Hospital car parking charges need reform

Today’s blog returns to an old hobby-horse of mine: hospital car parking charges.

This issue is back on my radar again as I will be making regular hospital visits for the next few months (my wife is pregnant) and was stung for more than £2 for an hour’s parking earlier this week.

Some of you may remember a recent blog where I highlighted/ranted at what I saw to be the scandal of hospital car parking charges for visitors and patients (Hospital car parking charge scandal) and how this should be ended. Pleasingly, it seems that I’m not the only one that thinks this way: consumer watchdog Which? has now called for charges to be revamped.

As reported by the BBC today, Which? has published a list of the best and worst performing hospitals in terms of clamping and fining car park users (or abusers, depending on your viewpoint). The worst were Epsom and St Helier University Hospitals NHS Trust (most clampings) and Leeds General Infirmary (biggest finer). Barnet and Chase Farm Hospitals NHS Trust charged the most at £4 – £4!! – for 2 hours.

The fines and clamping system highlights another issue I have with car park charging; having to be aware of how long you’ve got left on your ticket.

Again, I’ve experienced this one; having recently bought a ticket for 3 hours parking (which I assumed when I purchased it was more than enough) I had to dash out of a waiting room to extend my parking stay. I shouldn’t be thinking about a parking meter when being given important information about my unborn child.

Hospitals visits can be stressful enough without having to worry about the threat of extra charges, fines or even clamping, especially when it is usually through no fault of your own; we all know how hospital appointments can – and often do – run behind schedule.

Perhaps the worst bit is that there is little sign of this ending. While Labour announced plans last year to scrap charges for in-patients, their families and friends within 3 years, the new coalition government has made no such commitment. And with budgets cuts imminent, they are a useful moneyspinner for cash-strapped PCTs that they will not give up voluntarily.

Which? has called for a ban on clamping and towing, as well as “fairer” charging systems such as allowing patients to pay on departure rather than arrival – although some already do this, to be fair – or reimbursing patients for additional parking fees when appointments are delayed.

All good points, and hopefully, given the clout that Which? has, someone in power will listen.

But for me, it doesn’t go far enough; as I’ve said before, I’m not against charging per se, but it does seem ridiculous to pay more than £2 for an hour, given the costs of upkeep of a car park (not that much) and the number of people who pass through one on any given day (lots).

Surely a flat rate of, say, 50p to park would be fairer? After all, unless my memory is deceiving me, it’s not all that long since that was roughly the cost of parking at many hospitals. That would cut out the stress of the charging, but also still cover the costs of running it – car parks should not be there to make money out of people who have no option but to go there.

What will new government bring for social care?

After all the courting of the past few days, the Conservatives and Liberal Democrats have finally decided on a political marriage. But what will this mean for social care?

Now the dust is settling, here is a little of what is known, plus some conjecture and guesswork.

Firstly, it means that Labour’s plans for a National Care Service are dead. The Tories always opposed it, and the Lib Dems also had problems with it, so it’s a definite no-go. This means that social care will go back to square one, waiting again for the reform it so badly needs.

On the upside, it looks likely that plans for a set of national eligibility criteria for social care services, proposed by Labour, will be brought in as the coalition parties also both support it. This should end the ‘postcode lottery’ of unfairness in social care and can only be a good thing.

Now, things become less clear; we know there will be big public sector spending cuts in the Budget, which will probably be in June. Both parties have denied that it will hit frontline services, but councils will have to make some big savings and services could be hit – such as scrapping some services that are not perceived to deliver value for money – and eligibility criteria could be ramped up again.

I suspect that a new White Paper on the future of social care may be commissioned in the near future. The Liberals are in favour of (yet another) commission on reforming care funding, but the Tories aren’t, so action may come relatively quickly – we all know the problems in the sector, they just need to be addressed.

Whether the Conservatives’ stated plan for a voluntary £8,000 insurance scheme to pay for elderly residential care comes to pass remains to be seen.

Both parties were relatively light on detail about reform in their respective manifestos, but there were differing ideas, such as the Lib Dem idea of giving all carers one week of respite, so it is hard so say in which direction the government will go.

Also, remember there were the secret cross-party talks about the future of social care earlier in the year – which Andrew Lansley, the new health secretary, scuppered – could anything come out from that?

Hopefully in the coming weeks we will hear something more concrete about what will happen to social care. The sector needs reform quickly, so the coalition needs to work together to find the best solution – whatever that is…

Uncertainty in social care after election result

So, 3 days on since the election result was announced and we still don’t know who will form the next government. As a result, from a social care perspective, we still don’t know where the future direction of policy will go either.

So, nothing has changed there, then. It’s been like this for months as green papers and white papers have come and gone, with little changing on the ground.

The only certainty, in terms of policy, came with Labour and its plans for a National Care Service, as laid out in April’s White Paper. But many in the sector doubted it would ever make it to fruition, given their standings in the polls.

Indeed, at the time of writing, a Conservative-Liberal coalition is looking possible, which would mean the end of Labour’s ideas; the Conservatives did not sign up to it, and the Liberals rejected several elements of it.  

Their ideas for reforming social care have not been laid out in as much detail as Labour’s, so many are left wondering what will happen.

My hope is that if there is a coalition – be it Conservative-Liberal, Liberal-Labour or some other variation – it will give a chance for a consensus to emerge over future policy direction. If that happens then if there is another election in the near future, there is a chance that the policy might be consistent. But that’s a hope.

More realistically, my guess is that another commission will be formed to review social care and make recommendations from that – although what could be said differently to the results of last year’s Big Care Debate is unclear. The Liberals said they would do this in their manifesto, although the Conservatives are said to be against that as well.

So, as I write, it seems like the only things that are certain are: the social care industry will continue to do its best with the limited resources it has and a funding system that nobody likes – like it has done for years; and that nothing will change that situation in the immediate future.

What happened to social care in election debate?

After 3 weeks out of the country – I was one of those caught up in the volcanic ash crisis – I’m getting back up to speed with what’s been happening in social care and where the main parties stand on it before the election.

There was precious little mention of social care or older people in last night’s TV debate – well, the bit I watched before jet-lag caught up with me – but I haven’t seen much else about it in the news. I’m told there was not much talk about it while I was away either.

Considering that social care was supposed to be one of the main debating points in this election, everyone seems to have gone quiet on it since Labour announced its White Paper on the future of social care and plans for a National Care Service.

But while we know about Labour’s plans, you have to look hard to find the Conservative and Liberal Democrat policies on older people – social care as a category isn’t there, disappointingly.

More disappointing is the lack of concrete policies. For instance, the Conservatives pledge to introduce a ‘home protection scheme’ to ensure people don’t have to sell their homes to pay for care, but don’t say how it would work, or how it would be funded.

They do however advocate the extension of direct payments and individual budgets to give people more choice and control over their care. While this is a continuation of an existing policy, it does hint that if the Tories win, they may not make fundamental changes to the personalisation agenda.

Meanwhile, the Lib Dems say they would undertake a review of social care. It’s difficult not to be sarcastic about that pledge – hasn’t the sector had enough of those in recent years?

More promisingly, they talk about re-establishing the link between the basic state pension and earnings.

There has also been little mention of the future of social work, although there are fears among some social workers that cuts to frontline services may be made; there have been assurances that teachers, doctors and nurses will not be axed, but no such declarations made for social work.

So, the future of social care, one of the bigger issues facing the UK, has once again been swept under the carpet. In a way it is not surprising, because there are no easy answers or snappy soundbites and some of the solutions may not be vote-winners. But it should have been a key part of the debate because this will affect everyone in the UK at some point.

General election: let battle commence on social care

Finally, one of the worst-kept secrets in the country is officially announced; the general election will be on May 6.

It has been said by many that adult social care will be one of the crucial points on which the election is fought. If so, this can only be a good thing, but only if the public know exactly what they will be voting for and currently, they don’t.

We know Labour’s plans for the future of adult social care; they were in last week’s White Paper. They have outlined plans for a National Care Service, along the lines of the NHS. How it would be paid for is still unclear – but don’t let practical details get in the way of a good policy.

But as for the other main 2 parties – and, in the interests of balance, all the minority parties as well – we know that they don’t think much of Labour’s ideas, but other than that, we know very little about their plans.

The Conservatives have been plugging away with its £8,000 voluntary insurance scheme for paying for elderly care. However, those in the know in the sector don’t believe that this will come up with enough to cover the costs. The Tories disagree. Other than that, we know they favour telecare and a national system of assessment and eligibility for care, and that’s about it.

Meanwhile, the Liberal Democrats want to find cross-party consensus on the way forward in social care, as was being discussed in secret by health ministers earlier this year before Andrew Landsley blew the lid on the meetings. They also want yet another commission to investigate possible ways forward, and have said they would spend £420 million to give carer’s an extra week’s respite – as long as they care for more than 50 hours per week.

I haven’t heard much from any of the minority parties on social care – if anybody knows more, please leave a comment below.

But all this shows that we do not have a full debate on social care – that can only be achieved when others announce their policies and can be analysed objectively against the others.

That is the challenge now for the Conservatives and Liberals – show us your plans and let us decide which way forward is the best for social care.

White Paper reflections

It is now a day since the White Paper came out, and the response from the media, social care organisations and rival political parties has been quick and, in the main, fairly critical.

The White Paper was given short shrift by most of the mainstream media. While its aims of creating a National Care Service were seen as laudable, many focused on the delays to making changes, how it would be paid for – and by whom – and the lingering “Death Tax”.

Those that gave the White Paper the most enthusiastic welcome tended to be the organisations that are government-backed. To paraphrase Mandy Rice-Davies, well, they would, wouldn’t they?

Charities and third sector organisations seem to have generally given the White Paper a good welcome, but again question where the money will come from for it.

Meanwhile, think tank the King’s Fund – an advocate of the partnership approach before the paper came out – welcomed the ‘ambitious’ plan, but questioned where the money to do it would come from, calling for detailed proposals urgently.

I reckon the King’s Fund was spot-on.

Now I’ve had time to reflect, it seems clearer that the White Paper has been geared to the election – it is big on ideas, but short on detail. Style over substance, if you will.

I really like the idea of the National Care Service – its aims are laudable and it is something to be aspired to. In an ideal world it would be here already.

But – and it’s a big but – I cannot work out how it would be paid for, without having to raise taxes, impose compulsory levies on the public or take money from other budgets. Nether, I suspect, judging by the content of the paper, do the government.

Also, given that the original aim of its preceding green paper was to address the funding of adult social care – with the hope that it would get rid of the current means-testing system – it has singularly failed to do it.

Indeed, the whole question of funding was fudged, with a call for another commission to be set up to investigate the best ways. Evidently the government didn’t want to be associated with any new taxes before the election, so has kicked it into the next parliament.

As a result, the system will creak on, as it has done for years, hated by many. A chance for genuine – and needed – reform of the funding system has been lost, sacrificed at the altar of electioneering.

For me, that clouds all the good ideas contained in the White Paper.

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.

What will be in the white paper?

After what seems like an eternity, the adult social care funding White Paper will finally be published tomorrow. So what will be in it? Here is my bit of crystal ball gazing…

Firstly, it will lay out Labour’s plans for a National Care Service that provides clear national entitlements for everyone, rather than the current postcode lottery. This was first mentioned in last year’s green paper and the idea at least was widely welcomed. The White Paper should flesh out exactly what that might entail and the funding for it.

The free personal care at home policy will also be in there. This has been championed by Gordon Brown and there isn’t a chance it will be dropped now, although the timing of its introduction may be put back until after the election.

In terms of funding, I expect that a ‘partnership’ model – where the state pays a portion of care costs and the service user pays the remainder – will be proposed. In the debate over funding, this seems to have garnered the most support and is something of a ‘middle’ way – and less politically divisive than, say, putting a levy on the estate of every person.

That option is a non-starter because the Conservatives branded it the “Death Tax”. Leaving aside whether it is a good idea or not, the negative publicity already around it would make implementing it political suicide.

Funding will probably be the most controversial part of this; while it is widely accepted that the current adult social care system needs to change, funding it is the tricky bit. For instance, the free personal care at home policy has been consistently lambasted because nobody believes the government’s estimate that it will cost £670 million – some say it could be more than £1 billion.

In addition, setting up a National Care Service, and contributing to everyone’s care costs, will cost billions. In a time where government departments – including the Department of Health – are scrabbling around trying to save billions, you wonder where the money would come from.

And then there is the election. The white paper will probably become a large spoke of the election campaign, which will be a bad thing. As I’ve mentioned previously, cross-party consensus is needed if the best solution for the public is to be reached. With an election, and all the ‘our policies good, your policies bad’ mudslinging that comes with it, this is out of the question.

Of course, the election also means that the White Paper may come to nought if Labour is ousted from power. The Tories have suggested they may go for another consultation before they do anything. If there is a hung parliament, who knows what will happen to it?

So, with that in mind, tomorrow’s White Paper may make promises, but it is by no means certain that essential reform will come to the sector just yet.

Small print reveals continuing costs of residential care

So, Conservative shadow health secretary Andrew Lansley has pointed out that the government’s plans for funding residential care doesn’t include the ‘hotel’ costs of it.

For those of us that have followed this closely, this is not a revelation. This debate is about paying for care – board and lodging doesn’t come into it. When the green paper on adult social care funding was released last June, some people in social care pointed out that the proposals wouldn’t mark the end of people having to sell their house to pay for care. Interestingly, at the time, this was largely ignored.

Even in Scotland people in residential care have to pay ‘hotel’ costs – something which isn’t pointed out as often as it should be when people in England moan about ‘free’ care north of the border – and older people do still in some cases have to sell their house to pay for it.

But with the government set to shelve plans for the “Death Tax” this week, according to the Guardian, this seems to be the latest attempt to derail plans for reform.

Again, Lansley seems to be at the heart of this. While this smacks of another attempt at cheap political points-scoring ahead of the looming election, it does raise (albeit in a not-too-helpful way) a legitimate point.

One of the aims of any reform of adult social care funding, according to government messages when the green paper came out, is to eliminate people having to sell their homes. The options listed in the paper didn’t seem to do that.

It is still a problem – many voters see the practice as unfair and penalising those who have worked to own their own homes and leave an inheritance – and if it isn’t addressed many will see any white paper as a failure.

However, the green paper was only a consultation, and the white paper – apparently coming this week – may have a solution. We shall wait and see – and expect Labour’s opponents to seize upon it if it doesn’t.

Little honesty in social care debate

So, the political mud-slinging has begun in earnest. As the Conservatives, Labour and Liberal Democrats all strive to tell you how bad the others are (or would be), reasoned debate goes out of the window.

The Tories have landed the first blow, accusing Labour of planning a £20,000 “Death Tax” to be levied on all estates after death.

To ram the point home, a new poster was revealed depicting a gravestone engraved with ‘RIP Off’ (see what they did there?) and the slogan: ‘Now Gordon wants £20,000 when you die.’

Health secretary Andy Burnham has rejected this accusation (or hinted that the party is planning it, depending on which paper you read), saying that “firm proposals” will be set out before the election – one assumes he means the White Paper on adult social care funding, which is still being promised, although time is fast running out if it is to appear before the election.

Currently, Labour is sticking to its line that it is considering the outcomes of the Big Care Debate, which took place last autumn after the release of the green paper on the future of adult social care funding.

The Conservatives have said even less, apart from their £8,000 voluntary insurance scheme.

Responding to this, another other related stories, Stephen Burke, chief executive of Counsel and Care, a charity that works with older people, their families and carers, has appealed for an “honest and serious” debate that recognises that better care will cost more, and that radical reform and proper funding is required.

While many people in the social care sector will agree wholeheartedly with that call, the chances of such a debate happening are virtually nil.

Also, any hopes of a cross-party consensus on the future of social care – something various social care commentators have called for – now appear dead and buried.

With the parties now getting into the swing of electioneering, everything they say will be geared to getting your vote. So a reasoned debate on the future of care funding will not happen, because it will require some tough – i.e. not popular – decisions to be made, if a crisis of care is to be averted. No politician is going to say anything that might lose them votes.