Navigation
Shaping the future of care together
Executive summary
As promised in Building Britain’s Future, this Green Paper sets out the Government’s proposals for ways to reform the care and support system for adults in England.
We need to respond to the challenges that it will face in the future, to build a new National Care Service for everybody.
During 2008, the Government ran a six-month engagement process with the public, people who use services, and people who work in care and support. We heard from hundreds of people about their views on the challenges that we face for the future and the problems within the current system. This Green Paper is our response to what people told us and the issues we face.
Across the country, rising aspirations demand a better system of care and support both for those who look forward to a long and active old age – but who may need some support to stay well during their later years – and for those who need support earlier in their lives due to disability. This Green Paper offers several options for debate around how we as a country can respond to this challenge by building a new National Care Service for everyone.
This executive summary is the opening chapter of Shaping the Future of Care Together. The full text of the Green Paper will appear in this section of the website over the next few days.
Have contacted my MP Nigel Griffiths. He wrote to me to write again in 2 weeks. He awaited a reply from "the authorities". I did again a few days ago. Still no reply, and again -remind me, he says. This is a most important matter, he says. Will keep on at him.
Why are the elderly being punished. It seems a forgone conclusion that AA will be removed from us. My council will not provide well for me, my measure of independence makes all the difference and I provide work for many. In my experience councils are wasteful. We are not.
I care for both of my disabled parents, they have varying needs including dementia, for 24/7 care I am given £53.10/week which equates to 30p/hour or 15p/hour per person. We don't have any help, my health is being severely affected, a Carers Assessment has been submitted to Social Services but will not be acted on in any way as my parents have refused to have a financial assesment, this was because they felt the enquiries were over intrusive. By the time I reach 65 [if I am fortunate to reach that age], I will be most likely penniless with poor health, the means test will be there waiting for me, what's the betting the workhouse will be reintroduced or maybe we will all be expected to sleep on the street. Where is the recognition of unpaid carers? We save the government millions yet we are ignored, there is no fairness in this, my perception of the situation is that it is evil, we don;t even have the prospect of a comfortable old age.
I can't believe that people lose carers allowance when they become eligable l for state pension. Didn't they earn their pension? As people get older they generally need more care, not less.
Stop privatising everything!
Stop using your gravy-train of air-headed uneducatable morons as 'Consultants'!
Start offering the type of service you were elected to create. Your political lives & careers depend on you doing the right thing! -For once!
It is generally the case that caring and co-operation vs markets and profits are two different worlds.The Green Paper says the State will not have enough money to pay for care, so to me, this indicates that there is no underlying committment to a social value.
Instead,unable to put the burden for paying on the individual,and unwilling to tax the nation as a whole, the Green Paper heads for some middle road where individual and state will have a 'partnership.'
Buzz words like 'personalisation,' 'more choice,' 'joined up services' are used in this middle road, but these seem just tactics since the Government proposes to set these ideas within a new political structure, a system of controls which will be outside the remit of the individual.
As I read it, moves to privatisation begin to show in the methods by means of which money will be controlled: the Government proposes to use the local authorities to 'manage' the money by assessments and the engagement of private firms and a controlling organisation which 'knows best.'
'Better quality' is something which the Green Paper wants to be decided by an independent organisation.
As I understand it, it is clear from the Green Paper that personal choice and tailor made care packages will not involve a truly democratic input from citizens,but is a measure of putting the cost of care onto the individual and removing the State as the single safeguard for the citizen.
To argue who and how people should pay for care ignores the fact that the philosophy underlying stratification in the UK is Capitalist, and so the amount of money people have is rooted in that very stratification system. That some sections of the society won't have to worry about paying for care, while others will have to try and find ways to cope with their care needs makes the notion of 'partnership' academic. There cannot be a partnership unless the distribution system changes in the first place, and that is something the British class system will never countenance.
To conclude, the Green Paper wants to bring changes, but it won't do this by changing distribution of wealth. In my view, to take money from the present benefit system and hand it over to local authorities for a more privatised and market governed system is unjust and a bad mistake. Real choice and personalised care are wrappings for the market controls which will come.
For example, it is illogical to attack the Attendance Allowance when it is a benefit which already meets the very criteria the Green Paper says it will create, since those on this benefit have been rigorously assessed, and are free to use the allowance in a personal way. The Green Paper advocates these conditions, but they are already there.
My view is that the Government should not claw any benefits to create moneys for the local authority and free markets, nor engage in backdoor privatisation policies which take away the real choice of quality care by controlling assessment and funding to certain levels beyond which only those who can afford it will be able to top up.
The Government should re-think this paper and not remove any present benefits which the vulnerable and sick get. There must be a better way.
Handing disability benefits over to Social Services is both patronising and insulting. *I* know what care and mobility needs I have, and how my disabilities affect my daily life. Some unknown social worker doesn’t. I am anonymous because I had to move to a secret location to escape carers who were abusing me. I accessed my medical records and found a Social Services assessment which stated (I’m paraphrasing slightly): ‘[Patient] states that [Carer] is abusing her, depriving her of food and medication and stealing her money. I decided to ask [Carer] to stop doing this. This I did. [Carer] stated that he would no longer abuse [Patient].’ Then the carer took me home.
These people are not having a large part of my income. I may be disabled, but I am not stupid. I know how to budget. I spend my DLA on things and services that allow me to keep my independence and remain in the community, and am very careful who I allow into my home. Having Social Services strangers coming round to care for me would make me more disabled because of the nature of my disabilities, and would cause me considerable distress.
This situation would be even worse for elderly people, who are already at risk of abuse from carers and others. I have been written off by society because of my disabilities, and an elderly person with disabilities is written off worse. Keeping disability benefits in the hands of those best informed on how to spend them (the disabled people themselves) is cheaper, easier, less time consuming and more empowering for everyone.
As for the £20,000 ‘fine’ for reaching a certain age: others have taken the words out of my mouth and made some brilliant comments, so I won’t dignify this with a response. We are a Society. We are there for all, not just the ‘strong’. We should support *everyone* - as everyone has something to offer (not just the ability to earn a high wage). Those who disagree – we have no crystal balls. We were all tiny, defenseless infants once. One day we shall all hopefully live to old age, and we never know what mishaps life may throw at us.
I never thought: ‘When I grow up I want to be severely disabled.’
My mother is 93 and still living independently, with support from a carer that she pays form her DLA and Attendance allowance ( which hse would not have been awarded unless she had met the right criteria). She has significant impairments and is a determined person who gets on with life. She has only on one occasion used LA support service, when recovering form a broken leg at home. Without her benefits, she would not be able to do much at all and would have needed far more public intervention- assessment- waiting for people to trun up etc, and distressing to her. At the moment she costs the public purse a minimum- and takes up vety little staff time or bureacracy- it makes no sense at all to take DLA and attenance allowance away form older people- surely this would be age discrimination too? Certainly not maintaining independance, choice and control!
Please don’t withdraw DLA , AA and CA from the over-65s. Local Authorities are notoriously wasteful and tend to target help in an idiosyncratic way. Disabled people have a strong incentive to understand our own conditions and to take care of ourselves effectively, and we use the Benefits to defray the (very high) additional costs of disability. Please don’t take our independence and choice. It probably won’t save the government money.
Diabetes; I know from personal experience that some Social Services staff tend to discriminate against diabetics. I have a number of conditions that confine me to a wheelchair and lead to limited use of my arms. The one that seems to cause most hostility is insulin-dependant diabetes. (“Diabetics don’t look disabled to ME.”) I am 68; I use DLA to control my diet and to keep warm enough (or bone damage and denervation immobilises me.) I live alone and cherish my independence, but no DLA would mean Residential Care.
A friend was blinded by diabetes at age 50 (possibly before DLA existed.) She could not get help from Social Services because they appeared to believe that she would immediately develop super-hearing and enhanced senses that mean blindness isn’t a disability. She didn’t. She was already fairly deaf and remained that way: she became helpless and severely depressed but lived for years in that state.
The recent Diabetes UK report points out that the poorest people are 2 ½ times more likely to have diabetes and twice as likely to develop severe complications; (including blindness and the loss of limbs. Victims can suffer on in that state for years.)
Further, Pension Guaranteed Credit is the over-65s equivalent to Income Support; it is paid to people who have no savings and cannot draw a full pension = family carers who could not work and pay a full stamp, women who paid a reduced insurance stamp based on their husband's wage, those who lost their pension entitlement because of periods of sickness before the onset of full-scale documented disability – including many service people an carers who could not give their own health priority, even those who had children before paid maternity leave became a right. Pension Guaranteed Credit brings an over-65's income up to the rate of a standard old age pension.
It has been claimed that DLA and AA are to be replaced by Individual Budgets from Social Services. However, DLA and AA are exempt from mean-testing - this means that they can be paid and accessed by even the poorest of pensioners, those on Guaranteed Pension Credit. If a person on Guaranteed Pension Credit applies for Individual Budget it is deducted from their pension pound for pound.
The withdrawal of AA and DLA would have the effect of depriving the poorest and most vulnerable elderly disabled people of Benefits that support their basic needs: (possibly replacing these Benefits by a payment that can only be received by the relatively well-off!) Most of us will cost much more when we deteriorate due to deprivation.
Rather than setting up a new system, increase national insurance contributions and remove the upper limit. Therefore those who earn more will contribute more and those who are economically deprived will pay nothing. Setting up a new system will swallow a large proportion of the income raised. The use of the voluntary sector is a cheap option as they should be used to provide extras to those people on low incomes not the basic service to all. The voluntary sector makes use of people who wish to put something back into society without payment and it is immoral to use them to provide the basics. Any system which uses the profit-making sector is making a mockery of of the foundation of our society today. The system of care does need to be revised and improved but any funding should go directly to providing the service and not be profit making under any guise.
hello
i suffer with boderline personality disorder agrophobia depression and i hear voices im under pyschiatric services with a cpn im 27 and currently receive DLA High rate care what will happen to this in regards to younger people who will have difficulty justafying funds from my local council i have a mental health difficulty not a physical one its worrying
I ma not sure people with a learningdisability understand where they appear in this green paper or are able to comment.
firstly it seems geared toweards the elderly, secondly we must not lose the good progress made through valuing people and personalisation which has transformed the opportunities for all learning disabled whether mildly or severly affected as it has changed attitudes towards giving opportunities for takin g part in the community. WE MUST NOT LOSE THIS
I understand if you think why this is a silly question. Why don't the Unions ever get involved in Welfare Reform ?. I think it would be a good Idea to lobby the large Unions on this point.
It is the Large Unions where most of the Labour Party funding comes from. I could be wrong but if they were asked to intervene in certain Care reforms this Government would have to listen. At the end of the day quite a lot of Elderly and Sick are ex Union Members.
We are aware that DLA for under 65s is not under consideration, but if you axe DLAand AA for people 65 and over you are hitting at the most vulnerable members of our society. Elderly people deserve and have a right to better treatment. To deny them these benefits will have a drastic effect on their quality of life and living standards particularly those only in receipt of basic state pension.
I'm aware that the Health Secretary has stated that the Disability Living Allowance for under 65s will not be affected but I still have major concerns how the changes the effect the over 65s. Social Services are overstretched under the current system as it is. Scrapping Attendance Allowance and Disability Living Allowance for the over 65s will result in restriction to the access of services they wish to use, a loss of independence, and an effective withdrawal of support if a claiment had been receiving DLA before the age of 65.
The cost savings of removing these benefits will be minimal as there will be significantly increased costs in administering the new system.
Both AA and the care component of DLA should not be removed to pay into the local authorities coffers,. This benefit is to enable disabled people to be independant in the community and in my case is used in this manner. I would be in financial dire straits if this is taken away from me. I do not want strangers coming round giving me care provided by my family.
Even before the Green Paper was published and the ‘big care debate’ began, my own ‘preferred option’ had already been excluded from the debate, so how can I contribute meaningfully?
Care is care is care, but you have allowed an artificial distinction to be created, between health and social care. That is great for the for-profit care providers – who have seen their profits increase enormously, funded largely from general taxation. Buying up local authority owned premises for a penny, in some cases, sprucing them up and then renting those same premises back to the local authority/NHS/PCT in the form of ‘private care homes but with 25-year contracts with the local authority’.
I do not understand why the “fund all care from general taxation” has been excluded. That would have been my preferred option. And if the younger generation are to be allowed to be so selfishly short-sighted, that they can’t be asked to pay through taxation for the needs of others and eventually themselves, then that is a sad reflection on government’s opinion of the younger generation. I paid my taxes and national insurance contributions from the moment I started work, in Woolworths, earning the equivalent of 10p per hour. Safe (or so I thought!) in the belief that I was contributing to the future health needs of my own parents, grandparents and my brothers and sisters. Foolishly, I understood that to be a contract.
So, the plan now is to penalise older people, the very people who have contributed more to the welfare of this state than others. An easy target, one might suggest. Yet you refuse to consider means-testing child benefits paid to millionaires who have children.
To withdraw DLA and Attendance Allowance, and to place those funds into the hands of the local authorities, to squander rather than to direct towards those who need it, is beyond belief. As anyone who has ever approached Social Services for help will know only too well. My relative, born with cerebral palsy, was in receipt of DLA – and his mobility allowance allowed him freedom. It replaced his legs that never did what legs should do: support him and enable him to walk. That was of genuine benefit, to him. But the social worker would not even visit, when asked, to assess his home for modifications that could have enabled him to live more comfortably. What a caring local authority! The cynic in me expects that to get worse, once a local authority gets to control more aspects of the life of people with needs.
Your proposed partnership? No thanks. Partnerships like this are a short-cut to privatisation. I’ve experienced private care homes – run for profit, not for care. That is not the way forward. But the private care providers are already hand-in-glove with you, or is it vice versa, Mr Burnham?
There is only one option, for me: pay for all care through general taxation, whereby we all contribute according to our means, in the hope that when/if we need care, it will be made available to us, free of charge at the moment of our need.
Green Paper? Very green indeed. Unripe; pale and unhealthy; green around the gills; fleeceable, as in naive and easily deceived or tricked - or is that just the Great British public? Just a few web definitions of green, but they sum up my feelings of your plans.
Go back to the drawing board and submit another plan for full democratic debate.
I feel the need to comment on many points on this.
Firstly – as already been pointed out by others – the debate on this has not been high profile on television or in the newspapers. Only those with the internet have the ability to keep up to date and to respond. Therefore, the group most affected by these proposal (elderly and disabled) and their generally much lower incomes, and lack of ability to access computers at home, or even in libraries, means many have no opportunity to even be aware of the current position and debate, much less to respond, and therefore this cannot be considered a fair and full consultation process.
This is exacerbated by the government failing to provide the costs and figures behind the proposal before the end of the consultation period – as they had said they would. Do the sums not add up?
Across the board of the various proposals there is undoubtedly a need to find extra funding and balance the books – but I think a big mistake is being made in how to go about this. It discriminates against the disabled and elderly – surely against the law – and I wouldn’t be surprised to see this being tested in court. There are undoubtedly other areas of government expenditure that could be reduced (one immediately thinks of £47 million MOD bonuses).
To take first the proposal to make a one off charge of £20,000 at retirement age to fund (only some of) care home needs. People have made plans and balanced their own budgets based on current expectations and to change the rules, when they have no time to take any possible actions to compensate for this, is truly unfair and moreover affects mostly those who have been prudent and saved for their old age – those who have frittered away their money – or been unfortunate enough not to have had any - will not have to pay as it will be means tested. I am in my late 50’s and can in no way suddenly find an unexpected £20,000 between now and retirement – however I do own my own home, so this money will be taken from the proceeds of the sale of my house. I am relying on downsizing to provide with an income in my old age.
We have lived our lives paying Tax and National Insurance in the understanding that this would fund our Welfare State. If it turns out that the sums were wrong and we should have been paying more that is down to the inefficiency of the government not us. I myself would have been happy to have paid more as I went along to ensure that the vulnerable in our society received the care they needed. I think that this should be they way to address it in future, but that it is totally unfair to suddenly say to people – oh you should have paid more because now we’ve run out of money – so here’s a big bill you must pay now all in one go.
To address the threat to DLA and AA – I understand that Andy Burnham has made a comment to the effect that DLA will not be affected for the under 65s. And that care for the over 65s will be provided instead by Social Services.
I would like to respond to this on behalf of and from the perspective of several members of my family – apart from me none of whom have access to the internet and so cannot respond themselves.
My mother –in-law turned 80 earlier this year and her existing heart condition became suddenly much worse (she also has a number of other medial problems which exacerbate the problem and make it harder to treat). After a spell in hospital she returned to her home where she lives alone unable to cope without considerable care and support (from being totally independent and driving herself about). Social services, eventually after a wait of some weeks, assessed her care needs as mild to moderate and therefore unable to help as their budget only allows for higher needs. Requests for information about stair lifts or installation of a downstairs bathroom (as she cannot get upstairs to the only toilet) resulted in us being told assessment at home would not be for at least 6 months because there is a long waiting list.
Family and neighbours helped out as best they could and still do with shopping, making meals, washing clothes, changing bedclothes, emptying commode, driving to medical appointments and providing company etc. The AA she was eventually awarded only pays for a carer to get her up and wash and dress her and feed her breakfast every morning morning.
The AA means she has control over her care – who she allows into the house and when – and the ability to get someone else if she doesn’t like or trust the carer. She is also able to increase the care she receives at short notice if she is worse than usual, or a family member is unable to come to her aid. This gives her a degree of control, dignity, independence and flexibility which I cannot see being matched by Social services, who struggle to cope with their existing workload, and already have a shortfall in the number of Social Workers required.
Also receiving AA makes her eligible for extra Pension Credit – this also would be lost reducing income still further.
After a career of more than 30 years working (and paying taxes and National Insurance) I became ill with M.E. six years ago and have since been unable to work, my brother is bi-polar and has only worked sporadically between hospital stays and my teenage son has Aspergers Syndrome and ADHD.
Are we expected to believe that the day we reach 65 our support needs will suddenly disappear and we will be well again and able to cope without the financial support of DLA? As we get older and other health concerns inevitably occur, we are in fact likely to need more support rather than less. And if an exemption is made for those already receiving DLA before they are 65, what about other family members, friends or acquaintances who become ill or frail after reaching 65 – are their support needs less real? Do they matter less?
AA and DLA are supposed to provide not only for care or increased expenditure such as extra heating, but also to enable the disabled or elderly to have a quality of life. Questions on the application form relate to hobbies you could enjoy if someone was there to help, or outings you could enjoy if someone was able to take you. I fail to see that this aspect would be continued by Social Services who are geared up to provide minimal care within a restricted budget and would therefore leave people shut up within four walls alone.
AA and DLA may be spent however the disabled or elderly person chooses – and it must be recognised that different things will affect the quality of life for different people. Alternative therapies or vitamin/herbal supplements bring relief to many which is not available via NHS medication. This choice would be removed.
Current government policies appear to encourage independence and keeping people in their homes for as long as possible. These proposals will have exactly the opposite effect.
Our pensioners are already amongst the poorest in Europe, and this will make that worse.
It is already hard to successfully complete the application process for these benefits, increasing the stress and negatively affecting the health of the claimants. Additionally we are vilified in the press as ‘benefit scroungers’. The Department of Work and Pensions itself states it’s intention to ‘get people off Incapacity Benefits and back to work.
A measure of a civilised society is how it cares for it’s most vulnerable members. No-one plans to become disabled or to have a disabled child, and I would suggest the government need to consider - ‘There but for the grace of God go I’.
I am deeply concerned by the proposals to incorporateDLA/AA into a general care grant to be administered by social services. My experience of this through individual budgets is that unless you fit into the highest category of need funding is non-existent. DLA/AA is the only disability benefit given to all people with a disability and for that reason for many of us it is extremely valuable.
Carers have paid into this system so they should not have to beg for this allowance. Why won't this government admit that carers save the country millions.
The system has been going downhill for a while now and maybe a change would be beneficial if they get it right. One of the main problems is that they are focusing so much on cutting out the people that don't require the help, that they are generalizing most peoples illnesses. I have Crohn's disease and it can effect people in many different ways. A few years ago i was on the highest care component of DLA and my mother was my carer and in receipt of carers allowance.
I have recently applied for DLA 3 times and been turned down as many times. My illness is worse than it has ever been and i am waiting for surgery which will leave me reliant on my mothers care for several months. But she cant spare the time to look after me as she would have no income without me being in receipt of DLA. The main reason they are turning me down is that i do not require help to cook a main meal. This is because i cannot eat solid food! I have prescribed supplements instead called Fortisip. Which don't require cooking. I am now constantly in pain and trying to fight for my right to get the care i need. At least my occupational therapist at social services knows what care i need and tries to support me. Maybe it would be good if she can help get the funding i need....
I already partake in the (Direct Payments scheme (DPS) Since doing this I have reduced my care bill from £64k council run care to 34k under my control with DPS
I have the best care that I have ever had, this was tailored by me to my specifct needs.
I hire and train my own staff and have had zero problems so far and I am four (4) years into it. The "Care companies"that were assinged to my care by the local council were appalling, untrained, one dislexic, one thief, who stole £90 pounds from me, (police acion was taken) one male threatend me with violence, Phillipina's, who in genreral, were untrained, did not have a great grasp of English and so it goes on.
I love my care package now and I will be devastated if this new scheme tries to change it for something inappropriate.
Thank You
Firstly it has been hard work even finding this paper and knowing of its existence, having found out about this and rang for hard copies and also a CD version I was told they had run out of both the easy read and the normal green paper - the CD version took 10 days to arrive. Having recieved the CD it has taken me over 10 hours to listen to, with very fast speech and I found it very difficult to understand. Certain aspects within the paper are not clear - e.g is Disability Living Allowance going to be affected or not? Having got in touch with many groups and organisations to do with disability of all kinds no one had heard about this particular green paper. Much more time should have been given and more advertising to a wider audience at all levels. Our Wakefield Disabled Peoples Partnership group managed to organise a meeting with MP Jon Trikett and our local speakability group, some of these issues were brought to his attention and he informed us that he would bring it to the attention of Priminister Gordon Brown. Due to the nature of my illness, part of which is Aphasia I find it very hard to obtain and retain information, and I know that this affects many people with similar problems, I rely on many different people to be able to read and write on my behalf.
This green paper is raises alot of questions to me a few examples I am giving below;
1. how will any of the proposed changes affect my parents - both are over 80.
2. Will my children who will not retire under the state pension scheme until they are 67 be affected?
3. Will I loose any of the benefits that I recieve at present - e.g. DLA, Incapacity Benefit etc will I recieve the same amount of care that I get at present?
4. What will happen to my care when I am 65
No one really seems to know the answers to the above questions that I have raised - or even know who to speak to, to potentially get an answer.
All in all I have found this paper frustrating in both trying to understand and come up with a clear reponse. I would urge you to do alot more reserch into this before taking any further, and think, the people who you need to speak with are not always aware of these schemes and dont know where to go to find out about them, do not have the time to read and respond to etc
Someone with Alzheimers has an serious illness a serious medical condition. How can you care for someone with Alzheimers without seeing it as a serious medical condition. Cogniton losted, incontinence and then more complications. Yet someone with Alzheimers gets little support from the government We need clarification on illness, medical conditions and when someone just needs care in their old age, then dialogue can begin.
You really cannot continue to sweep people with serious illness under the carpet, just because they are elderly and cannot stand up for themselves.
Regards
Craig
The present system should be left alone and allow people with needs to live their life with the mearge help that they are entitled to. My sister needs the allowances paid to her so that she can be a contributing member of society and give her the mobility and independence she needs. She has enough problems without another set of assessments to satisfy some local so called experts to see if she deserves these allowances.
It doesn't need changing just more effecient management.
According to the blurb the future of care debate is about gathering our views and government acting on them. So what about keeping AA/DLA!! and why are all these concerned people having to wait for reassurance in this regard. Could it be that "working together" does not mean actually taking our views into account but is a little government PR exercise to see how much they can get away with! I may be cynical but why give people the worry?
If the government have wasted and lost so much money that they cannot afford to meet their welfare committments let them at least be straight about it. Call me "prudent" but would it not be better to admit the level of the country's debt and divide it by the number of people who are here and take it off everyone fairly. Lets no pretend that it is for the individual's benefit that their allowances are taken away and given to the LA - that it like telling us there are weapons of mass destruction!
Still at least it makes every new day exciting as you never know what this government is going to come up with next!
Sadly it seems that the country is financially bankrupt and to add insult to political injury the government is now morally bankrupt also.
KEEP AA AND DLA!!!!!