Care Support Independence

Reform of the Care and Support System

East Midlands Stakeholder Event
Leicester, 14 July 2008

In October 2007, the Government announced its intention to reform the care and support system in response to the long term demographic pressure likely to dramatically increase the number of people who need care and support over the next 20 years.

On 12th May 2008, the Prime Minister launched an extensive period of engagement with the public, people who use services and stakeholders that will lead to the publication of a Green Paper on care and support in 2009.

The reform is a cross government project between the Department of Health, Cabinet Office, Communities and Local Government, Department for Children, Schools and Families, Department for Work and Pensions, and HM Treasury. The Department of Health is the lead department.

The Department of Health ran a series of facilitated stakeholder events in nine regions across England. These aimed to gather a wide range of ideas on the reform of the care and support system and to debate some of the principles that should underpin any changes.

East Midlands Stakeholder Event

This report summarises the event in Leicester. In total 59 delegates attended the event from a range of organisations, including public, private and third sector care providers, community organisations, local authorities and locally elected members.

Participants debated a series of questions in small table discussions. The event also included some feedback sessions and a question and answer session with the Minister for Care Services, Ivan Lewis.

Key Themes from the Table Discussions

Do you agree with the vision?

There was significant support for the vision, with most people feeling it would be hard to disagree with the principles set out. However, the difficulty was perceived to be developing the details and putting the vision into practice.

To make this vision a reality, what are the key things that need to change?

Successful implementation of the vision was seen to require a significant change in attitudes across society. This change was envisaged by most to begin with improved education in schools.

Other themes included:

• Need to move away from siloed organisations and thinking
• Importance of exploring ideas around shared and collective independent living
• Importance of good and accessible advice and information
• Benefits to be gained through improved engagement with service users
• Need to attract and retain quality staff within the care and support workforce, through providing improved salaries and training

Many people also queried the need for an upper age limit for employment, feeling that there were many benefits to both the individual and society through continuing employment in some form in later life.

To make this vision a reality, what are the key things that need to strengthen?

Lots of the suggestions made here focussed on social change; strengthening the idea of family, extended family and community; promoting the value of age in society and promoting well-being as an individual’s responsibility.

It was also felt that conditions should be improved for care workers, so that they receive better salaries, as well as higher quality and more consistent training and supervision.

Other suggestions included:

• Introduce unannounced inspections, across whole 24 hour period
• Simplify employment law to encourage more employers to employ disabled people
• Lengthen the initial assessment procedure in order to put together a more tailored care package
• Assess what lessons can be learnt from smaller agencies where continuity of care seems to be handled much better

What role should each of the following groups play in identifying and meeting  care and support needs in the future?

Individual users of care and support services

Individual responsibility was felt to be important and some felt that individuals should plan for the future through some form of insurance.

Families

The notion of family was seen as difficult to define due to variations in family
structures. It was noted that although families usually feel a duty of care towards each other, this does not mean they always see themselves as full time carers.

Family care can take many forms and it was felt that the needs of family carers should be better recognised.

Everyone in Society

It was generally agreed that everyone in society did have responsibility for
supporting care needs, probably through a form of taxation. Education of young people in schools was again raised as important in creating a sense of collective responsibility.

Government

Government should take the lead in providing direction through understanding the ‘big picture’. They should decide upon what the level of universal care should be set at.

Employers

Employers should be sympathetic to the needs of carers and those being cared for, perhaps by being more flexible around part time work.

Who should pay more for care and support in the future?

There was a feeling that individuals should be encouraged to save and take some responsibility for their future care needs. Families were seen as contributing significantly already in terms of supporting family members with care needs, both financially and in kind. Their burden should not be increased further.

The predominant opinion was that everyone in society should contribute more to meet the increased cost of providing care and support in the future. Some form of taxation was suggested as the fairest method of ensuring equitable contributions from everyone in society.

It was felt that it should be made clear how funds raised through taxation would be spent on care and support, and for these funds to be ring-fenced so they weren’t spent in other ways.

The idea of community credits was also suggested, whereby people earn credits through various kinds of contribution within their communities, and then ‘cash in’ these credits to help pay for care and support if required.

Should we prioritise local or national control of budgets?

Overall most participants felt that national control should be prioritised, so that funding criteria and minimum service levels are made consistent across the country.

However, many people noted that there needed to be an element of local flexibility, ideally to enable Local Authorities to flex and adapt in response to local needs.

Should there be one system for everyone or different systems for people with different needs?

There was quite an even split of opinion in responses to this question, although there was a slight bias towards providing everyone with the same level of support regardless of how predictable their needs were. The point was made that funding should be flexible to deal with those with high level needs, whether these needs had been predictable or unpredictable.

Furthermore, those with the same needs should be assured of receiving the same level of care wherever they are.

Should people get different levels of financial help from the government based on their personal income and assets?

Some doubts were expressed about the fairness and effectiveness of means testing, with concerns about people trying to ‘beat the system’ and it being difficult for those on the borderline. The emphasis from the majority of participants was on ensuring Government provides universal cover to a robust minimum standard.