With well over 3,000 responses to this website alone, the consultation period is so far living up to its name. I would like to thank everyone who has contributed so far, and urge you to encourage others to do the same.

Among the responses, the issue of benefits is the one getting the most attention.

Many of the responses we have received are passionate in their defence of the current system, spelling out how a large number of people rely on Attendance Allowance and Disability Living Allowance to maintain their quality of life. We have also heard from a lot of working age people who are worried that their DLA will be taken away from them.

As we say in Shaping the Future of Care Together, we think there is a case for bringing some disability benefits and the new social care system together into a single system.

We are considering the role of disability benefits in the context of the overall system of disability-related support, and see this as a potentially better way of providing support through the new National Care Service. Our Regulatory Impact Assessment describes how this could work.

The Big Care Debate is a consultation about options for long-term reform, and it is vital that everyone has the opportunity to contribute to this important public debate.

We will only make any changes to disability benefits if we know that by doing so we can better support the needs of older and disabled people.

Whatever changes are made, we want to ensure that people receiving any of the relevant benefits at the time of reform would continue to receive an equivalent level of support and protection, under a new and better care and support system.

Our aim is to create a National Care Service that is fair, simple and affordable for all – one that ensures that everyone in the country gets the care and support they need and that fits the way they choose to live their lives, not one that is dictated by others. 

To achieve this, we must end the unfairness, inconsistency and complexity that people find in the care and support system as it currently exists. 

We fully understand why the current disability benefits are popular. They provide a universal entitlement which does not depend on where a person lives. They provide a cash budget, which can be spent on the services someone wants, and people often use them to support lower-level needs that help them stay well for longer. These three aspects will all be important components of the new care and support system.

However, we also know that there are problems with the overall support available to older and disabled people through the current social care and disability benefits systems.

These two systems were developed separately, with the result that they are fragmented and can be difficult to understand, access and navigate. 

People have to apply separately for disability benefits and social care, which can put some off applying for all the support they could be entitled to. They also face different needs assessment processes, adding confusion, and there can be some inconsistency and unfair outcomes because the criteria by which public funds are allocated are entirely different. Our vision is that we bring them together into one new system.

We believe that reform provides an opportunity to build on the strengths of both systems to produce a better system of overall support.

The Green Paper sets out a vision for a new National Care Service. As we all know, more and more of us are living longer, and of course this is a great thing. However, the harsh reality is that the current care system, designed in the 1940s, is no longer fit to face the challenges of the 21st Century. We need to create a system that is, one that ensures that we all get really good care, wherever we live and whatever our needs. 

This is a something that will affect all adults, people with a disability as well as older people, so it is something that we need to decide together. That is why we are launching the Big Care Debate.

During last year’s engagement process, people told us that they want a system that is, above all, fair, simple and affordable.

We need a fair system where people get the support they need wherever they are in the country.

We need a simple system where people know exactly what to expect and what they need to do to get help. Information and advice must be readily available to those who need it, when they need it.

We need a system that is affordable for everyone. Surveys tell us that more than half of people think that care will be free. But it’s not. Care and support costs can be very high: a 65 year old can expect to have to pay on average £30,000 for their care during retirement.

Many people will pay much less than this. Some people can live to be 90 and never need care, but many of us will also know people who develop a condition like Alzheimers and have to spend 8 or 10 years in a care home, which can cost hundreds of thousands of pounds.

The debate we need to have is about how we balance what it is fair for everyone to pay, against the need to protect people against having to pay a huge cost. These are big questions that we must answer together as a nation.
 
The Big Care Debate runs until the 13th November. There are many ways to get involved. Have a look around this website - you will see plenty of opportunities to have your say. Among them is a web-optimized version of the Green Paper where you can leave your comments, a stakeholder forum, and a toolkit for those who want to hold their own events. There will be details of events in your area, and look out for leaflets and postcards in public places, which offer you the chance to tell us what you think of the proposals in Shaping the Future of Care Together.

I urge you all to get involved in the Big Care Debate. This is a historic opportunity to help create something which could change the lives of people for generations to come.

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?

I was keen to raise a debate with directors on the importance of the reforms we are currently introducing in adult social care in England. I encouraged directors to create a climate where we in social care take pride in our work, and transmit that positive attitude to those outside the sector, in particular the media.

The presentation was informed by some recent visits to councils where I met staff and people who use services. Among the case studies of first class care, one from Surrey County Council particularly stood out for me.

The case involved a family comprised of a couple, “Mr and Mrs P” and their children, aged five, three and four months. Mr P suffers from obesity and depression, while Mrs P has a rare bone disorder, Ehlers-Danlos Syndrome Type three, diagnosed in 2006 but undiagnosed for around nine years before this.

The five-year-old was diagnosed with the same condition in 2008 and already requires a wheelchair for outdoor use. The second child is beginning to show symptoms and is undergoing tests. The third child was two months premature and there are concerns about her development.

The family moved into their current home in August 2008. Their care needs were recognised and Self Assessment Questionnaires (SAQs) were completed for both parents and support plans were drawn up.

As well as continued support for Mrs P, provision was made for Mr P to improve his health and fitness through assistance in weight loss, support to allow him more leisure time and to increase his motivation in day-to-day activities.

Other items included relief from caring for the children to allow free time for the couple to spend together, the purchase of a laptop to allow more contact with family friends, the landscaping of the garden to allow easy and safe access, and the continued employment of Mrs P’s mother as a carer for 20 hours a week.

The family described how their lives had been transformed by the help they had planned with their social worker.

I think this is an example of social work at its very best - creative social workers helping a family with severe needs through creating an individual care package that makes a real difference to their lives.

In this time when negative stories about social workers and the social care system abound, stories like this one all too frequently get lost. This is not to say that shortcomings in social services and their sometimes tragic consequences should not be reported, but so much of the good that care and support workers do gets overlooked.

I would be interested to hear any examples you may have of care and support work that has improved people’s lives.

The most recent development was the publication of the Adult Social Care Workforce Strategy, which is designed to support the workforce to improve the quality of care and support in England.

Social care and health is a people-intensive sector. Whilst technology and science will always make significant contributions to how we provide care, the essential tasks are carried out by people, for people. 

The workforce is key to the delivery of these strategies. How we develop, support and enable those who work in the sector will be a crucial element in the success of delivering our strategies to improve the care and support people receive. 

We know from the literature on management and leadership that successful organisations need to be well lead. Critically, they also need to engage positively and constructively with front line workers.

This open approach ensures that policies are relevant and authentic. After all, policies are a means to an end, not an end in themselves.

The workforce strategy for social care lays out the framework within which we would like to see the development of people who work in the social care sector.

Among the most eye-catching initiatives within the strategy is CareFirst, a scheme which will give 50,000 long term unemployed the opportunity to develop the skills necessary for a career care services.

The number of apprenticeships in social care will be increased by around 1,300, with recruitment targeted at groups which have not traditionally taken up careers in social care.

We want to support, and raise the status of, people already working in the sector, so there will more Social Care Awards to recognise the hard work the 1.5 million people working in social care. In addition, £4m will be made available to support for newly qualified social workers in their first year.

To improve quality, a National Management Trainee Scheme will be set up to encourage graduates and top quality executives to move into the social care sector, and a new voluntary registration scheme for home care workers will launch in 2010.

The new strategies were developed with key stakeholders, people who use services and carers working alongside civil servants. The aim is to ensure that people receive high quality care and support that maintains their independence.

I believe that, implemented well, and through engaging front line staff, users and carers alike, the work on dementia, carers, autism, mental health and learning disabilities will lead to real improvements in the way people can be supported to live independently, and be afforded choice and control over their lives.

2009 is a big year in social care. We are reforming the care and support system, and there are several pieces of major work in the pipeline.

One of the main aims of this blog is to give a flavour of what is happening as things progress, and to give you the opportunity to tell me what you think.

England’s care and support services help people with care needs to lead independent, active and healthy lives. The term covers a wide range of services, from housing support, support for disabled people, meals on wheels and occupational therapy to day care, care homes and support for carers.

They enable people to do many of the things that lots of us take for granted, like live in their own homes, work, cook, shop and care for their families.

With people living longer, and living longer with disability and long-term conditions, the provision and funding of care is increasingly difficult. The current system is unsustainable. We need to design a new system, which ensures everybody gets the kind of support they want, when they need it.

We want a fair system that will be robust enough to survive economic and political change and provide care into the future.  

The whole reform process is underpinned by two major pieces of work.

First came Putting People First, which we published last year, which addresses the changes necessary to mend the failing system in the present and in the short term.

The care and support Green Paper, which we will publish this year, will set the scene for long term reform, showing different options for funding and delivery of care and support. After publication we will consult with public and stakeholders, testing our ideas, and use this input as we design a new system.

You can read more about the Green Paper at on this site or visit our Facebook page here.

Already this year we have published Living well with Dementia: a National Dementia Strategy. The strategy will improve the quality of care for those with the condition, increase awareness and remove the stigma associated with it. Read more about it here.

In the early spring the Carers Direct service will launch on NHS Choices – a new online resource offering advice and guidance for carers. You can already see some content on NHS Choices here.

Other upcoming work includes a Workforce Strategy, an Ageing Strategy and the Housing Strategy for an Ageing Society.

In addition to this programme of work I will regularly be going on visits, seeing examples of best practice and innovation around the country. I will share these with you, and encourage anybody who has come across any impressive work to mention it here.

So now it’s over to you. What would you like to see from a new care and support system? I look forward to reading your comments.

Best wishes,
David