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Understanding the need for change
Since the Green Paper on the reform of adult Care and Support in England was announced in 2007, we have spent great deal of time talking to the public and stakeholders, outlining why the current system needs to change and what a new system will need to achieve.
The message is a simple one - the current system is not working well enough, so we need to create a new one. The task is challenging because –people simply do not understand the current system.
The task is made harder by the fact that care services are so varied and often quite difficult to define. The types and amount of activity carers commit to vary massively. The person who helps their neighbour with their weekly shop is providing help and support, as is the manager of a care home or a charity worker. This makes it tricky to find a starting point for discussion.
People find it difficult to distinguish between health care and care and support. They are often unaware that care and support services are not paid for by the state in the way that health care is provided through the National Health Service.
Throughout last year’s six month engagement with public and stakeholders,
many people admitted that they had thought care services were paid for through taxes, and that they had not given much or any thought to the prospect of needing services in the future.
Yet most of us will need some sort of care at some point in our lives, whether through disability, illness or old age. This is something that we need to help people to understand.
Our research has unearthed numerous statistics to illustrate the case for change.
In 20 years time, we expect over 1.7 million people to have a need for care and support. The number of people over 85 will double, and those over 100 quadruple. The cost of disability is expected to increase by almost 50%.
By 2001 one in ten of the population was already a carer, 5.2 million people. The ratio of those aged over 65 to those aged 20-64 is projected to increase from 27% to 48% by 2050. The list goes on.
All of these statistics make interesting reading but, compelling as they are, not one of them tells the complete story.
For me, the key statistics are around the rising "dependency ratio". The ratio measures the number of retired people to workers, which has risen from 1:19 to 1:4 over the past century.
That ratio is predicted to fall to around 2:1 by 2050, two people working to every one retired.
With people living longer, the demand for services will continue to grow. However, the major source of funding, the taxes we all pay, is shrinking proportionally as fast as the need for services grows.
This statistic says it all for me, it is a stark illustration of how demographic change makes the need for a new care and support system.
Of course, demographics are not the only reason for change, we also need to make the system fairer, clearer and able to meet people’s rising expectations. For me the dependency ratio come closest to covering all bases.
The ratio not only points at the funding challenge, but also speaks of the need for society to change. Care and support, once known as the “Cinderella services”, must be recognised and moved to the centre of every community.
This statistic will define what we will be able to do in the future, it is one of the single most important figures that we’ve got about why the current system needs to change.
How we achieve this change is the challenge that will be presented to us all in the Green Paper.
Which parts of the system, for you, are the parts that most need an overhaul? What can we all do to make thinking about care and support a part of people’s everyday lives in the future?
There is no doubt that our changing demographic profile points to one of the most challenging situations facing us today - it is as challenging as that of climate change but completely unrecognised by most people. Many people understant that the number of older people is increasing, but not that the birth rate is falling, which compounds the complexity of the problem of how to pay for the care needs of people in Britain. Not only will there be less younger people paying taxes to fund care, but there will actually be far fewer younger people to physically provide that care. We will need to find a work force from somewhere; even though advances in technology will help matters, it cannot provide all the answers. Further, with up to 50% of school leavers being encouraged to go to university there will also be less people willing to consider care as a career. With the best will in the world the actual numbers of those needing care mean that the numbers of those needed to provide care will continue to rise beyond that which will allow wages paid to those carers to raise the profile of the job role sufficiently to support care as a career choice. We must reconsider how care is paid for. An insurance based scheme is just about the only way forward, provided it is properly costed - it is not right to base this on current costs when the cost of care is already being subsidised in various ways so that no authority is paying true costs without either third party contributions or the financial exploitation of a cross subsidy from private payers - heavily relied on by LAs and Central Gov't. Never mind people being upset at selling the house to pay for care - this is understood if not accepted. But selling the house to pay for the care of yourself AND the person in the next bed is a dishonesty so profound that it knocks MP expenses into the long grass - or would, if enough people realised this is the only reason that formal care has not already imploded.
Finance as it always is will be problem. But if the budget is spent on many indians (front line staff and practicioners) and less chiefs then the better all the services providers could be. As it is we are a nation drowning under a plethora of managers, number crunchers, and big chiefs swallowing up copious amounts of the budget.
The front line troops do the best they can - in between all the numerous re organising that goes on with various departments and institutions. Talk about re arranging the deck chairs-- here we go again . . .
Sense at last!! What happens to the Government's proposed funding if it loses the election next year?
To be honest, what's needed is more communal homes for the mentally-ill that are warden controlled 24hrs. This would take some sting out of respite care for the carers or care-givers. Such action would be most welcome as it would allow the "cared-for" to be independent and give them the opportunity to interact and socialise with each other.
It is hoped that this green paper will address the closer integration of health and social care.
As a person living with dementia, a member of the external reference group for the Dementia Strategy it is absolutely clear that this is an absolute imperative. Much talk has been given to this subject so far but little action, if any, has emerged.
The methods of funding are such as to make this integration impossible at the moment. The DH fund Health through the NHS and Social Care is funded by devious means, from DH via local government, by SLA's from Primary Care Commissioners, from Local Taxation and from the individual beneficiaries themselves.
We claim to be living in a "Caring Society" let's practice what we preach.
Increasing VAT by 5% would raise £25 billion, more than enough to cover the cost.
Following my last entry in this blog the Green Paper has been released.
I will summeries my feelings in a few words "the paper does little in taking us forward; if fact whilst I haven't had time to study it word by word it appears on superficial reading to be an unmitigated failure to make any real progress at all".
My previous entry in this blog concluded with the following:
"We claim to be living in a "Caring Society" let's practice what we preach"
Our government is not meeting that objective in this paper.
The idea that people on retirement will pay £20,000 for care they may or may not need is nothing short of a tax on growing old. This would be the time when people would be less able to pay !
haven't we heard all of this before? particularly this emphasis on joined-up services. I seem to remember that it was a recurring theme in 1997.
Despite the billions thrown around on layers of inefficient, self-serving and incomprehensible bureaucracy, little has been achieved - aside from a whole new language,
Anyway, having listened to news items and read everything that has been published thus far, I can see that hard-working middle England will be squeezed yet again. Who will actually make sure that they HAVE the requisite £20,000? responsible middle England. Who will suffer from subsequent means-testing? responsible middle England. whose families will have to prvide additional support? responsible middle England.
Yes - the basic reasoning is correct and something radical must be done. But this has been neither thought-through nor costed.
I hope that enough people will attend debates and roadshows to show how fed up we are with words and jargon and really set this vital legislation on the right path.
This latest green paper seems to focus mainly upon the elderly and sidelines the special needs section of our society. My concern is twofold:- for those with special needs who have no incomes and are incapable of leading the 'idealism' of independent lives, what bricks and mortar provisions will be made in concert with care provision? Secondly, for those of us carers who are at present providing free, non-stop, twenty four hour care for the above category, where will provision for us be in the overall scheme of things. At present there is much talk of caring for carers, but we see virtually little, if any proactive results.
If the definition of elderly is that of people reaching pensionable age, then how long must we carers, imminently to be in that age group, continue to shore up what the government is failing to do right now,
I might add that as someone who has paid national insurance all his working life, I find it an insult to hear that a) it was used for general taxation matters and b) that it counted for very little towards any care I might require. I certainly won't have £20,000 to spare when I am older still.
An earlier blog above mentioned too many managers and not enough ground workers. The same could be said about the chronic waste in all areas of the NHS and local government. Why do very highly paid managers need to pay large sums in consultancy fees, surely they should be up to the job without help from outsiders, if not then the interview and employment procedures need a serious and effective rethink.
Patients (and carers) on the ground have little input into the decision making about services on the ground, in their local practices for example. have you every been asked by your local practice what you feel is right or worng with what is offered?
Having interviewed many, there are often clearcut, clearly voiced needs but no vehicle to communicate these to policy makers. (A closed
In my local town (unnamed for the moment) Health and Social Care have implemented major changes to the detriment of patients and carers when told to consult by the DH before taking action. Changes are now underway and cannot be reversed so they the Trusts and Social Care now decide to consult retrospectively.
We all know this is meaningless and purely a political ploy so they think they can say "we talked to 'them' anyway" - well they must think again.
For a fact I know that the Mental Health Trust are seeking Foundation status and for a fact I for one will be objecting to them getting it.
It sounds like a bargain for me - my mother is paying that much each year for her care (acute mental health for 20 years plus and dementia), with the prospect of selling her home. At least it would be fair. My late father and mother both worked full time until retirement (mining and pottery industries, paid all of taxes, never claimed benefits but managed to save really hard to buy their home. I would be in favour of a flat rate payment of £20k for everyone going into care - at least that might be the maximum payable, whereas there is no maximum in my mothers case until her home has been wiped out.
What a cop out! this government is still trying to change the law to make it right for the fat cats who own care homes to charge the most vunerable people in our society who have Dementia ect: exorbiant amount of monies for ship-shoddy care in return.
This needs to change! any one who thinks differently, should remember NHS care should free! Dementia is a disease not mental Health and these people should not be got at because they have fallen ill.
Remember these people are too old to change their circumstances, wouldn't you say the government should be talking to younger people still at work etc.
It amounts to Fraud!
The Green Paper as a consultation document needs to be exactly that!
This is as important a change as when care management came in ,in the 90's
Yes there is too much bureaucracy in social care and there needs to be a root and branch reform in how the assessment process is made less cumbersome, personalization may help ,in the short term
Also however I for one middle Englander would not be prepared to sell my home or pay for the care of the feckless in the next room through personal insurance, but how else are we to find resources
i do not want strangers assessing me i do not want strangers in my home i do not want strangers controling my life when are the sick and disabled going to be listened to we are human beings with minds of our own and feelings who can honestly say they want some stranger in an office deciding on how much help they get how much dignity and self respect they can keep and what time of day they can bathe and eat i know i dont there are numerous ways the goverment can fund extra services for those who actually want them but robbing the sick and disabled is the easiest for the goverment and the most lucrative for stakeholders
Now that you've given way on the threat to remove DLA from it's recipients leave AA in the hands of the recipients. It never makes sense to interpose public authority employees, no matter how well intended, between the need and the delivery of services to the public, particularly the disabled. Disabled people know best what they require and do not need the help of interferring bureaucrats.