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

Budget and benefits: what’s happening with the pledges on carers?

Waking up from the hangover of England’s World Cup campaign? Here’s what you missed.

coins arranged as a question mark

Cuts could still happen at the local level

Budget and benefits

All benefits, except pensions, will rise in line with the Consumer Price Index measure of inflation, which excludes most housing costs, rather than Retain Price Index. CPI is usually about 1% lower meaning benefits will rise slower in future.

There will be a new medical test for Disability Living Allowance from 2012 and Iain Duncan Smith MP has subsequently said that  people who are able to work should do community work to keep benefits.

Will social care escape funding cuts?

Paul Burstow MP, Minister for Care Services, advised that no grants for adult social care would be cut in 2010/11. The Carers Grant remains unring-fenced although each local authority has an amount identified within its’ budget as its’ share of the £256m national Carers’ Grant from the Dept of Health. £20m will be reinvested in respite for disabled children from what would have been invested in the now scrapped Child Trust funds for disabled children, and this will be ongoing annually.

However, because these grants are not ring-fenced local authorities could use some of the funds to cover shortfalls in other areas of their funding where there have been cuts. So cuts could still happen at the local level but it would be madness to cut support for carers – see an earlier post. Sir David Nicholson, CEO NHS England, has recognised this whilst saying that the NHS should use its funding to cover shortfalls in social care.

What’s happening with the pledges on carers?

The previous Minister for Care Services, Phil Hope, requested that Strategic Health Authorities scrutinise what PCTs are doing to support carers. The new Minister, Paul Burstow MP, is currently analysing information from SHAs.

Burstow has also said that in future he will:

  • encourage the NHS to do more to identify and respond to carers’ needs earlier to prevent ill-health
  • improve information, advice and support to help carers stay in or get back to work if they are able and willing
  • refresh the Carers’ Strategy as it only taken partial steps to improve support for carers

However, the recently revised NHS Operating Framework for 2010/11 does not increase carers as a priority for the NHS, but does ask PCTs to publish how they are implementing the Dementia Strategy. Why can’t they do this for the Carers’ Strategy?

So there should be a lot for MPs to talk about during their debate on carers on 1st July. Kick off is 14:30 in Westminster Hall. Let’s hope there’s something to cheer about.

Take care


June 28, 2010 Posted by | Budget, Carers Strategy | , , , , , , , , | 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

Party leaders call carers “unsung heroes”, but that’s just the start…

Carers – the nations’ unsung heroes. That was the message given out to the country last night by the three party leaders during their televised debate. The last five minutes focused on social care, and carers in particular, with the Lib Dems taking the opportunity to highlight their £500m commitment to provide breaks for carers. The party leaders should be congratulated for bringing carers into the national debate.

the leaders debate on ITV

Let's not kid ourselves that singing carers' praises will solve the huge issues we face

My mobile went berserk immediately as people recognised that such a high profile debate was great news for carers. However, media coverage and political debate will only be worth something if carers’ lives are improved as a result.

In my first ever blog I said how it was wrong to think that there was one single magic bullet that would solve all of the problems carers experience. Most carers desperately need a break; others need financial support; some would like to combine work with caring; many cry out for emotional support; whilst training carers in first aid and handling medications will make lives a lot easier for some.

We are changing as a society. Life expectancy is increasing, families are smaller and more geographically dispersed, and it’s likely that both parents now work. This means an increasing need to care for relatives with a decreasing ability to do so.

At the moment we do not enable people to care, we expect them to do so. Taking carers for granted translates into a lack of support which causes carers to suffer mental or physical breakdowns. But given the issues noted above, it is imperative that we get help to families and friends who want to care.

How we do that is bigger than just a five minute debate. It is not just the responsibility of politicians, or even carers to lead this. It is something that will affect all of us and our families. We have a duty to them to sort this now before it’s too late.

Carers – the nations’ unsung heroes? Yep, but let’s not kid ourselves that singing their praises will solve the huge issues we face. You can read a statement from The Princess Royal Trust for Carers Chief Executive, Carole Cochrane, here.

Take care,


April 16, 2010 Posted by | General Election, Uncategorized | , , , | 9 Comments

Consensus on social care? Not yet…

This week we have seen social care everywhere in the news.

Our Chief Exec, Carole Cochrane, attended the much publicised care conference today, called by Secretary of State for Health, Andy Burnham, and attended by Lib Dem Shadow Health Minister, Norman Lamb, but boycotted by Conservative Shadow Health Minister, Andrew Lansley.

With all the major charities represented, the conference sounds like it was a much more sensible and thoughtful discussion than some of the stand up rows the politicians have been having recently.

Andrew Lansley in front of a poster of David Cameron

The Tories have specifically ruled out a compulsory levy

The view of the majority of those represented at the conference is likely to add further fuel to the flames, however, because there appears to have been a consensus that some kind of universal (read: compulsory) insurance system was the best solution, or perhaps the least worst option would be more accurate.

This won’t go down well with the Conservatives who are favouring an opt-in solution and have specifically ruled out a compulsory levy, particularly one that you pay in inheritance tax after you die (the so-called “death tax”).

Neither option is perfect. People don’t really like compulsory systems – most of us keep our fingers crossed that we’ll never need to give or receive care, despite the overwhelming evidence to the contrary. Optional systems give more choice, but are much more expensive to buy into, because the risks are spread across a smaller group.

Our view is that whichever option is chosen (and let’s hope that, whoever wins this argument and the election, we do at least get one of these options in place, however imperfect), most care will continue to be provided by unpaid family carers.

Today’s conference agreed with us that, whichever option is chosen, as well as being able to pay to participate, the unpaid caring that you provide should also count, in lieu of a cash contribution. After all, people who care full time for years simply don’t have the same opportunities to build up income and savings.

It’s time that the political parties stopped focusing all of their energies on criticising each other’s ideas and instead came up with a decent offer to the UK’s six million carers.

Our sources tell us that one of the parties might be going to do just that on Monday…watch this space.

Take care,


Alex Fox, Director of Policy and Communications at The Princess Royal Trust for Carers, is standing in for Gordon on his blog this week.

Alex has written an article in Society Guardian this week on the “need for a clear emphasis on unpaid carers”.

February 19, 2010 Posted by | General Election | , , , , , , | Leave a comment

Social care must be a priority in the General Election

a road sign that reads "changed priorities ahead".

We must make social care a priority at the ballot box

Devolution in Scotland has caused some in England to look enviously northwards and ask why is it that they’re getting stuff that people in England are not.

I was at a Mark Thomas comedy gig the other night where a radical suggestion was for eye tests to be free, until I pointed out that they already are in Scotland. Then of course, there is ‘free’ personal care in Scotland, which isn’t actually free but people aged 65+ do receive contributions towards nursing/residential care costs or care at home.

What is not reported is that to fund these policies, the Scottish Government has to find savings in other areas – they have to re-order their priorities.

The Lib Dems announced a re-ordering of their priorities this week, which has meant a focus on fair taxes, extra investment in schools and improving transport and energy production. A loser in this re-ordering has been their commitment to provide a Scottish style system of personal care funding, which has been put on hold until it “becomes affordable again”.

The Conservative Party have also made some policy announcements publishing their draft health manifesto (does this mean it could change?) this week:

– £10 million a year funding beyond 2011 to support hospices in their work with children

– preserve disability living allowance and attendance allowance and allow a single budget for individuals combining health and social care funding

– provide separate public health funding to local authorities, which will be accountable for–and paid according to–how successful they are in improving their local communities’ health.

It also included their previously announced social care policy of people paying £8000 on retirement to receive free residential care, but there’s no announcement yet on their domiciliary care policy…

Politics is all about choices; the choices politicians make and the choices the electorate makes. There may be some issues on which you agree with one party, but on a different issue it is another party you agree with. So we have to make a choice about what our priorities are when voting.

Politicians know this so focus on issues that they think voters care about. “It’s the economy, stupid” is meant to illustrate that the economy is the priority for voters. British politicians often believe the NHS is, while Blair and now the Lib Dems think education is a priority for voters.

What is clear is that for social care to be considered a priority by politicians, we must first make it a priority in how we vote. Folks, it is time to consider our priorities.

Take care,


PS. There are Parliamentary outreach events on 26th January in Birmingham, Manchester and Norwich advising how people can effectively engage with Parliament, and understand its inner workings. If you’re interested you can find the details here.

January 14, 2010 Posted by | General Election | , , , , | 6 Comments

Personal budgets: carers must have a real choice

Liberal Democrat Shadow Health Secretary, Norman Lamb, speaking at The Trust's fringe event

Liberal Democrat Shadow Health Secretary, Norman Lamb, speaking at The Trust's fringe event

They came in their droves. 10 minutes before the start of our event at the Lib Dem conference, we had already run out of seats and indeed people were having to stand outside. It seemed that personalising health and social care was a popular topic.

Tim Luckhurst chaired our event with Norman Lamb MP representing the Liberal Democrats. Tim recently lost his father to Motor Neurone Disease and praised the help his family received from their Carers’ Centre, so was a very able advocate. We also saw a video of a carer explaining the benefits and problems with having a budget to choose the care you receive rather than being given a care package.

It became clear that many delegates felt that the type of information, advocacy and brokerage that Carers’ Centres could provide are wholly necessary if people are able to manage their own care support. Choice is not real choice if it is not informed.

It was also made clear that carers must have a choice; the burden of managing a budget and organising care should not be dumped on the carer. Don, the carer in the video, explained how he was able to buy respite but then spent it doing paperwork!

And finally, people must have the choice to say no. Some people do not want to manage their own care and would rather social services provided them with a package. This is also linked to local authorities and health bodies ensuring that there is a range of services available for people to choose from.

Norman Lamb was quick to agree that for the Lib Dems personal budgets can give people more choice but that real choice meant informed choice and the choice of saying no. An important point was also made by two of his fellow Lib Dem MPs that services finding and identifying carers cannot be lost, or they won’t even get the chance to make any choices.

Take Care

September 23, 2009 Posted by | Liberal Democrats, Party Conferences | , , , , | 3 Comments