Tag Archives: older people

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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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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Social care possible victim of government cuts

Chancellor George Osborne announced the first wave of cuts to public spending yesterday, but it is still unclear what this will mean for social care – yet.

Most of the announcement dealt in headline terms – talking about millions of pounds worth of cuts to government departments, but not saying exactly where they will be made.

For instance, councils have been told that they will have to cut £500 million worth of services in the next 10 months. In the absence of concrete details, there is lots of speculation about where these cuts could come – such as in residential and home care for the elderly, according to a report in today’s Times.

This would seem likely – a recent poll for the BBC’s Panorama said that more than half of councils were considering making cuts to adult social care provision.

In practice, it may mean that eligibility criteria gets ramped up again, so that only those with ‘substantial’ or ‘critical’ needs will get services – which already happens in many council areas. Also, services such as day centres may be targeted for cuts, as will any service that struggles to demonstrate it provides value for money.

With budgets needing to be slashed other areas, such as the roll-out of the personalisation agenda, may be hit. There is the £237 million Social Care Reform grant scheduled for this year, and there is speculation that might be cut, according to a report in Community Care.

Meanwhile, children’s services were largely protected from the cuts, except for the abandonment of the Child Trust Fund, which wasn’t that popular anyway.

But this is just educated speculation. I assume the details of the cuts will gradually come out in the next few days and weeks, which should shed more light on what will happen and then councils – and service users – can start to plan for the future.

But what is certain is that these are only the first cuts – and not necessarily the deepest. June’s emergency Budget is expected to announce further spending cuts, while with the Comprehensive Spending Review – which sets out council budgets for the next 3 years – there are fears that council funding could fall off a cliff.

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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.

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True cost of dementia revealed

If there is one way to make government, and those that hold the purse strings, sit up and take notice of something, it is to put it in financial terms. Especially if the numbers involved are big ones.

So, a figure of £23 billion – the cost of dementia annually in the UK – is bound to have piqued the interest.

This is one of the findings of the Dementia 2010  report from the Alzheimer’s Research Trust, which also reveals that there are 820,000 people in the UK with dementia – a rise of 120,000 on the previously accepted figure.

Usually when these ‘so-and-so costs the UK x each year’ statistics crop up, I take them with a pinch of salt; rarely do you get told how they arrived at their figure, and sometimes you get the feeling they have made it up for dramatic effect.

But in this case, the University of Oxford, which carried out the research, show their working out; adding up the costs of healthcare, social care, unpaid carers and productivity losses, and arriving at a grand total of £27,647 for each person with dementia.

So, with such costs, you would think that research into finding a cure for/preventing dementia would be well funded. Wrong. Dementia research receives £50 million per year, a fraction of the £600 million spent on cancer research, for example, and a drop in the ocean compared to its cost to the economy.

Rebecca Wood, chief executive of the Alzheimer’s Research Trust, has called dementia “the greatest medical challenge of the 21st century.” While that may be slightly hyperbolic, with the number of people with the condition estimated to hit 1 million in the next 15 years, it is certainly an increasing challenge that needs to be tackled.

In financial terms, increasing the research budget is a no-brainer. Even if researchers were to find a drug that just delays or slows the onset – more effectively than those already available – it would save billions.

It is a pretty convincing argument, and one the government should listen to and deliver on. In today’s financial climate, can they afford not to?

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Paying for care still biggest concern for older people

How to pay for residential care is still the biggest worry for older people, their families and carers, according to a new report.

Older people’s charity Counsel & Care’s Care Concerns 2009 reported that 25% of calls to its advice line are about this.

Nothing new in this – it’s been a worry for years – but it shows that the issue will not go away and that reform is needed.

Indeed, the main concerns of older people are pretty much as they have been for years. Here are the top 5, according to Counsel & Care:

  • Concerns about whether older relatives or friends starting to lose mental capacity are receiving the most appropriate and high quality care available in the setting of their choice
  • Lack of available and meaningful information and advice for older people, their families and carers, particularly those who pay their care costs themselves
  • Difficulty accessing the care and support system
  • Difficulty navigating the complaints process if you experience poor quality care
  • The ever-increasing costs of care and support.

Nevertheless, there are hopes that the government’s white paper on adult social care funding – promised to come out before the election – will address this.

While last summer’s green paper on the future of adult social care funding had some useful suggestions on providing better information for self funders, as well as making the care system easier to access and navigate, it still failed to address one of the most vexed points; people selling their houses to pay for care.

In addition, the government’s free personal care at home bill would go some way to addressing the concerns of older people paying for care, but it only helps those above the threshold for social care funding with high needs and who still live in their own home.

The green paper outlined several options to pay for care costs, from insurance to a mix of state and self funding, but none covered paying for the accommodation costs of residential care, which can still mount up if someone is in care for several years. In that situation, selling their house is still an option.

If nothing else, Counsel and Care’s report is a useful reminder of the main concerns of older people in the care industry and if the government does address these issues, it could leave a long-lasting positive legacy.

Keywords, however, are ‘if’ and ‘could’; if the white paper comes out before the election and if it makes it through parliament. Could, in that nobody knows yet what conclusions the government has come to.

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A nation of silver gamers

Think games consoles like the Nintendo Wii are just for kids? Think again. According to a survey by online discount voucher provider MyVoucherCodes.co.uk, 18% of over 60s now regularly play games, with one in three of these identifying the Nintendo DS as their favourite console.

While these figures may surprise some, it highlights a shift in gaming culture over the past few years – it is no longer the preserve of children. For instance, in the media the ‘care home residents playing on Wii’ story has been done to death in the past couple of years.

Games makers have also twigged this; I noticed over Christmas a crossword game on the DS being heavily advertised on television. Not wishing to disparage the intellect of today’s youth, but I’m willing to bet this game wasn’t aimed at them.

But this is not just pensioners finding a new way of filling their days, there is a serious side to gaming; for older people it can help to stimulate them mentally and physically, as well as helping them to connect with the younger generation.

Older people are encouraged to keep mentally stimulated – the ‘use it or lose it’ principle – and physical activity is good at any age.

The popularity of games like Brain Training, as well as things like Sudoku, demonstrate that on the mental side, while things like Wii Sports have got older people the nation over playing sports they never thought they would again.

Most of all, its fun and, especially with consoles like the Wii, it’s social as well. For older people in care homes or attending day centres, this gets everyone involved and active, rather than sat in a chair watching TV.

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Scandal of selling homes to pay for care

Over the past few days, one of social care’s great recurring stories reappeared, as it seems to do every few months; the ‘scandal’ of old people having to sell their homes to pay for residential care and/or not being funded by the state for their care.

This time, it was the Daily Mail, which ran with a typically hyperbolic headline of ‘3,000 victims of home snatchers: Record numbers of elderly are forced to sell their homes to pay for care’ .

As usual with these stories, the gist was how scandalous it is that people who have worked hard all their lives to save money and/or buy a house now have to lose/sell it to pay for residential care in their old age, while people who never saved get it for free.

Leaving aside the rights and wrongs of this – there are good arguments on both sides – it again shows that politicians cannot afford to ignore this issue.

Social care has been getting a higher profile in recent months – the green paper on the future of adult social care funding was published in June, for instance – but little action has so far be forthcoming.

While Labour has announced its free personal care at home bill, this doesn’t address the problem of people having to pay for residential care and could even create other issues.

For example, it is likely to encourage older people to stay in their own homes for longer, knowing that if they move into residential care they will have to pay for it and possibly give up their home. As a result, some people may not go into care when they need to, and could suffer as a result, whether in the form of injuring themselves in an accident or fall, or in terms of isolation if they are housebound.

And for those who say ‘well, in Scotland they get it free’; they don’t. There, while the care element might be free, the ‘hotel’ costs of residential care – food, board and lodgings etc – isn’t, so many older people still have to stump up money to pay for their care, including selling their home.

This issue is hugely emotive and could become an issue in the upcoming election. Any party that offers a solution to this ‘problem’ would be onto a sure-fire vote-winner.

The options mooted thus far by Labour and the Conservatives involve insurance schemes, which involve paying a lump sum up front. Labour’s idea is a £20,000 scheme, which would cover the costs of personal care at home and residential care, and while the Tories’ response only costs £8,000, it just covers residential care.

The Liberals meanwhile have sat resolutely on the fence, calling for an all-party commission to come up with a solution, rather than posit any ideas of their own.

None of these options seem to have garnered much public approval so the way forward is unclear.

All it does mean is that the current system creaks on and the reform of it – desperately needed, as organisations within the sector have said time and again – is delayed again.

Perhaps if it does become an election issue, then something might get done. If not, then the Daily Mail, as well as the other national newspapers, will have a guaranteed headline article to publish every few months.

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Pre-budget report pleases few in social care

If ever there was a pre-budget report that was going to be unpopular, it was this one. Chancellor Alastair Darling knew it and has pretty much admitted it too. Unfortunately for him, it seems he was right; finding anyone with much positive to say about it is tricky at best.

From a social care point of view, the PBR seems to have been attacked from all sides. While it is generally accepted that cuts to the public sector are necessary if the country is to dig itself out of the financial hole it is in, the size of these cuts is causing consernation.

For example, the drive to keep older people in their own homes and out of residential care by using preventative measures continues. While the government thinks £250 million can be saved this way, ADASS’ John Jackson has slammed these proposals as “naïve”. He says that most councils are already planning cuts of 4% in this area and to make more, without new initiatives designed to help local government or promote closer working and better resource utilisation between the NHS and local government, is unrealistic.

Elsewhere, the announcement of a cap of 1% on pay increases for public sector workers from 2011-13 has been met with dismay. With National Insurance set to go up by 1% in 2011 too, add in inflation – expected to rise to 3% next year – and that’s a pay cut for millions. However, many councils would have struggled to find money for pay increases in any case.

But as BASW’s chief executive Hilton Dawson has pointed out, this seems to fly in the face of the Social Work Task Force report’s recent recommendations on career structure and pay grades for social workers. He called it a “slap in the face for the profession”.

Public sector unions have also been critical of the plans to cap state contributions to local government employee pensions by 2012.

So, while the public sector is unhappy, is the private sector more welcoming? Err, no. The English Community Care Association, the representative body for the independent care sector, has also slammed the PBR. Chief executive Martin Green said that the; “report signals that the government is intent on protecting the statutory services at the expense of independent provision and putting dogma before need”.

But this criticism has come without anyone really knowing what the alternative is; the Conservatives have focused mainly on criticising Labour’s plans, rather than promoting their own. Ditto the Liberals.

Certain details have previously emerged – such as the Tories’ plans to make deep cuts quickly and freeze social work pay for a year – but nothing in the same detail as Labour.

Only when the other parties outline their plans in the same detail will everyone get a true sense of what may be to come for the social care sector and the country more widely on the other side of the general election.

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Big Care Debate – any closer to a solution?

The Big Care Debate closed last Friday (the 13th, ominously, for those of a superstitious bent) ending the consultation on the government’s green paper, Shaping the future of care together , which set out the government’s options for the future funding of adult social care.

Now, the Department of Health will go away and contemplate the results, before, in theory, coming back with a White Paper, possibly in early 2010.

But with an election looming, I wonder if any of it will actually get through and make it into law.  

A spokesperson from the DH told me earlier in the year that if there is no consensus from the Big Care Debate on the best way forward, then it may go to a further period of consultation.

Looking at the reactions to the green paper from various groups, there seems to be little consensus; there have been criticisms, notably from mental health and learning disability groups, that the green paper focused on too much on older people. Indeed, much of the media focus has been on old age care funding and people not having to sell their homes to pay for residential care costs.

But then, older people’s groups, such as the National Pensioners’ Convention, have also voiced dismay over the government’s dismissal of the option to pay for care from direct taxation.

This option also found favour in a Joseph Rowntree Foundation survey. But then other organisations have supported the partnership and comprehensive models of funding the government suggested, which involve insurance and some state provision or the creation of a National Care Service.

If this is reflected among the wider responses, then we could be in for further consultation, which neatly kicks the debate into election time, when nothing concrete will happen because every politician will be scrapping for votes.

So, it seems like the social care industry will be in limbo for some time to come. And all the while the current regime will continue to creak along, and the problems within it will continue to mount, and – crucially – service users will continue to suffer at the hands of a much-disliked and over-complicated funding system.

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