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.

Carers caring more but do the government?

An interesting juxtaposition of carers news over the past couple of days; firstly, the percentage of carers providing 50 hours or more care a week has more than doubled in the past 9 years; meanwhile, the government has axed the Caring with Confidence programme, a support package for carers worth £4.4 million a year.

New statistics from the NHS Information Centre reveal that 5 million adults in England – nearly 1 in 8 – act as a carer for a sick, elderly or disabled person, with more than a fifth providing care for more than 50 hours a week.

Today, 22% provide care for 50 hours or more, compared to 10% in 2000-01. Also, nearly half of carers (48%) provide 20 hours or more of care a week and 30% provide 35 hours or more.

These figures are based on 2 surveys of more than 37,000 carers; the Survey of Carers in households – 2009/10 England – Provisional Results, and Personal Social Services Survey of Adult Carers in England, 2009/10, so it’s fairly in-depth.

So with this in mind, it seems odd that the government has chosen to close the contract for the Caring with Confidence programme – a scheme designed to improve support for carers – in September, rather than March 2011, as was originally planned.

Care services minister Paul Burstow’s justification for cutting Caring for Confidence is that the money used in the scheme could be “spent smarter” elsewhere. He didn’t elaborate on how, other than to say that he plans to offer more support to carers’ organisations and for carers’ training.

However, given that supporting carers and giving them training is – was – Caring with Confidence’s raison d’etre, the decision makes even less sense, especially as it was coming to the end of its government funding early next year and, anecdotally, was making a positive difference to carers’ lives.

It seems like the government is trying to make quick savings to cut the financial deficit with this decision, and it flies in the face of its manifesto commitment to support carers.

Hopefully Burstow makes good on his words and this is not a sign of things to come for carers, otherwise the Personal Social Services Survey of Adult Carers survey’s statistic that 17% found their quality of life was either “bad, very bad or so bad it could not be worse”, could increase in years to come.

Reflections on the Budget’s impact on social care

As usual, Tuesday’s Budget was a mixed bag; some gains, some losses for the majority of people, including those in social care. Here is a brief summary of what I have spotted.

Firstly, the downsides; public sector pay has been frozen for 2 years, except for those earning less than £21,000 per year. As many people in social care work in the public sector, this could have an impact on service users down the line.

For instance, it could demotivate workers, but some may decide to leave the sector entirely if they see the chance of better pay in the private sector – however, losing experienced staff is something that can be ill-afforded.

Also, the government will introduce a medical assessment for Disability Living Allowance from 2013 for new and existing claimants. Interestingly, the wording in the Budget says that this measure is to “ensure support is targeted on those with the highest medical need”.

I assume this will be some form of capacity for work assessment, which is the prevailing trend in disability benefits. It also seems to indicate that the criteria for eligibility may be raised. This could see some claimants moved onto other benefits that do not pay as much, or off them entirely.

Also, and a little oddly, the document also says that the medical assessment will “ensure payments are only made for as long as a claimant needs them”. As DLA is paid to people with a disability – generally an ongoing thing that doesn’t get better – this makes me wonder if the government really understand what it is and what it is for.

DLA has never been a form of unemployment benefit; it is there to help people with disabilities – physical or mental – pay for items they need to live, such as care services, which the general population do not need. To take this away could make life very difficult for some disabled people.

Elsewhere, VAT will rise to 20% from January 2011, which is a move that will hit everyone in the pocket, but for people on benefits or low incomes, the effect could be magnified.

Also, capping Housing Benefit at £280 a week for a one-bedroom property and £400 a week for a four-bedroom family home could also adversely impact on service users and carers, especially in London and the south of England.

On the plus side, from April 2011, disabled people who require an extra room to support a resident carer will be able to claim Housing Benefit. This again supports the government’s ongoing commitment to the personalisation agenda.

Also, the changes to tax thresholds could see some people on low incomes – which often include carers – taken out of the tax system.

Likewise, the move to link pensions with earnings from April 2011, meaning that it is guaranteed to rise in line with earnings, prices or 2.5%, whichever is the greater, will help older people.  

Chancellor George Osborne added that proposals on welfare reform will be announced by October this year, before the government announces its comprehensive spending review (CSR), which will set out the plans for public expenditure for the next 3 years. It is good to see that – finally – there may be some movement on this much-needed measure.

So there are plusses and minuses to this Budget – possibly more of the latter than the former. However, benefit cuts have not come directly, which had been rumoured, but other measures will impact adversely nonetheless.

But there is also still much that is still to be decided; local authority budgets, which will be announced in the CSR, and that could yet have more impact on social care.

Carers need a life of their own

Isolated, lonely, marginalised; that is how the majority of carers feel, according to a survey published to coincide with this week’s Carers Week.

The survey, which took in the views of more than 3,200 carers across the UK – the majority of which care for more than 50 hours per week – paints a fairly bleak picture of a carer’s life.

For example, 76% said they feel like they have no life of their own outside of their caring role, with a similar percentage saying they have lost touch with family and friends as a result of being a carer. Many feel they have no time to socialise, for romantic relationships or even to have children.

Being a carer also adversely impacts on many financially – 4 out of 5 report being worse off, with more than half having to give up work to devote more time to their role. This also exacerbates many carers’ sense of isolation, with work often a vital means of social interaction.

It makes for depressing reading. What makes it worse is that the survey also reveals what many carers feel they need to make their lives better – and they are relatively modest demands. The 4 main needs are:

• Access to relevant and practical information, to help them with their caring role
• The opportunity to take a break when they need it
• Support at times of crisis
• Financial support.

To my mind, there is nothing in that list that cannot be achieved, if the political willingness is there.

There is the possibility that some of it may be realised in the relatively short-term. The government has said it is committed to providing a week’s respite for carers, although I believe this is only for carers of severely disabled children (please correct me if I’m wrong) and I haven’t yet seen a timescale for when this might be implemented.

Putting mechanisms in place to provide better information for carers and more support at times of crisis are also achievable at a local level through better working with local authority social services and independent social care providers.

The only demand that may not see any action is that of financial support. Current media speculation about the forthcoming cuts to public spending in next week’s Budgets predicts cuts in benefits so any significant rise to the Carer’s Allowance would seem unlikely. I don’t agree with that, but that’s just the way I think it will go.

These demands really need to be taken into account in the forthcoming independent commission on the future of social care.

Indeed, one of the criticisms of last year’s Big Care Debate and subsequent White Paper – now consigned to the dustbin, of course – was that carers seemed to be largely ignored in it. This always seemed like a huge oversight – not only are carers a vital part of the system, they are often the people who know the most about caring and what service users need.

Hopefully the new commission will take more notice of their opinions and needs and surveys like this will not make such troubling reading in the future.

Carers need to be central to social care agenda

This week is Carers Week, and with many events planned across the country in support of this, it will hopefully raise the profile of this largely ignored, but vitally important group.

Since the election, reform of social care has again been back on the agenda, with another commission to be formed to investigate its future, and various pledges to not cut frontline services, but measures to help carers have been conspicuous by their absence.

To trot out the oft-quoted statistic, there are about 6 million carers in the UK, who save the economy £87 billion per year. With those numbers, it constantly surprises me that carers aren’t a higher priority for politicians – after all, they make up more than 10% of the electorate.

But they seem to be constantly sidelined. Indeed, since the election various organisations, such as Carerwatch (www.carerwatch.com) and the National Pensioners Convention (www.npcuk.org), have complained about the lack of attention carers have received and how the political agenda has ignored them.

Indeed, from what I have read, the only real commitment specifically to carers has been the pledge to give an extra £20 million to pay for 8,000 week-long respite breaks for people caring for severely disabled children. Which is great, but doesn’t help those who care for severely disabled adults.

Elsewhere, there are also commitments to roll out more direct payments to carers, which could give them more choice and control over their role.

Other bits of legislation could help, such as extending the right to request flexible working to all employees – which could help more carers to remain in work.

This is important because there has been no mention of increasing carers benefit from it’s currently – pitiful – level of £53.10. When you consider that many carers work more than 50 hours a week – it is a disgrace that it is still at this level.

Indeed, with welfare benefits reform on the horizon, it is important that any changes take account of carers and their circumstances. There seems to be a general thrust of getting people back into work and ending benefit dependency in the UK, but for many carers caring is a full-time job in itself and this needs to be remembered.

With government looking to make billions of cuts in the coming years, carers are an invaluable resource and for a relatively small investment in them, the savings that could be brought about – if they are able to continue caring, rather than see their loved one go into residential care, for example – would more than cover the initial outlay.

Let’s hope the government recognises this.

Adult social care White Paper: good points but short on funding detail

For all Andy Burnham’s fine words about following in the footsteps of Bevan and establishing a National Care Service, the White Paper – Building the National Care Service – doesn’t address the main problem with social care – and the original purpose of the green paper last year: how it is paid for.

But first, the good points:

The proposals for a National Care Service – free at the point of use, given according to need, with the principles of being universally accessible, having a strong national framework locally delivered, being preventative and flexible, with support for carers, and information and advice for all – is admirable.

Social care has – as the government admits – lagged behind other sectors, such as healthcare in terms of provision. It has never had a national structure and one is well overdue. It is hard to argue with the government’s aims here.

The commitment to put in place nationally consistent eligibility criteria for social care – enshrined in law – is one that many have been crying out for. The ending of the postcode lottery will go some way to addressing the perceived unfairness of the current system.

Likewise, ensuring accurate, relevant and accessible information about what people are entitled to, how the assessment process works and how to access care services is provided to everyone, and improving the gateway for accessing social care and disability benefits to make it simpler and easier for people, are also welcome and long-overdue developments.

Keeping Attendance Allowance and Disability Living Allowance also shows that the government has listened to some outcomes from the Big Care Debate – getting rid of this would have proved very unpopular.

The continuing commitment to the personalisation agenda – in giving service users choice and control – will also be welcomed by the majority, not least social workers who may have feared yet more upheaval.

But on the downside…

It also talks about people in residential care only having to pay their own fees for 2 years. Fine, but the average time spent by an older person in residential care is 3 years, so they would only get one year ‘free’.

Also, while people in residential care would still have to pay their accommodation costs, there is a commitment that no-one will have to sell their house to pay for care within their lifetime. With a deferred payment plan, their family may have to pay for it out of their estate after their death.

This leads neatly to the crucial bit – and one I suspect made with an eye on the election – no decision on the funding of the National Care Service will be made until 2015 at the earliest. Not so much kicking it into the long grass but the jungle.

This is where the White Paper falls down. The social care sector has been creaking along with the much-hated means testing system for years. It is widely accepted that the system needs reform – mostly because it is too complicated and perceived as unfair in some cases – and while it says it will address this, it doesn’t say how.

The government still leans towards some sort of compulsory levy – which means the so-called “Death Tax” isn’t dead – but is not specific on what. Indeed, they have called for a new commission to look at when and how the fee should be applied, and how much it should be. But wasn’t that the original aim of last year’s green paper?

However, in fairness, there wasn’t a great deal consensus on funding. Andy Burnham revealed that, of the 3 funding options outlined in the green paper, 35% favoured a partnership approach, 22% opted for an insurance model, while 41% backed the comprehensive approach.

Meanwhile, the Conservatives are still talking about their £8,000 voluntary insurance scheme to pay for all this. As mentioned before, this doesn’t seem to be enough and I doubt enough people will sign up to it, knowing it is something they may not need in the future.

So, much-needed reform is on the way for the social care sector. While the proposals are great in principle, I can’t help but worry how all this will be paid for – there is precious little on that.

Also, the lack of political consensus on this – the Tories branded the White Paper a ‘train crash’ in today’s Daily Mail – means that after an election we could be back to square one again.