Social care funding commission has 2 options

This blog was originally going to be about how unhelpful the newspapers’ focus on the Commission on the Funding of Care and Support’s decision to not automatically discount bringing in a “Death Tax” was, but since I started writing, the government has ruled it out completely, according to Community Care.

This isn’t a surprise, to be honest. Firstly, the government would want to defuse criticism from the newspapers that saw this as the Conservatives back-tracking on their stance from the election campaign.

But in any case, since it was christened the “Death Tax”, that idea – a compulsory levy on estates after death – would have been impossible to implement because of the backlash from the press it would get and the image it has in the public’s eye. Whether or not it was the best option is a moot point.

But on the upside this should help bring about a more reasoned debate in the media on what the funding options are – no more tub-thumping headlines screaming about the injustice of the “Death Tax”, for instance.

Many people do not understand the social care or benefits systems currently, so a clear setting out of the current regimes, along with an explanation of all the options being considered and their relative merits/downsides would be good.

Not that there is that much to cover now. Currently, there would seem to be 2 options realistically on the table; a voluntary insurance scheme and a partnership of state finance and service user finance. A system completely funded by users or by the state was ruled out by the last government and has hardly been mentioned by this one, so I think we can assume those ideas aren’t really being considered.

So, it seems as if the commission’s job is to decide which of the 2 options – or slight variations on – is better.

Considering when this last went out to consultation there was no consensus on which option was best, they have a tough job ahead.

So how does the commission decide? Perhaps they should get Harry Hill in – “There’s only one way to find out…”

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Care funding commission must consider all adults

Here we go again. Today sees the launch of the latest Commission on the Funding of Care and Support (catchy title) for adults.

We’ve been here before, most recently with last year’s Big Care Debate. That got as far as a White Paper before the election, but as soon as the government changed the proposals were swiftly dropped. So we’re back to square one. Again.

Nevertheless, the new commission has been detailed to report back within a year. Health secretary Andrew Lansley expects legislation in front of Parliament next year, and it will eventually form part of a larger White Paper that also takes in the Law Commission’s work on creating a single modern statute for social care, and the Government’s vision for social care.

The commission will focus on:

  • The best way to meet care and support costs as a partnership between individuals and the state
  • How an individual’s assets are protected against the cost of care
  • How public funding for the care and support system can be best used to meet needs
  • How its preferred option can be delivered, including an indication of the timescale for implementation, and its impact on local government (and the local government finance system), the NHS, and – if appropriate – financial regulation.

The politicians have, as usual, made all the right noises about this; for instance, Lansley said; “we must develop a funding system for adult care and support that offers choice, is fair, provides value for money and is sustainable for the public finances in the long term.”

All regulation political guff and nothing that anybody disagrees with; it’s just that successive ministers have said this for some years, so its hard not to feel cynical.

But reading between the lines, service users should not get their hopes up that reform will improve things too much. As care services minister Paul Burstow said: “Trade offs will have to be made but we are determined to build a funding system that is fair, affordable and sustainable.”

Trade offs? Is that a euphemism? To me, that is a subtle way of saying that to get to a solution, some existing ways of being funded may have to be axed/cut back. However, this is just speculation on my part – I may be reading too much into it.

But the commission does take place against the backdrop of swingeing budget cuts and this will form a major spoke in their thinking, hence why a leading economist, Andrew Dilnot, has been chosen to chair it.

He will be assisted by the CQC’s Dame Jo Williams and Lord Norman Warner, a Labour peer and former director of Kent social services – and also an outspoken critic of Gordon Brown’s free personal care at home policy earlier in the year – who will help to ensure that the commission does not just focus on the numbers.

As with the last commission, a range of funding options will be assessed, including a voluntary insurance scheme, as favoured by the Conservatives, and a partnership of state and individual contributions, the Liberal Democrats’ preferred option. No mentions of a compulsory levy – aka Labour’s “Death Tax” – being considered in the press release however, so we can assume that that won’t be an option.

But if this is to be successful the commission has to look at funding care for all adults. One of the criticisms of Labour’s last attempt was that it focused too much on older people – especially the voter-winning solution to people having to sell their houses to pay for care – with people with disabilities sidelined.

While older people do make up a significant proportion of those receiving care services, those with disabilities are just as important and any solution has to appreciate their needs and circumstances as well.

The solution also must been seen to improve – or at the very least not cut – services, if it is to get widespread acceptance from the public. Again, this will require doing more with less – a neat trick if you can pull it off.

But what the commission must do above all is to come up with a conclusion. The Big Care Debate had 3 options, but no one option was significantly ahead of the others. This commission should look at all the options and consult widely with frontline workers and service users before making a decision – and then sticking to it.

Coming up with a solution to funding adult social care is not going to be easy – otherwise it would have been done years ago – but this time it needs to happen. However, while some tough choices will have to be made – the financial situation is inescapable – the option of doing nothing is even worse for service users.

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What does Big Society mean for social care?

Today saw the launch of the much-vaunted ‘Big Society’. The Big Society is David Cameron’s Big Idea and “Big Passion”. His vision is for services to be provided on a more localised level – as an antidote to Big Government. So, all in all, this is big. Here are my initial thoughts.

The theory behind Big Society is great – getting people more involved in their communities, everybody using their own skills helping each other to provide the services they want and need, such as the Post Office or transport services – and it is hard to argue against that. It is almost a (whisper it) socialist ideal.

But, like many policies that are great in theory, the practice will be somewhat different.

One of the main tenets of the Big Society is enabling charities, social enterprises and voluntary organisations to take over the running of public services.

Already, many social care services are provided by the third sector – such as day centres, mental health recovery programmes and meals on wheels – and have local authority contracts to do this.

Some of these organisations rely on volunteers to ensure they keep running – from helping to serve tea at a day centre to driving a care home minibus on a weekly outing – and it is, in a way, an example of how the Big Society already works. That isn’t the problem.

This is: how much more can the sector take on? Many volunteer organisations find themselves crying out for more people to join them – is this going to change under the new government directive?

While many people like the idea of volunteering, few do it. To use a current marketing buzz-phrase, many people are ‘time poor’ – or to you and me, busy – and feel that they can’t spare the time. Others may not have the skills required. Or, perhaps more obviously, some people won’t be bothered or willing to do it because some people just don’t like the idea of working for nothing.

For me, this is one of the major sticking points of the Big Society; getting enough people to not only buy into its ethos but also to take part in it. When the social care sector often struggles to get good people into the workforce when it offers to pay them, I’m doubt that they’ll get them voluntarily.

There are other aspects I am sceptical about. One of the examples being quoted is the pub in rural Cumbria that is being bought and run by the locals, with 105 of them stumping up £1,500 each to take a stake in the pub. OK, this is a great example of how it can work (hence why it’s being used) but will this happen in a run-down inner-city area, for instance? How many people in a housing estate have that sort of money knocking about?

This can be applied to social care – would enough people get involved to, for example, run a day centre? Especially in rural areas, where there is a smaller pool of potential people to help.

I also have a nagging feeling that this is just a back-door way of making cuts and saving money by giving the running of public services to volunteer organisations, which, by their nature, employ people who aren’t paid for their work – much cheaper than civil servants and council employees. David Cameron has denied this, but then he would, wouldn’t he?

Maybe I’m being over-cynical. There are some great social enterprises out there, and things like hyperlocal websites where local people are getting together and making a difference to their communities. Doubtless this policy will create more of these, which is great, but I doubt it will provide the change in society that David Cameron envisages.

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People with learning disabilities still face discrimination

Discrimination against people with learning disabilities is still rife in the UK, with a third of people still believing that they cannot get a job or live independently, according to a new survey.

Health and social care provider Turning Point has found that 9 out of 10 people believe people with learning disabilities are still discriminated against, with 51% saying they are the most discriminated against group in society.

This is not necessarily a revelation – everyone involved in the sector knows that it is rife – but does show how much still needs to be done if people with learning disabilities are to be truly integrated into society.

OK, while it is a survey of only 1,100 adults and nobody knows whether it was weighted to get certain results etc – I know some people are sceptical of statistics – but taking these on face value from a reputable source it nonetheless provides snapshot that can at least create a debate about the topic.

From looking at the survey results, a lot of this discrimination seems to be down to a lack of public understanding about people with learning disabilities and how they live.

For instance, the survey found that 8% still expect people with learning disabilities to be cared for in a secure out-of-town hospital, while 23% believe they live in care homes.

Whether these views are borne of ignorance or prejudice, all this shows that information campaigns about learning disabilities need to be redoubled. Some of the findings show a basic lack of knowledge – such as identifying mental illness as a learning disability – that needs to be addressed.

Adam Penwarden, Turning Point’s Director of Learning Disability Services, hits the nail on the head: “As a sector, we need to work together to challenge preconceptions and show what a positive contribution to society people with a learning disability can make. This includes working, living independently and playing an active role within the local community.”

There have been high-profile anti-stigma campaigns for mental health in the past couple of years and perhaps the time has come for a similar campaign for people with learning disabilities.

Another way to break down stigma would be to have someone with learning disabilities become a regular member of the cast of one of the major soap operas. While this may sound flippant, it can work – the Stacey Slater bipolar storyline in Eastenders (which I blogged about previously here) has helped to bring the condition into the mainstream and increase understanding.

Yes, I know Billy and Honey Mitchell had baby Janet, who has Down’s syndrome, but that character has all been written out now. I am thinking more of an adult/teenage character.

While better information about learning disabilities would not be a panacea – stopping discrimination is an ideal only – it would at least eat into those statistics and provide a good basis for further work.

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NHS reform – impact on social care

Andrew Lansley’s much-vaunted white paper on the future of the NHS was published yesterday afternoon, promising widespread reform, including the abolition of PCTs and SHAs and giving commissioning power to GP consortiums. But what will it mean for social care? Here are a few of my initial thoughts.

Firstly, there are concerns that the reforms focus on general services and that people with learning disabilities, mental health problems and dementia have been largely ignored – this came through strongly on Twitter yesterday, from what I saw.

To test this, I did a quick word search of the white paper to gauge how many times certain phrases were mentioned; mental health is mentioned 8 times in the 61-page document, Alzheimers or dementia receives one mention [as @seetheperson pointed out to me], and learning disability – or learning disabilities – never crops up.

To me, this is shocking. Considering that people with learning disabilities, dementia and mental health issues make up a significant chunk of those that use NHS services, the lack of attention given to them is a worrying omission.

Specialist services are often a lifeline or those who use them and an acknowledgement of this – and preferably a commitment to give them at least some degree of protection – would have been reassuring to the many service users who are already distinctly nervous about what government cuts will mean for services.

Hopefully the government is planning for learning disability and mental health services separately…

Also, do GPs, who will now have power over which services are commissioned in their area, have the specialist knowledge that is often required in MH/LD to be able to give an authoritative view on what sorts of services are needed? Mental health charity Mind’s chief executive Paul Farmer has already questioned this and called on them to talk to experts and “tap in to the personal knowledge of patients and mental health charities about what works.” 

There is also cynicism over whether GP commissioning will work from some within the profession. For example, the GP for hire blog gives a distinctly lukewarm reaction to the proposals, saying it will put more pressure on salaried and locum GPs, and could lead to divided interests for those doctors involved on a consortium.

Also, will GP consortiums not exacerbate the postcode lottery, which was supposed to be got rid of? If commissioning a service depends on the decision of the GP consortium – a group of individuals with their own opinions – surely there is the risk that one consortium would approve it, but the one next door would not.

It hardly improves patient choice if they find that their needs are rejected in one area but available in another.

But there were some good points in the white paper. For instance, it talks of promoting the joining-up of health and social care services and promoting preventative action. I can’t argue with that principle – health and social care are closely linked, so that is a no-brainer and could help to reduce duplication of information and bring about efficiencies. Also, preventative action is generally accepted to reduce the need for costlier, more complex services down the line.

The white paper also says that the government’s vision for adult social care will be outlined later this year, and indicate that it will be a continuation of the current personalisation drive towards choice and control for service users. A white paper will follow next year. Nothing new there, but it is good to have the timeline in place.

In conclusion, the government’s reforms are certainly ambitious, but they are also risky. Social policy think-tank Civitas has warned that considerable resources will be needed to enact the restructuring – I’m not sure how that sits with the aim of saving £20 billion by 2014 – and if it is got wrong it could lead to a dip in the NHS’ performance for at least a year.

That will be the acid test of these reforms – will it make services better for service users? I’m sceptical, but only time will tell, as ever with any reforms.

This white paper provides so many points for discussion so it is more than likely that I will blog on aspects of it again later in the week.

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Social care providers worry about maintaining service quality

These are worrying times for service users, carers and families involved in social care; with the uncertainty over service provision, eligibility criteria, benefit cuts and future policy all causing stress. Now, care providers are adding to that by saying that services may get worse.

A survey published last week by accountants PricewaterhouseCoopers (PwC), Fair care crisis? An independent survey of social care providers for the elderly,  found that many care home and domiciliary care providers are worried about the effects of cutbacks on service users, and have warned that some have ‘unrealistic expectations’ of the services they receive and ought to revise their expectations downwards.

Providers said a key challenge is maintaining the quality of services against a background of rising costs and downward pressure on fees. Indeed, 80% worry that quality of care services will suffer due to cost reduction measures.

While it has to be remembered that these are the views of care providers, who are always going to say they need more money – the majority want a fair fees policy for local authority commissioners, for instance – this survey nonetheless highlights some of the current concerns among the sector.

Respondents also fear that smaller providers may go out of business because of cost pressures, which could lead to reduced choice for service users – so much for the increased choice and control promised by the personalisation, it seems.

OK, that’s the scary part over with. The survey also had some positive messages; 97% feel they are equipped to meet current or future challenges and 94% are already taking action to address market challenges.

Of those taking action, 83% are increasing skills and capacity – meaning better-trained staff – but 78% are controlling costs, which can be a double-edged sword, depending on where the cuts come.

This survey provides an interesting snapshot of the mood of social care providers. While there is optimism about meeting the future challenges, it is worrying that some say that service users should not expect so much of them.

While this may be realistic talk from providers – if you know how to do more with less please tell me – it does not augur well for service users; it seems they will face increased eligibility criteria, fewer services, less choice and less care.

The uncertainty in the sector is also not helping. The survey notes that 79% of providers want the government to outline its vision for the future of elderly social care, but they are likely to be disappointed. While there may be some measures outlined in the plans for the NHS today, for the definitive standpoint I imagine we will have to wait until the independent commission on the future of adult social care reports back sometime in the next year.

Only when policy is confirmed, along with budgets – we’ll find out what local authorities have to spend in October when the comprehensive spending review is announced – will providers be able to plan with certainty, and therefore give service users a better picture of what services will be provided – or not, as the case may be.

While PwC’s report closes on an optimistic note from a business point of view – many expect to cope with the future challenges and see opportunities in an expanding marketplace – I can’t help feeling that the outlook for service users, their families and carers is much more pessimistic.

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The future for social care programmes?

Last Friday I blogged on the government’s axing of the Caring with Confidence programme, and how on an initial reading it seemed to make little sense. But comments since then from care services minister Paul Burstow have explained more about the decision – and given a hint as to future policy direction.

Burstow, as reported in Community Care has justified the move to end Caring with Confidence by saying: “We were not getting value for money from the delivery. Not enough carers had been through the programme, and there was no evidence that delivery would accelerate significantly.”

Whether that is accurate or not is a moot point. But this statement may tell us more about future policy direction when it comes to social care programmes: if they can demonstrate they are providing value for money, they will be safe, if not – watch out for the axe.

Now, once upon a time I was a business journalist, and I used to regularly interview entrepreneurs who would explain that a project or an arm of a business had been closed because it wasn’t providing value for money. Their priority was the bottom line and if it wasn’t contributing to it, and showed little sign of doing so in the future, then it would be axed, more often than not.

That’s fair enough in business – they exist to make profits – but in social care, it is a whole different ball game.

In social care, investment in a project may not provide demonstrable fiscal returns; it is often a lot more subtle than that. For instance, how do you quantify the value for money for someone taking part in a mental health project? It may aid their recovery and wellbeing but does it provide value for money? How do you judge? Is it whether they are able to get a job at the end of it and therefore can come off benefits and start paying tax?

It’s not an easy call to make; social care projects often provide intangible benefits to those that use them, and in these cases it is generally more important than any financial returns.

In fairness to Burstow, he has added (again according to Community Care) that the money from Caring with Confidence will be reinvested in other carers’ projects, including a training programme to raise GPs’ awareness of their role in supporting carers. He has also said that Caring with Confidence materials will be available free to carers’ centres that want to carry on the work.

Nevertheless, Caring with Confidence will not be the last project to bite the dust in the coming months. The government is making difficult decisions and with the cuts coming – said to be 25% of local authority budgets – it is inevitable that some social care programmes will be axed.

There are projects out there that are not doing what they were set up to do well enough and need to be weeded out, but there are many more that do and should be protected. Government and council leaders will need to examine each one very carefully and assess the benefits it gives to service users before deciding which should be cut and not just make a decision based on financial data.

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