a number of benefits into social care budgets. This is despite Phil Hope MP and senior civil servants telling people (including me) directly that it was only Attendance Allowance that was being considered.

Now, they may only be seriously considering AA, but mixed messages on such a sensitive subject are alarming. They give the impression of a power struggle between government departments. They are a huge distraction from what should be a once in a generation chance to transform social care.

Arguably, the government should have separated out discussion about benefits from the Green Paper, to avoid the rest of the proposals (some of which we think are really good) getting lost. But now that benefits are included, ministers should be crystal clear about the scope of the discussion they want to have. The Green Paper seems to say it’s just AA being considered. If they are really thinking about rolling DLA and even Carers Allowance into social services budgets as well, we need to know. They can rest assured that carers will not be shy about giving their opinions on that.

www.theyworkforyou.com/debates

www.theyworkforyou.com/lords

Take care,

Gordon

PS. You can now read Phil Hope’s responses to carers from our online Q&A

October 16, 2009 Posted by | Social Care | , , , , | 6 Comments

Tory social care vs. Labour social care

The devil is in the detail, which is why political parties often avoid it. But in the last week we have seen two detailed polices from Labour and Conservatives on social care.

First came Brown’s promise that to “those with the highest needs we will now offer in their own homes free personal care” (England only). In detailed terms, this would mean that those assessed at the highest level, critical, would not have to pay for any care received in their home. Care in residential homes goes unmentioned. Reports have suggested that up to 350,000 people may benefit from this although it can be assumed that a large number of those with the most critical needs already receive free care.

Interestingly, this policy doesn’t quite fit in with any of the proposals in the Green Paper.

The Conservatives retaliated with their own proposal: 65 year olds can pay a one-off £8000 which will “guarantee that absolutely all fees for permanent residential care would be waived – for life.” (Conservative website). However, there is no mention of covering costs of care in their own home.

It is this omission that I find strange. The Conservatives believe it is wrong that 45,000 people every year sell their home to pay for residential care. Their response is not to improve care provided in the own home, so that they don’t actually have to leave their home, but appears to incentivize the opposite. Care in a residential care home could be free (if you have paid £8k) but you would still have to pay if you were receiving care at home.

Tory Shadow for Health and Social Care, Stephen O’Brien, believes that it will not create an incentive for people to move into residential care because the desire to remain at home is so strong, therefore this policy will help those who have to move into care. I am not wholly convinced and what happens to those who cannot afford £8000 has not been mentioned either. This policy does allow people to keep their home, but does not seem to help them live in it.

My second question regards the amount. A one off voluntary £8000 will guarantee the Government pays all residential fees, which presumably means the cost of care and the cost of accommodation. In the same article on their website, the Conservative’s say the average amount in fees some pay is over £50,000. This means that you would need 5 or 6 people paying into a scheme to cover the costs of 1. I would love it if anybody reading this blog knows of current figures and projected trends for residential care…

Big announcements, but questions still to be answered.

When it comes to looking at the detail, take care,

Gordon

October 6, 2009 Posted by | Conservatives, Party Conferences | , | 5 Comments

The Labour Conference and the Big Care Debate

The final Labour Conference before the election; would the tone be going out with all guns blazing a la Butch Cassidy and the Sundance Kid or one mired by infighting and every man for himself? In the ornate lobby of The Grand Hotel, it felt more like the Titanic with people denying the reality of a sinking ship.

At a meeting with Labour Ministers Phil Hope, Gillian Merron and Mike O’Brien, we were asked to imagine a world in which we had to deal with a Conservative Government. The Tories would listen and respond to us less we were told.

Phil Hope and Andy Burnham (Minister for Care Services & Secretary of State for Health) also spoke at a Big Care Debate event where it was repeated again that moving finances for Disability Living Allowance into social care budgets will not happen. However, it is clear that because of the ambiguity (see previous blog) in the Green Paper, the Big Care Debate has turned into a series of denials on a single part of the proposals.

Actual debate on other issues does not seem to be widespread, which is harming the chances of changing the social care system for the better. Millions of lives are affected by our social care system and millions more will be, but we as a general population are not engaging with this debate. Is it because we do not care, or is it because of a lack of knowledge?

I accept that whole family assessments does not make sexy news, but for families with multiple care needs this could be key to getting the support that is best for everybody and not just an individual (Phil Hope was very interested in this idea by the way). Perhaps most people have not considered whether there should be a single national assessment process or variable local ones, but surely this is highly relevant in a world where people move around more. Some may not know that you have to pay for social care and others may believe that they will never need it, but we should still be debating whether we should all pay regardless of whether we use social care or not.

Labour say the Tories won’t listen, but what are they meant to be listening to? I guess that is up to us all.

One thing we do want Labour to listen to is that PCTs are not using the £50m allocated to provide breaks for carers for that purpose. This is partly because of a lack of information given to PCTs by the Government. Secretary of State for Health Andy Burnham has said that he will listen and we are to set something up after the conference. However, listening is only one part, we want action. You can help by signing the carers breaks petition

Take Care

Gordon

September 28, 2009 Posted by | Labour, Party Conferences | , , , , , | 8 Comments

National vs. local: What’s best for carers?

We held our first ever event at a Liberal Democract conference today. It was a joint meeting with the College of Occupational Therapists and proposed greater support for carers and occupational therapists if we are to help people live healthier longer and for people who receive care to live a more independent life.

Sandra Gidley MP (Health Minister) and Paul Burstow MP (Chief Whip and Chairman of All Party Parliamentary Group for Older People) were there with a few other invited guests. It was agreed that greater identification of carers was crucial and that GPs had a large role to play in this. Evidence was given where GP surgeries that have contact with their local Carers Centre identify many more carers than those with less or no contact. We hope that our recently published guide for GPs will increase GPs’ support for carers.

The Green Paper was also discussed with general disappointment at its lack of detail and depth and this was repeated at a meeting I attended with the whole Lib Dem health team and other health organisations. The Lib Dem position on social care is being reviewed but currently could be described as broadly supporting the Scottish model where everybody receives a contribution to their care costs regardless of income, but some may have to top up this contribution with their own funds.

Their policy would inject a further £2bn into social care funding but I think they are looking at finances to see where they could get this £2bn from, given current Government deficits. I spoke to Greg Mulholland MP at the end who agreed to do a web chat about social care when Parliament returns so we’ll keep you posted about that.

Both meetings also discussed the need for commissioners to listen to their communities, service users, carers and professionals about the range of services that are needed. This gave me a perfect opportunity to plug a new guide on Commissioning for Carers that we helped write, which I duly grabbed.

However, the big story at the conference was the speech given by Norman Lamb MP, shadow Secretary of State for Health. He announced that they would scrap Strategic Health Authorities and improve local autonomy of health bodies. I got to discuss this issue of local control with the Lib Dem health team in the context of Primary Care Trusts (your local NHS body) and providing breaks for carers.

My previous blogs have detailed that the Government announced in a National Carers’ Strategy that they would give PCTs £150m to provide breaks for carers. Then it turns out that the Government were just giving PCTs £150m to spend on whatever they wanted, would not tell PCTs how much each was getting of the £150m nor ask them to report on how they spent it. So the Government makes the proclamation then washes its hands of delivering what they announced.

The Government have defended this saying that local NHS bodies know their local areas best, so it should be up to them how to spend the money with local people holding them to account. However, PCTs boards are not elected and it is very hard to hold people to account when you do not know how much they have received or what they have spent it on. You cannot have accountability without transparency.

We are currently stuck in no mans land where national government abdicates responsibility to those who we have no control over. We either move to a system where national politicians take more control and responsibility for delivery, or where local bodies are more accountable to local people who are given greater support to getting involved. The Lib Dems prefer the second option, do you?

Take Care
Gordon

September 21, 2009 Posted by | Liberal Democrats, Party Conferences | , , , , , | 4 Comments

Disability benefits: Where does the Care and Support Green Paper stand?

So going back to the meeting that I was discussing in my previous blog, I will expand on what they were saying about moving the finance that funds disability benefits into the budget that funds social care.

Phil Hope wanted to be clear that it was only Attendance Allowance (AA) and not Disability Living Allowance (DLA) that was included in the proposal, and seemed a little mystified that people may have thought otherwise.

Of course, the reason why was that the Green Paper was not explicit (my italics below):

“We think we should consider integrating some elements of disability benefits, for example Attendance Allowance, to create a new offer for individuals with care and support needs.” (p 15)

“There might be a case for integrating some disability benefits such as Attendance Allowance into the care and support system.” (p 103)

It was explained that the reasoning for this proposal is related to resources. Attendance Allowance is a non-means tested benefit meaning rich and poor get it alike and their proposal is to use the money that funds Attendance Allowance to target social care support for those of less means. It is what they described as a “trade-off” (see previous blog, I fear this term could become ubiquitous jargon) where some lose and others win; a universal cash benefit is lost to enable greater free social care support for those eligible.

A colleague asked whether all of the money used to fund AA would be transferred to social care budgets, or whether a saving would be made by only transferring some of it. The reply was that all of the money would be transferred.

There appears two main objections: Firstly, at the same time as the Government says it wants to give individuals more choice and control, they take away a cash benefit free to use as the individual thinks best so that government/local authorities can disburse as a personal budget or direct service. So does this restrict individual choice and control?

Secondly, the Green Paper says that while people currently receiving AA will continue to receive the same level of support after any change, the same could not be said for those after the change who would have been eligible for AA. This is clearly linked to the “trade-off” described above.

Our briefing contains more details on this and there is a survey as well. There are also discussion forums running on this and other Green Paper issues.

Take Care, and in the spirit of my last blog’s sign off, Take Part

Gordon

September 11, 2009 Posted by | Social Care | , , , , | 11 Comments

Social care reform must value carers contribution

If you hear me saying “I’m going green” you may think I have fallen in line with my girlfriend’s environmental leanings. However, until the Government’s consultation ends on 13th November, it means that I’m off to a meeting about the Green Paper on reforming social care. Today was my first “going green” day.

Minister for Care Services, Phil Hope and Director General of Social Care, David Behan led a meeting to discuss the various proposals in the Green Paper. After a brief summary of the Green Paper they asked for questions. I am usually polite and don’t make a Usain Bolt like dash for the microphone but in this instance it was within arms reach so how could I not?

On page 114 of the Green Paper, it is suggested that in a Comprehensive Model, where everybody aged 65+ has to make a financial contribution, couples could be asked to pay less. The Green Paper gives two reasons for this:

• The costs to a couple having to use savings to pay two contributions could be very high
• Couples often provide mutual care and support, therefore saving the social care system money

I am not convinced by the first reason given that it is increasingly common for both adults to be working, but I do see the logic of the second. It is fair that we value in-kind contributions that carers give to the system by reducing the financial contribution we ask them to pay.

My question was whether they would be prepared to extend the proposal to all carers as there are lots of carers who are not caring for a partner but should be equally valued. It would appear strange if only carers with a romantic interest would qualify, although it might hasten the return of Blind Date to help match people up.

Their answer was that if this was a case that the carers’ movement wanted to make, then we should make it and the Department of Health would listen. There are various issues within the Green Paper that will affect us all but this is one of the only issues that is specific to carers and it demands our attention.

Carers provide the majority of care and support, and without them the social care system would collapse. These in-kind contributions are as important to the future sustainability of social care as any model of raising extra funding for it is. And it should be treated as such. What carers give should be valued by the State giving something back in return. It is fair, it is right and we should make sure that the Government, Parliament, councillors and even the man down the road know this.

However, we cannot win the argument alone. For carers to pay less, others will have to pay more and it is their support that we need. We need them to accept that this is a fair “trade-off” (a new Dept of Health buzzword going by today) and support our campaign on this. We have a briefing on this issue and will be running a poll on it later this month. Please take part in it and encourage others to do so. If we’re going green, then it’s time to move.

Take care, and take action

Gordon

PS. Despite my clarion call to support Queens Park (aka The Spiders) last week, they unfortunately fell to a 1-0 defeat to Berwick Rangers at the weekend. 519 hardy fans paid money to watch it.

September 3, 2009 Posted by | Care and Support Green Paper | , , | 18 Comments

Care demands a bigger cake

This week has been a busy one with two key things happening: the joint meeting of the All Party Parliamentary Groups for Carers; Dementia; Disability; Equalities; Ageing and Older People; and Social Care and a roundtable meeting that The Princess Royal Trust for Carers and Crossroads hosted to forge greater joint campaigning between disability and carers groups.

The joint APPG meeting focused on soon to be published Green Paper on Social Care (England only) which is expected to propose that everybody will have an entitlement to social care support if needed but that everybody, except the poorest, will have to pay a sum or make contributions towards this new system. These contributions could be through regular payments during you working life, a lump sum payment on retirement or even a payment taken from your estate on death. If you don’t blow it all in Vegas.

As well as proposing what might be fair to ask people to put into a new social care system, the Green Paper will ask what is fair for us to get out of a new system, and whether this should be the same no matter where you are in England.

The Green Paper is not expected to propose national uniformity compared to the current local authority right to plan and deliver its own services – so Reading can still be different to Newcastle. However, it is expected that the Green Paper will propose a right to ‘portability’, meaning that if you move from Reading to Newcastle, you get to take the exact same support package with you.

Anyway, I could be completely wrong and unfortunately there are little leaks about it, unlike the roofs of Parliament during the thunderstorms on Tuesday evening. Staff were running about taking bins from rooms to place under huge drips in the corridors and I did even see people using umbrellas inside. Unfortunately, not one person was singing in the rain…

To more serious matters of our roundtable discussions with Carers UK, Equality and Human Rights Commission, Mencap and other organisations where cakes were the big talking point. Alas not a cake for my impending birthday, but a reference to the agreement that disability and carers groups should together demand a bigger financial cake for social care, rather than arguing amongst themselves for shares of the same cake.

A Care and Support Alliance has been created and one of its aims will be to argue for social care to receive greater funding and prominence a la the NHS. This had also been discussed at the APPG meeting mentioned above and indeed the Dept of Health hosted Health & Social Care Awards last week (my boss knows how to show me a good time).

However, two things suggest we have a long way to go:
1. At the awards ceremony, most of the awards focused on health rather than social care services which gave a telling indication of priorities.
2. In discussing future spending cuts, both Labour and Conservative parties have sanctified the health service as something untouchable but social care has gone largely unmentioned.

What is it about social care in comparison that we do not value as much? It is because there are no last minute life-saving miracles? Is it because professions in health care are perceived to have greater standing than those connected with social care? Is there a problem with the very term ‘social care’ conjuring up images of Government intervening in social issues rather than assisting the maintenance of people’s health and quality of life? Could it be that we need George Clooney to reprise his Dr Doug Ross role in ER, but instead play an Occupational Therapist in Chorley?

Answers on a postcard please…

Update 15 July: read the Trust’s response to the Care and Support Green Paper

Take Care
Gordon

July 10, 2009 Posted by | Care and Support Green Paper | , , | Leave a comment

Social care: will carers get choice and control?

We have been waiting for the publication of the Green Paper on Social Care for a few weeks now. I am beginning to think it is like tomorrow – always there but never arrives. The Greater London Authority has a Carers Advisory Group that asked me a few weeks ago to present a summary of the Green Paper to its meeting today. Of course, the damn thing is still not out but of course the show went on and I instead gave some personal thoughts.

Much of the debate focuses on how to fund an expected £6bn plus shortfall in social care funding by 2026 to maintain a creaking care system. It will probably end up involving some form of co-payment system where individuals will have to contribute. However, equally important but less discussed is that the key to maintaining a functioning care system is to support the millions of carers who actually provide the majority of care and support.

Far-sighted people have predicted the number of carers to rise past 9million but we cannot put unreasonable burdens on carers risking their own health and employment, often leading to the carer breaking down. Carers do save the Government billions of pounds, but by being forced to give up work or need healthcare themselves, the Government loses money as well.

The Government has said that choice and control should be principles of any new social care system. But will carers be given the choice and control of how much support they want to and are able to provide? Will carers, and whole families, know what support they are entitled to and what they are giving up if they do decide to become carers?

Currently, many carers do not feel it is a choice that they have made but a life that they were forced into. By properly supporting carers, we could have carers providing the support they want to whilst remaining healthy and active in workplaces and communities. This could mean even greater savings for Government, a more stable social care system and, crucially, happier people.

You never know, maybe the Green Paper is delayed because they are now incorporating these views. If so, sorry about that.

Take Care
Gordon

PS
It was announced in Parliament that The Standing Commission on Carers will place details of the proceedings of its meetings on its website by 31st July

July 3, 2009 Posted by | Care and Support Green Paper | , , | Leave a comment