Care Support Independence

Reform of the Care and Support System

East of England Stakeholder Event
Norwich, 3rd November 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 upport 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 of England Stakeholder Event

This report summarises the event in Norwich. In total 71 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 Phil Hope, Minister of State for Care Services, and David Behan, Director General for Social Care, Local Government and Care Partnerships.

Key Themes from the Table Discussions

Do you agree with the vision?

Participants agreed that the vision was broadly right, although there were concerns about how the vision would be delivered, and thoughts on clarifying some of the language used.

To make this vision a reality, what are the key things that need to change?
It was felt that there was a need for a real culture change in terms of society’s understanding and expectations for the future, and that far more needs to be done to educate and encourage people to take responsibility for their own futures.

Participants also felt that more needs to be done to inform people of what they are entitled to. It was felt that this would be helped by improving the sources of information about what care and support services are available.

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

A number of participants felt that voluntary organisations should be empowered, through further training and clearer standards, without forcing them down a prescribed route.

A number of participants stressed the need for more joined-up services, particularly between health and care and support.

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

Individuals

Participants felt that individuals should take more responsibility for planning ahead for their care later in life. It was also acknowledged that the correct education, information and delivery vehicles had to be in place to achieve this.

Families

While it was acknowledged that families can have a very valuable role to play in providing care and support financially and in kind, it was noted that it is extremely difficult to enforce a requirement that they should provide care for their relatives.

Employers

Some participants felt that employers should permit more flexible working patterns that allow people to combine their employment with their role as a carer, rather than having to choose between the two. It was also felt that employers could encourage people to save more effectively for their future care and support needs.

Everybody

It was felt that everybody in society has a responsibility to contribute to care and support in the future.

It was felt that new methods are required to make this happen. An enhanced National Insurance system was seen as one option for this, while others preferred the route of direct taxation.

Communities

Communities were felt to be in a position to take an increased role in the provision of care, but also to raise awareness of our social responsibility to those around us.

The voluntary sector

Participants felt that the voluntary sector should continue to have a role in supplementing care and support services and information, with some arguing that they should have an increased role.

Government

Participants thought that the Government needs to clarify its position with relation to social care. There were a number of suggestions that Government should ensure that all of society contributes to care. Government was also seen to have a key role in providing information and promoting responsible planning for the future.

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

Over 90% of participants agreed that everyone in society should pay more for care and support in the future. Ideas for how this could work included a system of direct taxation or via National Insurance.

In order to succeed it was felt that the funds in any insurance schemes would need to be guaranteed by the Government, ring fenced and linked to a clear and flexible entitlements scheme.

There were also a number of discussions around the role assets should play in contributing to social care funding, and how people’s contributions to such a scheme of taxation or national insurance might vary according to their circumstances. A number of points were made suggesting that people should not necessarily assume that assets will be passed on to children in the future.

Should we prioritise local or national control of budgets?

More than 80% of participants favoured national control of budgets, as they believed this would lead to consistency about decisions and a uniform standard of care.

However, it was also widely recognised that for the best results a national system should be combined with local flexibility, in order that different areas and populations receive the most appropriate services for their locality.

Should financial support be targeted to people with low income and assets?
Participants were split between those who felt that financial support should be focused towards those most in need (35%), and those who felt that everybody should be treated the same (65%).

Some thought that care should be free at the point of need. It was also suggested that a basic minimum level of care could be provided, above which individuals could “top-up” if they had the means to do so.

While means testing was felt to be unfair and inconsistent, it was recognised that if there were insufficient funds, then those most in need of support should get priority, in which situation a form of means testing could be the only option.

Should there be the same funding system for everyone?

74% of participants were in favour of a single funding system for everyone, although the point was made that the most important thing to consider was the delivery of services and benefits received from the user’s point of view, and that any system should be based on the needs of the individual.

It was felt that a single system could be more focused on individual needs and would not judge people purely on age. It was felt to be clearer and simpler administratively, and more transparent from the outside.

Some favoured a two system approach, as it would cope better with the different circumstances of older and disabled people. There were concerns voiced around transition between the two systems, and fears that two systems would encourage ageism.