The White Paper on Social Care is coming “very soon” and promises to strengthen carers’ rights but appearance of a funding solution to the impending crisis in adult social care looks increasingly unlikely. Despite the ‘Quad’ (the regular meeting of the Prime Minister, Deputy Prime Minister, Chancellor of the Exchequer and Chief Secretary to the Treasury that discusses important coalition issues) discussions last week over the government’s position on Dilnot and funding reform, hopes of even having sight of a progress report on social care funding are fading fast. It looks like there may not be any progress on addressing the funding crisis in adult social care until the autumn at the earliest.
It is in this expectant and what is feeling like an increasingly hopeless atmosphere that the Local Government Association has issued its stark warning about social care funding – either we reform the system now or fundamental change will be needed to the way local services are funded and organised and or to statutory and citizen expectations of what councils provide.
The LGA projections show that even if social care demand is met (and this will still only be services for a minority of people) there will be a likely funding gap of £16.5 billion a year by 2019/20. What this means is that there will be hardly any money left at all for all other council services like libraries, housing, parks, playgrounds, street lights, community centres, leisure centres to a name a few.
The projections are based on the fact that central government funding for local government has already been cut from 29.7bn 2010/11 to £24.2bn in 2014/15 and that there will be further reduction to around £17.6bn by 2020 in line with Departmental Expenditure Limits set out in the Budget 2012.
The LGA projections appear to leave local government with two choices. Either maintain spending on social care and reduce spending in other areas which will drastically impact our communities or distribute spending across social care and other services. This would leave more vulnerable people with care and support needs with inadequate services or without any services at all, which is why the LGA have put it quite simply – “Without money and reform, there is no solution”.
This is really bad news for many carers who are already battling on a daily basis to get the care and support that they and their loved ones need. At the many events during Carers Week, it was made clear to me that many carers are incredibly worried about the future and how they will cope with the costs of care. They experience a lot of anxiety about their own ability to fund the care their loved ones needs and about financial restraints on the services they rely on. One carer explained “the day centre is very important for my son but also for me – it really is the best respite for a carer”. Someone else commented that the centre offering many of the activities that she and her husband take part in is closing. She’s not sure whether there will be anywhere else to go.
Carers Week was all about the fact that carers have poor health outcomes. But doesn’t it seem odd that despite the Government making it clear that they think carers should get breaks and that their health should not suffer, carers are actually experiencing high levels of stress and anxiety about funding for the services that their loved ones need?
Contradiction is at the heart of Government’s policy making on adult social care – they are willing to overhaul the complex and messy legal framework and willing to look at strengthening carers’ rights to assessment and support, but currently there is no way of funding the increase in demand for care and support. This will make it extremely difficult to fulfil carers’ rights. Of course, we welcome the Government’s “determination” to do more for carers but the legal reforms alone will not result in access to high quality care and support.
Carers know only too well that, without a funding solution for adult social care, they will continue to worry about the future because they will be left responsible for meeting the care needs of their family member of friend. We know that many of those being cared for are receiving the bare minimum from local services. This increases carers’ responsibility which is why they constantly tell us what they really need is more support for the person they care for. If the Government is serious about making support for carers a reality then it’s time to listen to them and have that difficult conversation about how we’re really going to pay for adult social care.
For years we’ve been campaigning for a total change to the social care system in England which has been with Government inactivity. But now, there is a chance.
Government health ministers, Andrew Lansley and Paul Burstow, are generally supportive of the recommendations made by the Dilnot Commission. And they would be supported by Labour if they implemented these recommendations.
But the person we need to convince is George Osborne, Chancellor and the man who manages Conservative political strategy. Implementing the changes would cost £1.7bn p/a which is a lot of money but equal to only 0.25% of total current Government spending.
When the Government can find £1.05bn from nowhere for bins and council tax freezes then we cannot allow Osborne to use the excuse that there is no money to pay for this. Make social care a priority and find the cash George.
The message we need to give George Osborne, David Cameron and other MPs is this. If you do not implement these recommendations, then the next time we read about carers breaking down because they receive no support, we will blame you. The next time we read about people receiving shockingly poor levels of care, then we will blame you. The next time we hear of councils cutting vital services because they have no cash, we will blame you.
With power comes responsibility. Osborne and Cameron have the power and the opportunity to improve the lives of millions, they must take responsibility for doing so.
But we each have a role to play. Whether you need social care support now or not, at some point you or your family will. We have a responsibility to our friends and family to make sure we grab this chance for change.
We’re organising a mass lobby of MPs on 6th March. People from all over the country will have the chance to meet their MP in Parliament and lobby for better social care support in England.
Get involved and make change happen. http://carelobby2012.org.uk/
My last blog was about how the value of £10 is different for different people depending on what it enables them to do with it. Then comes research on America and Europe which shows that the richer you are the less likely you are to provide care.
The Kiev Economics Institute found that for every 10% rise in salary women will spend 36% less time providing care and men will reduce their input by 18%. This actually corresponds with research in the UK which indicated a link between earning and whether you give up work to care or not.
Basically, these projects suggest that if you can afford to pay for care then you are more likely to do so, and if you cannot then you are more likely to give up work to do it yourself. Money enables choice. So, should a priority for Government be enabling carers of all incomes to have choices?
Technically, social services should provide care to meet all needs of the disabled or seriously ill person, and should only reduce what they provide if the carer is willing and able to provide certain levels of care. However, the reality is that it is assumed that carers will provide care and social services will only top up on the care that the carer cannot provide.
One woman I know has a husband who has a serious condition. Social services told her that it would cost them over £100,000 p/a to provide care to meet his needs, and that they couldn’t afford this. And despite her being a successful professional, she could not afford to buy enough private care. The solution was that she gave up her job and the council provided support worth about £7000 p/a.
I believe the Dilnot Commission’s recommendations (see previous blog) would make purchasing care more affordable and therefore give more people greater choice about how much care they provide and how much care they purchase. At the moment, being able to choose is too dependent on how much money you have.
This also has ramifications for Government economic policy, which I’ll cover in my next blog.
August 26, 2011 Posted by mrgordonconochie | Benefits, breaks for carers, Equality Bill, Social Care | carers, Dilnot Commission, Government's economic policy, money, rich, social services, wealth | 6 Comments
On Monday, the Dilnot Commission published recommendations to reform social care in England. More people would get social care support; fewer people would have to pay for it; and everybody would be protected from paying huge costs for care over their lifetime. What’s not to like?
Well if you’re the current Government, two things. Firstly, some newspapers that are generally considered to support the Government have attacked it because older people may be asked to pay towards funding this new system. This wholly ignores the fact that people aged 65+ are already paying £8.3bn a year for social care at the moment. Dilnot’s recommendations would mean they would have to pay less
Secondly, it would mean additional Government spending of £1.7bn p/a, which would rise in the future. £1.7bn is 0.25% of public expenditure. Dilnot advised that this 0.25% could be found in three ways:
- Through an increase in general taxation income
- Reduce spending by 0.25% in other areas to pay for this
- Introduce a specific tax increase to pay for the 0.25%
The question is not whether we can afford the 0.25% or not. The question is do we want to afford it?
For me the answer was provided by another big story of the week – Elaine McDonald, the former ballerina. Her council is removing her overnight care that helped her use a commode, instead giving her incontinence pads to wear. And she’s not a one off. There are stories like this all over England where people’s quality of life are being severely affected because we are not providing enough social care support.
The immediate blame for poor social services is often laid at the door of councils as it is they who provide the services. We don’t blame Government for causes behind this, making it easier for them not to do anything to improve the system. That has to change. Government should act and find this 0.25%; if they don’t I won’t be the only one who will blame them the next time another person’s dignity is stripped away.
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.
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.
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.
About this blog
|At Carers Trust, together with our Network Partners, we provide support, information, advice and services for the millions of people caring at home for a family member or friend.|
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