You cannot change the quality of care in this country without respecting carers and improving the support they receive. This was the simple message delivered to the three political parties at yesterday’s conference on carers. The response we were seeking was what each party would pledge to do for carers in the next Parliament…
Care Services Minister Phil Hope focussed more on what the Government had done in this Parliament to increase support for carers, and there have been improvements: £25m training and employment support for carers; recent £1m investment in young carers’ services; new credit scheme to help carers build up pensions; and a national helpline and website for carers.
But the big moment came when he put himself on the line in response to our report “No Breaks for Carers” on PCTs not supporting carers – “I will personally hold PCTs to account for the carers’ money they will receive but do not spend on carers and will keep going until they do spend the money on carers” (read the full story here).
It’s not often that politicians make a personal pledge like this. Eyes darted around the room to see reactions.
Shadow Health Minister Stephen O’Brien did not give detail but pinpointed two issues that he wants to tackle: carers losing Carer’s Allowance when earning over £100p/w and when they begin receiving a State Pension. O’Brien restated that the Conservatives would retain Attendance Allowance and Disability Living Allowance and that indeed his parent’s in law rely on AA. He also said that the Conservatives would announce a policy to improve care in the home to accompany their residential care policy, and that they wanted to extend flexible working for carers.
Liberal Democrat Chief Whip Paul Burstow expanded on his party’s pledge to commit £500m p/a to carers. Carers would be able to receive a personal budget, for example of £510, and could choose what to spend it on. Lib Dems would act upon the Work & Pensions Commons Select Committee report (August 2008) which recommended increasing Carer’s Allowance.
Burstow also agreed with a carer who spoke later that carers must be a higher priority for the NHS – not a Tier 3 lowest priority giving the NHS the option to support carers or not; carers have to be a “must do” for the NHS. He finished by praising his local Sutton Carers’ Centre which he said had “educated him” about wide range of carers’ needs and issues.
Two carers spoke and gave their recommendations which included making GPs improve their identification of carers, and the RCGP representative agreed they would continue to raise the profile of carers amongst GPs. Tory MP carers campaigner in Parliament, Tony Baldry, suggested that a voluntary register of carers would prompt all professionals to ask if people had caring roles and then people could have an annual review to ensure they were receiving support.
What found universal agreement was an approach that saw everybody in health and social care informing, advising and supporting carers as part of their role. This responsibility cannot be passed to a few appointed individuals within organisations or there will still be too many carers ignored, isolated and in danger of failing health themselves.
We presented questions from carers, including a one asking the MPs if they would like to be a carer for the day. The MPs declined, which goes to show how much harder we have to work to improve the lives of carers.
We have known since February that this was likely to happen and have reported this to the Government at every opportunity in person and in writing. David Cameron spoke about it on GMTV during an expenses interview; MPs have questioned Ministers in Parliament (Stephen O’Brien and Simon Hughes, 13 Oct); and the media have covered it as a major issue. People are incredulous that a government can announce £50m will be given to support carers when in actuality they are giving £50m to PCTs to do with as they want and PCTs do not have to report if they have used any of the money to support carers.
The Government response is that local decision makers in PCTs know their communities best and are best judged to respond to their needs. Localism is currently very popular; national government should not decide everything as it is the people ‘on the ground’ who are most in touch and who know best. However, in terms of encouraging local democracy, local decision making is only one half of the equation. The other equally important aspect is that local people should be involved in decision-making and be able to hold local decision makers to account.
£50m was distributed among local PCTs without telling anybody how much each received as their share; it was simply included with their general budget. Lack of information is the first problem.
Despite us making these figures public, many PCTs did not involve carers and carers’ organizations during their spending plans for this money. Lack of participation is the second problem.
The Freedom of Information (FOI) Act requires public bodies to respond within 20 working days to requests, so we asked PCTs under this Act what they were planning to do with the money. Half did not respond within the 20 days, some still haven’t despite reminders and others responded with one sentence to seven questions advising “We do not currently hold that information”. Lack of transparency is the third problem.
The problems affecting the Carers Strategy is not a one-off issue. It pervades many areas of national government plans that are to be delivered by semi-autonomous local organizations. I see that Every Disabled Child Matters Campaign has released information about similar problems with money given to PCTs to support disabled children.
National government can either make announcements and take responsibility for ensuring delivery (even if it is local organizations delivering the change) or they stop giving false hope and make it possible for local people to hold local decision makers to account. This is not just an issue about carers; it is an issue about our democracy. But politicians should not forget that 5 million carers in England have suffered as a result.
This is our message when speaking with Ministers, civil servants, strategic health authorities, health regulators, local authorities and other charities to try and make sure that with £100m being given next year, some carers will actually get a break.
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,
Well we certainly stretched Carers Week out as much as possible. The first event (Thames Walk) was before it even started and the last media interview took place at 11pm last night. The lucky person who got to stay up late on a Sunday night for the Five Live interview was my esteemed colleague Danni Manzi. Danni heads the development of young carers support work in England and Wales for The Princess Royal Trust for Carers.
I’m going to have to take some tips from Danni who managed to remember our website address and telephone number during the interview, which was something that I failed to do with Quay Radio (Portsmouth) last Thursday.
Last Thursday was a busy one with me attending a question time type event at our Southwark Carers’ Centre. I do fear these events in case everybody realises that the carers in the audience know more than me sitting on the panel. Thankfully, I wasn’t heckled or booed and the event showed how poor the level of discourse on the real Question Time can be.
Two fellow panellists were councillors who admitted to me beforehand that had learnt so much in preparation for the event. This honesty meant that they actually listened and even agreed to meet with carers to discuss how carers’ policies could be included in their local party manifesto for council elections. Genuine working together can hopefully bring greater understanding of the pressure on both sides.
Sadly, this will have to be done without Allan Johnstone, who was enjoying his last day as Chief Executive of the centre. He will be missed but will still be working to support carers – so all is not lost. Centre managers often put huge amounts of their lives into supporting carers and I am generally in awe of what they manage to do on a shoestring.
Doing this did mean that I missed the short debate on carers in the House of Commons. However, I did manage to read the debate online.
It was good to see that Dr Andrew Murrison spoke. He was one of the MPs who dropped in to our information service last week who had never previously been involved.
There was much focus on Primary Care Trusts (PCTs) not providing breaks for carers, which I’ve mentioned in earlier blogs. MPs Paul Burstow, Greg Mulholland and Stephen O’Brien all asked Phil Hope MP (Minister for Care Services) how the Government was tracking whether PCTs were spending the £50m given to them (£100m next year) to provide breaks for carers. Mr Hope didn’t give the wholly truthful answer of “we’re not” but chose to absolve himself of responsibility instead placing it on MPs and carers themselves:
“Part of his responsibilities as a local MP, along with those of carers, might be to ensure that the local primary care trust understands the needs of carers, does the job that it should be doing to assess people’s needs and ensures that it allocates from its budget the money that the Government have allocated to it to support carers in the area.”
I would love to find out how much Northamptonshire NHS, which covers Phil Hope’s constituency, is spending on carers.
The truth is the Ministers gave the money then washed their hands of it. Little guidance was given to PCTs and PCTs were not even told how much of the £50m each was receiving. We have been gathering information over recent months and the feedback shows that only four out of the 70 PCTs we have information on are spending all of their allocation (we worked these out) on carers’ services. The majority do not seem to be spending any of it on carers.
Anne McGuire MP also asked the Government to consider not defining Carer’s Allowance as an income replacement benefit, which would allow a carer to receive a State Pension and a Carer’s Allowance at the same time. Many carers dream of such a scenario.
Young carers also received some focus and the debate does show that there are MPs who care. However, if a new speaker does reform anything, it should be making MPs answer the questions put to them in Parliament. It’s a shame that local councillors find it easier to be open and honest than national Parliamentarians do.