When I agreed to write this blog post, I somewhat naively hoped that by the start of 2015 I would have a clear picture of what the next 12 months might bring for carers services, and that I’d be able to make some predictions about how commissioning is likely to change and develop over the coming year. But the reality is that it’s still too early to determine exactly how the Care Act and the Children and Families Act will be translated into reality and how these and other developments will affect the commissioning landscape. Continue reading
Well, Wednesday was the day we’d been waiting for. After months of saying “we’ll have to see what happens in the Comprehensive Spending Review (CSR),” we finally got there. We were expecting the reduction in funds to local authorities, and the scythe to benefits for many. That doesn’t make them any more palatable. We didn’t expect the social care money – £1billion to local authorities and £1 billion from the NHS – somehow. It is unlikely to be ring-fenced , so get your calculators out folks and start counting where it goes. A bit of a sweetener, and in the spirit of fairness (to use a Cameronian term), this is better than we thought it might be.
But then you look at some of the details. Carers are generally not at the most affluent end of the market, and are likely to start experiencing this new “fairness” first hand. Rents for new tenants in social housing are 80 per cent of the private market rate. This means that the average rent for a three-bedroom council home is likely to treble from £85 a week to £250 a week. Benefits are being capped at £500 a week which means that about 50,000 families, mainly in London, will lose on average £93 a week. And that’s before we start on the one year time limit for some people on Employment and Support Allowance, changes to Housing Benefit, removal of Education Maintenance Allowance, reduction in support for adult learners studying for GCSEs or A levels for the first time, and a vast range of local amenities likely to be severely cut.
Carers support a family member or friend, often at great personal cost, generally for nothing or for a pittance of £53 a week Carers’ Allowance . They save the national exchequer 87 billion pounds a year. I’m not sure what is more cost effective than that. Cutting chunks of a vulnerable family’s income means they end up with fewer choices and fewer chances. Social care can help, but it can’t replace a decent income and a range of community support.
“Those with the broadest shoulders must carry the heaviest burden” said the Chancellor. Well I’d agree with that. It’s just that these don’t sound like the people with the broadest shoulders to me.
The Government’s consultation on their Carers’ Strategy (England) closed on 20th September and they will publish what they will do over 2011-15 in Nov/Dec after considering what is announced in the Comprehensive Spending Review on 20th October. This is when we find out how much government departments and local authorities will get and for what over 2011-15.
“We will use direct payments to carers and better community-based provision to improve access to respite care.” (England)
Hitherto, it is local authorities after a care(r) assessment that decides who should get a Direct Payment and it is local authorities that fund organisations that provide respite. If Government cut funding to local authorities, as they will, then how can they deliver the pledge of improved access to respite?
So, I was surprised when Paul Burstow repeated that there will be more direct payments to carers. Likewise, how will they deliver better-community based provision when local authorities will be receiving less and it is a near certainty that the Carers’ Grant will not be repeated?
In 2010/11, local authorities in England received £256m within their total budgets to spend on carers. It was not ring-fenced but how much each council received of the £256m was published so local people were able to hold councils to account for what they did with that money. Councils will still be expected to support carers, and they will be monitored on this, but it is unlikely they will receive an identifiable amount for this.
We also talked to Paul Burstow about the commission on long term funding of care and support. This commission will produce a detailed plan by the end of July 2011 and Paul Burstow will not comment on potential plans while the Commission is deliberating. I told him that a health professional once told me that the biggest stumbling block to close working between health and social care is that health care is free at the point of need and social care is not. Since he was so enthusiastic for closer working, I asked him what he thought of this. Seeing what I was angling for, he just smiled and declined to comment.
Ivan Lewis MP, who has been elected to the shadow Labour cabinet, agreed with me in the future system carers have to be compensated for providing care as I set out in a previous blog discussing insurance scheme for care needs.
However, we do need to know soon how they will give more direct payments to carers and ensure better community-based support.
This is the final blog of a series of three. It may help to read the previous two to understand what the heck I’m talking about.. I previously outlined why families and the State should have responsibilities to provide care, and that the Commission on Funding Care and Support must consider how care provided by families can be valued in terms of giving something back to families.
The final question to be addressed is how do you work out how much should be given back?
My report nine months ago outlined a method to do this.
Step 1: A person would be assessed to work out how much care they need and the cost of this care (or value of personal budget).
Step 2: A carer agrees how much of the care needed will be provided by them, which results in a reduction in value of the personal budget or care package provided by the State.
Step 3. A % of the value of care provided by the family is given back to the carer
My report outlined projections based on percentages of 15%, 20% and 25%. I found it strange that none of the positive or negative comments on the report were about the percentages that I chose. Just to reiterate, I was saying that Carer A provides X value of care that would otherwise be provided by the State, and that they should get 25% of that value back.
One person did comment that if you started at 25%, what would stop people asking for 40%, or 60% or 80% or right up to 100%? And some may say, if I’m providing care that would otherwise have to be provided by the State, then why should I not receive 100% of that value?
The answer to this goes back to my first blog in this mini-series; care should not be the sole responsibility of the State. In fact, the responsibility of the State is to support families to care, and provide care where families cannot or are unable to meet all needs. So, the starting point is not that families are doing the State’s job, rather the State is adding to or replacing what families do.
Giving carers 100% would be equal to paying families to provide care as you would a care agency. This appears to contradict the responsibility that families have and implies that my wife would only care for me if she were paid to.
So, is 25% correct? Honestly, who knows. There is no definite answer or mathematical proof that can work out exactly what it should be. It would be a judgement call dependent on circumstances at the time. So I’m afraid at the end of these three blogs, I don’t have the final answer but I think I know the direction we have to go in.
Finally, I realise that this blog strongly argues that families have responsibility to provide care. However, individuals also have rights, and individuals should not feel forced into giving up their own life to provide care. The State has a responsibility to help individuals enjoy their own rights to work, leisure and a quality of life while helping them to provide care.
That is the aim.
This is part 2 of the previous blog, so read that now if you haven’t. We established that individuals and Government have a responsibility to provide care.
The Coalition Government have created a commission to look at the funding of care and support in England. A chief consideration will be creating either a mandatory or voluntary insurance scheme whereby you pay in advance of having care needs and the policy will cover the costs of your support needs that are not met by the Government’s contribution.
So, I pay £20 p/m and then when I’m 75 and need support to live at home or residential care, my insurance company will cover the costs (let’s assume reasonable insurance companies for this blog’s purpose). Sounds simple.
But what if my wife (this isn’t a public proposal Mum) decides that she would like to care for me and doesn’t care that the insurance wouldn’t pay her to do it? We’ve just paid all that money for no reason. This could lead to two things:
1. Fewer people provide care because they feel as though the insurance company, or Government if it is publicly run, should pay for all care
2. People don’t pay for insurance because they expect to receive family provided care
Let’s start with the first scenario. Fewer people caring increases demand on paid care, pushing up costs of the system. This is bad news for a Commission that is trying to create a more sustainable system because of projected funding gaps. If carers currently provide £87bn worth of care, the system could very quickly become completely unsustainable if families stop caring.
But the second scenario doesn’t look good either. This would increase the demands on families to provide care when we already know there is too much pressure on them currently.
The solution to overcome these problems must encourage and account for families who are providing care.
There is no way of knowing how much informal care you will receive whilst paying your insurance, which is generally before you have support needs. So the only way to recognise the caring contribution is by giving rebates to families when they are providing care.
Does this solve the problem? Not quite. How much do you decide to give them?
It’s another ‘to be continued’ as the next blog will look at this question.
Till next time, take care
Well, we finally reached an important landmark on Monday 26th July, with the publication of “Caring Together”, the new Carers Strategy for Scotland, and “Getting it Right for Young Carers” the UK’s first separate Young Carers’ Strategy.
As we move into one of the most difficult financial periods for decades the Scottish Government has allocated approximately £5.5 million to the Carers and Young Carers’ Strategies – and all of this will go to the voluntary sector. £5 million will be focused on developing and expanding innovative respite and short break services for unpaid carers and young carers.
The Princess Royal Trust for Carers has been directly involved in helping to shape the content and actions of both documents.
Key highlights include:
- Creating a Carers Rights Charter – the Government is also consulting on legislating for carers to have access to Direct Payments in their own right.
- Investing in carers training, building on an existing £281,000 investment during this financial year.
- Improving the identification of carers by health and social care services
- Making carers’ own health and wellbeing a priority
- Promoting carer-friendly employment practices and encouraging income maximisation
- In a Scottish and UK first, it includes a separate strategy on young carers – “Getting it Right for Young Carers”. This includes a range of actions which will help professionals from a range of agencies to better identify and support young carers to achieve their full potential.
- An investment of £150,000 to The Trust to develop a 4th Scottish Young Carers’ Festival in 2011, which will help review progress in implementing “Getting it Right for Young Carers”.
Carers and young carers in Scotland will directly benefit from the welcome additional investment in a range of ways, demonstrating the Minister for Public Health’s commitment to carer and young carers’ issues in Scotland.
As a carer going through our own crisis situation at home, I know how hard we will all need to work to ensure that both documents are fully implemented. Much still needs to be done, and the strategies are a brilliant starting point.
We retain some concerns about what happens now that the strategies have been published:
- The need to ensure that sustainable funding is in place for Carers’ Centres and young carers’ projects. They continue to experience a substantial increase in demand for support in their local areas, but in many cases, with no increase in funding to deal with this.
- The Concordat between local and national government which means that there is no compulsion on local authorities to implement the strategy documents.
- As we move toward unprecedented public sector cuts, the strategies make a clear case for investing in support for Scotland’s 657,000 carers and 100,000 young carers. However, the fact is that carers and young carers are still an easy target when cuts are being sought – recent developments at Westminster in relation to benefits and feedback from local areas in Scotland demonstrate this.
It is vital that an implementation plan is put in place as quickly as possible with all key players ‘signed up’ to take things forward. The Trust has a key role to play in this.
Carers’ Centres and carers can also use the documents at local level to hold councils, health boards, Community Health Partnerships and others accountable. How are they implementing the documents; what actions are they taking locally to improve carer support; what are local authorities doing with other partners to ensure that young carers have the chance to be children and young people first?
So, we are on the next stage of the journey – and we are under no illusion about the challenges which lie ahead in implementing both the vision and actions within each document. We would urge carers to speak to their local MSPs to ensure they are supporting and pressing for the strategies to be implemented. Meet with your local Councillors to ask how local authorities will take the strategies forward.
We will also be working with Carers’ Centres to ensure that decision makers are fully aware of the brilliant work that they do, how this benefits carers and what carers and young carers need to enjoy a quality life in their own right.
The Independent Budget Review report was published yesterday (29th July). Lead by Crawford Beveridge, it outlines that no part of public sector spending should be exempt from cuts. John Swinney has invited all political parties to look at the findings and the options for Scotland’s budget in future. Members of the public have been asked to contribute ideas about public spending. Please take some time to submit ideas and highlight the importance of maintaining funding for carer support.
See below for more information:
Note: This post is from our guest blogger Tony Baldry MP who is Co-Chair of the All Party Parliamentary Group for Carers. Tony Baldry MP made a speech at the meeting of The Princess Royal Trust for Carers held in the House of Commons on Wednesday, 28th July 2010.
Last week, the Prime Minister repeated his commitment to the Big Society making it clear that its’ success will depend “on the daily decisions of millions of people – on them giving their time, effort, even money, to causes around them”. My whole political life has been predated on this same principle.
However, I am concerned at a potential and unintended conflict between the Coalition Government’s very understandable desire on the one hand to promote the Big Society and the need to cut the budget deficit.
In my constituency in Banbury we have the North and West Oxfordshire Carers’ Centre, member of The Princess Royal Trust for Carers and has been successfully running now for nearly two decades.
Such has been the dedication and commitment of the volunteers that the centre has won the Queen’s Award – one of very few such awards in Oxfordshire. The Banbury Carers’ Centre like the Oxford and South Oxfordshire Carers’ Centres are comprised of a mixture of experienced volunteers and some paid staff, enjoying the financial support of the local community.
They help train carers. They provide outreach services for carers. They provide a place where carers and different types of carers can come and meet, share experiences, unwind and support each other.
As we all know, carers come in many kinds from young carers to very elderly spouses still looking after a much loved husband or wife.
In undertaking this valuable work, for many years the Banbury Carers’ Centre has received funds from Oxfordshire County Council to deliver specific agreed services to carers. The reasons the County Council was procuring these services from Carers’ Centres are exactly the reasons set out by the Prime Minister in support of “the Big Society”; Carers’ Centres and their volunteers are exactly the people who are making a difference, are in contact with other carers and are in the best position to understand, articulate and meet carers’ needs. They are full of people who come together and work together to affect social change and to improve life for carers.
As far as I am aware there has never been a suggestion that the Banbury Carers’ Centre or the other Oxfordshire carers’ centres have failed to meet the objectives with which they have agreed with the County Council. However, the Council has to make savings in their budget.
They are proposing withdrawing their funding from the carers’ centres in Oxfordshire and replacing that service by a telephone call centre, almost certainly run from outside of the county to which carers will be able to call.
Part of the justification of this move, in addition to the need to save money, is an assertion that it will help them reach more carers. However, there doesn’t appear to have been any or any real discussion with the existing Carers’ Centres as to the number of carers that they are already reaching.
I would suggest the issue here is that many people who are carers simply don’t recognise themselves as being carers and if they don’t recognise themselves as being carers, they are not likely to ring a carers’ telephone hotline.
We need a collective effort to help carers voluntarily register themselves as carers so that they are recognised as being carers by GPs or by schools if they are young carers. This requires a sustained campaign in GPs surgeries, in the schools, and in the media to make people ask the question “are you a carer?”
I suspect that for many years GPs haven’t been asking the question of whether someone is a carer, because there has been very little that they could do to support them. However, now that PCTs have funds to support respite care, GPs are in a position to refer carers for respite care and short holiday breaks and for that reason alone, one would hope that every GP practice would know which of their registered patients are also carers.
I think the reality is that for many years central government has used local government to support a whole range of social interventions. Money for carers’ breaks is given in part to PCTs and given in part to local Councils. However, if local government is obliged to save money, they understandably start by reducing funding for those organisations for which they have no immediate responsibility.
However, there are a very large number of active citizens undertaking constructive voluntary work within our community who to a certain extent depend on some funding from local government. An alternative, of course is to allow organisations such as the Banbury Carers’ Centre to bid direct to central government to provide carers’ services.
Here we appear to be bedevilled that Oxfordshire County Council has decided to bundle up all its carers’ contracts into a single contract, thus bringing it within the parameters of the EU procurement directives and requiring compulsory tendering. This makes it much more difficult for local voluntary organisations to bid and appears to run completely counter to the desire for localism and the Big Society.
I think we all have to accept that these are particularly difficult and unusual times. No peace time government has had to tackle a similar financial deficit. We need to develop the Big Society. We need to see how we can best reconcile these two policy objectives. However, to start with we have to recognise and acknowledge that there are some real tensions that need to be worked through.
Tony Baldry MP
House of Commons
Note: Following is a blog post from our guest contributor Beryl who is the Development Manager (South East) at Princess Royal Trust for Carers
I was at the launch event of The Princess Royal Carers Out of Hospital Report yesterday afternoon and….it was really exciting! Sounds an odd thing to say about a formal do but it was exciting because everyone there was determined to take practical steps to put the report into action and to improve support in hospitals for carers.
The Royal College of Nursing (RCN), represented yesterday by Dr. Peter Carter, fully endorsed the report. He suggested that RCN work together with The Princess Royal Trust for Carers to make the changes that will improve support carers and families receive in hospitals and at discharge.
Carers, carers’ workers and hospital staff were at the launch to tell us about the partnership work they are already doing to change things for the better for carers. In Swindon, for example, the hospital trust have taken a very practical step towards sorting out hospital systems so that carers can be identified and supported.
Jim, who cared for his partner, a patient in Barnet hospital, told us about the difference it had made to him having the support of a hospital based carers worker. Jim made contact with the worker after seeing a poster in the hospital lift. He even called for the better publicity of information about the support available to carers within and beyond the hospital setting: “Aeroplanes should be up there skywriting it!” he said.
Not sure if we can sort out the skywriting but The Princess Royal Trust for Carers will be continuing to work in partnership with the RCN and with hospital trusts, carers’ centres, carers, health commissioners and policy makers to get the word out on supporting carers and families in hospitals and at discharge and on getting that support in place. I’ll report back to you in a couple of months time on how we’re doing. Meanwhile please do feel free to share the Out of Hospital report key messages and statements of support with your local hospital.