Social care in England is broken, not just fragmented

This post has been written by Moira Fraser, Director of Policy at The Princess Royal Trust for Carers

The Prime Minister’s  been saying a lot on domestic policy recently. I wonder if he was saving it all up over the Christmas break, making notes in between his turkey and plum duff. He’s been wading in on a few issues which he normally leaves to others, which have  hit a bit close to home on the caring front.

Over the weekend he made what was apparently an off the cuff quip about Tourette’s syndrome. Maybe some people found it funny, but I bet people with Tourette’s and their families didn’t. Most people with a disability will tell you about the names they’ve been called  or the humiliation they’ve had to put up with, just because they look different, need different things, talk differently, behave differently. Making fun of someone’s disability  to score a couple of laughs just isn’t on, and if you’re the Prime Minister, frankly, you should know better. Zero points, Mr Cameron, for disability awareness.

David Cameron

We’ve been talking about joined up care for as long as I can remember

And  last weekend he was on about health and social care and how they need to be more joined up. He wants to make it a priority, as care in England  is too fragmented .

I’m delighted he’s taking an interest. We desperately need our political leadership to social care right at the top of the list as a major priority to be addressed. He’s absolutely right that the artificial boundaries between health and social care make no sense and act as a barrier. I can’t tell you the number of times I speak to carers who are stuck in the middle, making never ending phone calls to different departments trying to put together all the pieces of the jigsaw puzzle. It’s no wonder carers don’t access support for themselves- by the time they’ve got the essentials in place for the person they care for, they’re exhausted, just can’t face it, or think there’s no blooming point.

But it is a bit odd, all the same. We’ve been talking about joined up care for as long as I can remember. We have pooled budgets which are supposed to mean health and social services plan  together. We have jointly agreed care plans and in some places care trusts which bring all the services together. And whilst there are successes,  they’re there because the local leadership pushes it and people on the ground are fully, root and branch, committed to making it work. In many places it’s still very much  a case of the right hand having no clue what the left hand is doing.

At the same time, the Health and Social Care Bill drives policy in the opposite direction – removing more and more central direction, and removing the need to have the same boundaries for health and care authorities. We lobbied hard on this, including talking to the PM about it directly,  because  where families need to work with multiple services – for example,  adults and children services, health trusts, education services, all at the same time –  creating extra confusion doesn’t  help and people who are the most disadvantaged get missed.  The reorganisation which health services will have to go through following the Health and Social Care Bill is going to make things a lot worse at least in the short term. I’m worried about how we will make sure everyone gets what they need whilst the NHS is trying to figure out who’s in charge and who works for who.

It’s fantastic that the PM  has spoken about the importance of social care, and of integration. If we can find ways of achieving better joined up working, let’s do it. But I’m worried that his comments suggest that if we all try a bit harder to work together then the social care system might turn out not to be quite so broke and therefore not need fixing, meaning we can shelve the difficult decisions for another day. No matter how much integration there is, social care in England needs reform and needs more funding. Let’s keep our focus there.

January 11, 2012 Posted by | Health, Social Care | , | 2 Comments

Considering Insurance Scheme for Care Needs

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


August 16, 2010 Posted by | Big Society, Carers Strategy, David Cameron | , , , , , , , , | 5 Comments

Do Carers Fit Cameron’s Big Society?

Whilst you’ve been treated to a few guest bloggers, I’ve been doing some thinking. This could be dangerous but please stay with me!!!

Cameron’s Big Society is all about redefining the relationship between individuals, communities and Government/the State. But what does, or should, this mean in relation to carers?

I actually think carers don’t fit Cameron’s view of current society. His view is that Government is too involved; does too much in people’s lives; and has extinguished the do-it-yourself (or ourselves) attitude. We have become reliant on the government.

David Cameron on GMTV

David Cameron announced a Big Society plan

How many carers feel that they are reliant on Government? Or that Government in the form of social and health services are too involved? Or that carers don’t very often do it for themselves?

No, it seems that carers fit the society that Cameron wants to create. Individuals, families, friends and neighbours taking responsibility for the care of each other. Carers are not people passing the buck to the State, they are people doing it for themselves.

But that’s not the end of the story. There are fundamental questions that follow from this:

  • Should Government be more involved – what is or should be their responsibility?
  • Carers are taking responsibility, but is it their responsibility to do so in the first place?

Legally speaking, Government does have responsibilities regarding people requiring care and support, but there is not a law saying that people have to provide care.

From this, you could say that carers are doing what Government should be. You can see this feeling contained within some of the campaign messages that we/carers/carers’ organisations use: carers save the Government £87bn from the care they provide; carers only get paid £53.90 (Carer’s Allowance for which you have to care at least 35 hours p/w) which is well below the legal minimum wage.

But these two messages raise two questions:

Are we saying that people should not be providing any care and the Government provide it all? Are we saying that people should be paid to care for spouses, parents, children or siblings rather than expecting families to provide some element of care for each other because they want to?

I don’t think many people believe that the Government should provide all care, with many wanting to be the one who cares for their wife/husband/father/mother etc. And I think many would say that families should be there for one another, and not need to be paid to do so.

So, there should be responsibilities on both individuals and Government. What should those be and what does that mean in terms of policy? That’s for the next blog.

Take care,


August 12, 2010 Posted by | Big Society, Carers Strategy, Conservatives, David Cameron | , , , , , , , , , , | 11 Comments

Government’s White Paper on Restructuring NHS in England

Thankfully, the birthday card I got at work yesterday included some humourous messages from colleagues giving me comic relief from the Government’s White Paper on restructuring the NHS in England. The White Paper is obviously important, but it’s just not the most fun read in the world.

In a nutshell, the proposals are:
• GPs will commission the vast majority of all health services for patients and carers meaning Primary Care Trusts (PCTs) will vanish. A NHS Commissioning Board will oversee GP commissioning.
• There will be a new Public Health Service with local Directors of Public Health being appointed jointly with local authorities, who will have new Health and Wellbeing Boards to replace Health Overview & Scrutiny committees.
• Patients should have a choice of providers – so not just NHS organisations
• More information should be shared with patients and carers and decisions taken jointly with health professionals – no decision about me without me

I don’t think the question should be whether GPs being responsible for commissioning is a perfect structure (it really isn’t) but whether it is better than the alternatives. Not everybody seems convinced of that either.

However, proposals for more patient and carer involvement and a new performance framework that focuses on outcomes for patients rather than processes should be welcomed.

This focus on the duties of health services is timely given Barbara Keeley MP’s Bill in Parliament today proposing that all health services should be required to identify patients who are carers or have a care, and consider the carers’ needs. The Bill would also require schools to have a policy to identify young carers – something which we have campaigned on.

There is little chance that Barbara Keeley’s Bill will become law unless the Government support it. So, we should ask our MPs to to support this Bill and ask them to write to Paul Burstow MP (Minister for Care Services) asking him to take the Bill forward.

The Bill has received support from MPs in the Conservative (Tony Baldry MP), Liberal Democrat (Annette Brooke MP) and Labour parties (Diana Johnson MP + others), plus Caroline Lucas MP of the Green Party. The NHS has a history of neglecting carers and it is imperative that carers are not further forgotten during and after any restructuring. This Bill could ensure that doesn’t happen.

Take Care

July 14, 2010 Posted by | Carers Strategy, Health, Uncategorized | , , , , , , , , | 5 Comments

MPs Debate How to Support Carers

Burstow vs Keeley, Round 1

On 1st July, MPs debated how to support carers have a life of their own in Parliament giving us the first opportunity to see Paul Burstow MP and Barbara Keeley MP, Minister and Shadow Minister for Care Services respectively, debate the issue.

Big BenBurstow began by highlighting the huge benefit that being in contact with social services can make to carers: a DH survey of 35,000 carers in contact with social services found that only 13% said they did not have the time to do anything they enjoyed whereas a Carers Week survey of 3200 carers, many of whom may not have been in contact with social services, found 76% did not think they had a life outside of caring.

From this the first of his three priorities is for more carers to be identified and for GPs to play a large role in this. His other two are to improve joint working between health, social care, and the voluntary sector, and secondly to extend the use of direct payments/personal budgets.

On cancelling Caring with Confidence (CwC), he advised that the course materials were good but they weren’t getting value for money from delivery. So, he will give the materials freely to Carers’ Centres and other providers of the programme while reinvesting the money in training for GPs on carers’ issues and other support for carers which will be announced soon.

He also advised that the DH would shortly publish an audit of Primary Care Trust support for carers, which is welcome news. Keeley replied that money for carers must be ringfenced as history has proved it is the best way to ensure that money goes where Government (& Parliament) intends… If only her previous colleagues had learnt this lesson.

Keeley expanded on this by arguing that with GPs taking on a larger role in commissioning local services and schools becoming independent of local authorities, it would be even harder to ensure that a strategic view of the needs of carers was taken in every area.

To address this, she plans to reintroduce her Carers ( Identification and Support) Private Members Bill of 2007. This would require health bodies to identify patients who are carers or have a carer and that health services took the carers’ needs into account. It would also have require schools to have a policy to identify young carers.

Responding to the CwC cancellation, Keeley pointed out that there will still be costs of actually running the course and training GPs should come out of NHS core budgets. Tony Baldry MP (Chairman of the All Party Parliamentary Group for Carers) commented that carers will still need to be trained to help manage their caring role. He also asked the Minister to look at the Work & Pensions Select Committee’s report on carers which recommended a costs of caring payment of approximately £25-£50 p/w could be given to all carers in intensive caring roles, even if receiving the State Pension.

Other MPs spoke of the need to increase benefits for carers pointing out that proposed benefit changes will see Carer’s Allowance rise slower than before and potentially fewer carers receiving it due to fewer people they are caring for getting Disability Living Allowance (DLA is requisite for the carer to get Carer’s Allowance). Many spoke of the particular need to support young carers and it was good to hear that so many had visited their local Carers’ Centre and young carers’ services and been impressed by their work.

So, seconds out, we await round two. I’m quite looking forward to it.

Click here for the transcript of the full debate

Take Care


July 6, 2010 Posted by | Budget, Carers Strategy, Young carers | , , , , , , , , , , | 4 Comments

Carers Can Wait No Longer for Government Plans

Paul Burstow, new Carers Minister, at our roundtable event earlier this year

On health and social care, what’s in store for us?

It’s the waiting that’s the worst. So say civil servants, local authorities and the NHS as they wait to find out exactly what the Government plans are. Carers are maybe more used to waiting.

They wait months for a hoist that will help lift a disabled husband out of bed. They wait for information and basic training to care for a daughter dying of cancer. They wait for a break from caring 24/7 for elderly parents who live with them.

Words are spoken and strategies published but for too many, the waiting continues.

I don’t think anybody should underestimate the scale of what new Government ministers have to learn and comprehend in a very short space of time. There are also lots of competing priorities to order but next week is Carers Week and it is time for carers to wait no longer.

I met Paul Burstow MP (new Minister for social care) on Monday. He told me that they made a firm pledge to increase access to respite care and they would deliver on it. Carers now need to know how this will be achieved and when.

I also met the new Labour shadow Minister for social care – Barbara Keeley MP. She has consistently campaigned for carers locally and in Parliament and worked on carers’ issues before entering Parliament. I also met her fellow shadow Minister for Health, Diana Johnson MP who has supported local carers and carers’ organisations.

The appointments of Burstow and Keeley are positive but this will not mean that all the policy changes carers need will happen instantly – or at all. But, I do believe we have two people who regularly meet, listen to and understand carers. The election is passed, new ministers are appointed and the waiting must end – it’s time for change.

Take Care,


June 11, 2010 Posted by | breaks for carers, Carers Strategy, Conservatives, David Cameron, General Election, Liberal Democrats | , , , , , | 2 Comments

Carers Cannot Suffer Financial Cuts

Carers are already doing their bit

Long summer nights tend to bring out the wistful, romantic in me. What a wonderful world is on repeat in my head and I embellish my mood of serenity.

Then on the 21st/22nd June, the earth begins tilting away from the sun meaning shorter days and longer nights. It seems appropriate that the emergency budget outlining future spending plans will happen on 22nd June. The first day of the darker nights.

Our pre-election demand was that the £256m non-ringfenced grant given to English local authorities to support carers cannot be cut. And this was spared from the £6bn savings for this year announced a couple of weeks ago.

But, the financial cuts experienced by local authorities in other areas means that they will have to pull money from some areas to cover other losses. We are already hearing reports of our local Carers’ Centres and Crossroads Care organisations having funding withdrawn or greatly reduced.

I am wholly convinced that we all should “do our bit” – some of us will pay higher taxes and other programmes may lose out. But, what is clear is that carers are already doing their bit. If you take what little support they get away, they will fall over due to physical and emotional collapse.

And if this was to happen, there would actually be a bigger cost to this country.

Our latest report produces evidence that supporting carers is not only morally right but actually leads to better outcomes for people they are supporting and saves money in the long term. We show that by supporting carers, there will be:

  1. Less hospitalisation of stroke patients saving £3500+ per patient, per annum.
  2. Delayed entry into residential care of person needing care by over 500 day
  3. Improved hospital discharge processes that means freeing up beds

Money has to be saved but government and local authorities must look elsewhere because put simply, this country cannot afford to not support carers.

Take care


June 7, 2010 Posted by | Social Care | , , , , , , , | 7 Comments

Carers issues feature in leaders debate for a second time

Liberal Democrat Leader Nick Clegg

The Liberal Democrats plan to give a week of respite to those who care for 50 hours or more per week

Watching the Leaders’ Debate on Sky News last night, the needs of carers again featured strongly – as well as issues which impact on carers’ lives like pensions which obviously effect the financial well being of older carers.

And again respite breaks were discussed. We’re all aware that having a break from caring is one of the key needs expressed by Scotland’s unpaid carers. Indeed it is a key recommendation in Care 21.

As a carer myself, I appreciate the need to ‘get away’ from caring – that might mean having a couple of hours of ‘me time’ with a friend, being at the hairdressers – it doesn’t always mean having a week away – or indeed the person you care for having time away from the home environment.

A short break can be so many things – something which I think political parties have missed in the ongoing debate around carers as we move towards this exciting General Election.

There is still a real need – and gap – in terms of social services and other key professionals involving carers in planning services for those they care for. For carers, a Carers’ Assessment does not always lead to them getting the support they need, at the time they need it – and that includes having access to a short break. A break can range from simply being able to leave the house to do things which others take for granted, right through to a full holiday.

The needs of unpaid carers are featuring in this election – and leaders are listening. We welcome developments such as the commitment by the Liberal Democrats to give a week of respite to those who care for 50 hours or more per week.

But my plea to Nick Clegg, Gordon Brown, David Cameron – and Alex Salmond – is please listen harder. Work with The Princess Royal Trust for Carers, with the network of Carers’ Centres and organisations such as Shared Care Scotland to create and develop new and responsive opportunities to have a break from caring – with carers as equal partners in this process.

And above all, please keep asking questions of your local candidates – find out where they stand on these issues. The voice of carers needs to be loud and clear.

Take care,


April 23, 2010 Posted by | General Election | , , , , , | 2 Comments

There is such a thing as society, carers are building it…

Former Prime Minister, Margaret Thatcher

It is carers who are building society

Mrs Thatcher proclaimed that “There’s no such thing as society” capturing the dominant belief in individualism of the time. Now, we believe that individuals can only prosper within a society but that our society might be broken.

I’m reading The Origins of Virtue, which describes how communities are built upon reciprocity. This does not mean that people only do things for others if they get something back in return, but that my act of giving will prompt you to show kindness to me at a later date. The willingness to give as well as take creates trust and builds relationships.

If people worry that this act of giving is absent from our society then they should look to carers. 6 million people give tremendous amounts of care to friends and relatives who may have a disability or serious illness.

These are people who give without taking, but what do we give in return..?

The answer is not much. Indeed, it is so little that carers who have spent years giving without any support find themselves without anything left to give, facing a mental or emotional breakdown.

We cannot talk about building society when we take from carers and give little in return.

To celebrate the act of giving, we should be holding up what carers do and showing what we give to support them (kind words and sentiments is not enough).

Our society needs to be stronger and we can achieve this by supporting those who are already developing such bonds by giving so much. Carers must receive support to enable them to continue giving or we risk losing the very people who can inspire us to give more.

Messrs Brown, Cameron and Clegg – it is carers who are building society.

Take care,


PS. Quick update, we’ve just published our ‘Crediting Carers: Building Society to Care’ report. Give it a read and let us know what you think to the proposals…

November 18, 2009 Posted by | Social Care | , , , , | 8 Comments

Is there room for carers in David Cameron’s “big society”?


We cannot afford to ignore carers

Managed to catch the opening of David Cameron’s speech at Guardian HQ last night – his biggest speech since the party conference address in Manchester.

The Hugo Young Lecture is not Cameron’s natural territory by any means – and he joked it was probably a good thing he is too young to be included in Young’s acerbic journals.

But Dave had done his homework and it seems like he judged his audience pretty well.

Here’s The Trust’s official comment from our Director of Policy and Communications, Alex Fox:

“Big society” is a clever left-friendly spin on “small government”. The Conservatives’ aim to build “civil society” chimes with the current government’s agenda for building “community capacity”.

But even in the most optimistic assessments of how society and communities can be strengthened, the biggest single contribution made to this country’s infrastructure will continue to be the millions of hours of unpaid care and support provided to older and disabled people by their families and friends.

Perhaps we need a “big families” agenda that ensures that the state supports, rather than distorts, family relationships. We certainly cannot afford to keep ignoring ordinary people whose caring roles too often collapse due to poverty, isolation and stress.

Back on Cameron’s home turf they had their own view of how the speech went.

Take care,


November 11, 2009 Posted by | David Cameron, Uncategorized | , , , | 2 Comments