Care Support Independence

Reform of the Care and Support System

London Stakeholder Event
London, 24 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.

London Stakeholder Event

This report summarises the event in London. In total 88 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 broad agreement with the vision but also general concern surrounding the challenges of realising it.

Many thought a greater emphasis should be given to the ideas of choice and control, emphasising that people who use care and support services should be considered active contributors to meeting their own care needs.

There was a strong feeling that a greater focus should be placed upon carer support and workforce training and development.

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

A greater investment is needed in carers and the care workforce to ensure a high quality of care. Suggestions for improvement included:

• Higher wages for care professionals
• Continuous training and professional development
• Improved access to and better communication of information was another key issue raised.

There was a call for reassessing the commissioning of care and the role of local authorities. Many would like to see care and support reform as a citizen-driven agenda.

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

The need for more effective information, advice and advocacy was cited.
Other areas for strengthening included:

• Government partnerships with local, private and voluntary providers
• The need for a risk assessment that reconciles individual choice with local authority safeguarding
• Investment in support groups
• Investment in technology to improve quality of life and access to care

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

The majority felt that individual users’ primary responsibility should be expressing their care needs rather than financially funding their own care.

Families

It was acknowledged that the nature of the family unit is changing to accommodate a wider social network and that geographical distance is often a hindrance to providing care and support for family members.

It was felt to be important to define the responsibilities of the family to ensure families do not feel forced to care. It was acknowledged that carers should have more rights and play a larger role in reporting back on the effectiveness of care systems.

Employers

Employers were perceived as having a responsibility to be more flexible and willing to take on trainees and employees previously considered unemployable.

Community

As key sources of social support and networking in the absence of a strong family unit, it was felt that communities should better understand the issues facing those needing care.

Voluntary sector

The ability of the voluntary sector to respond to and anticipate local, regional and national needs was expressed.

Everyone in society

There was a sense that society as a whole should bear responsibility for care and support through progressive, universal taxation. This was seen as a moral responsibility in line with broad cultural values.

Government

There was a strong feeling that government has a responsibility to:

• Effectively allocate resources
• Ensure that local flexibility around provision is maintained
• Integrate care and support in policy and provision

Care workforce

The need for professional carers to put individuals at the heart of their practice was raised.

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

The vast majority felt that everyone in society should pay more for care and support in the future either through financial or in-kind contributions.

It was felt that there should be a base level of support provided through increased taxation, incentivised to promote individual contributions to care and ring-fenced to prevent funds from being used elsewhere.

It was suggested that integrating health and social care could ensure this minimum entitlement Many thought that insurance or savings schemes could complement tax increases. Some thought that individuals could top-up government provision through equity release schemes or contributions to a ring-fenced fund.

Employer contributions and coordinated fundraising were offered as other means to pay for care and support.

Should we prioritise local or national control of budgets?

The majority supported the prioritisation of national control of budgets to ensure consistency, confidence and equality. At the same time, most would still like to see a system that facilitates local delivery.

The option of individuals controlling their own budgets was also raised.
Should financial support be targeted to people with low income and assets?
There was an even split of opinion over whether or not financial support should be targeted to people with low income and assets.

Amongst the discussions this question stimulated, many voiced problems with using income and/or assets to test needs and wondered if other variables such as age, benefits, pensions or specifically disposable income should be considered.

Many reiterated the desire for a core provision for everyone regardless of means that could be topped up with individual contributions or other government sources.

Should there be the same funding system for everyone?

A majority of participants agreed that there should be one funding system for everyone that can account for evolving needs throughout a person’s whole life. Many thought a single system would ensure clarity and eliminate confusion, especially for those who are most vulnerable.

It was thought this system could better allow for personalisation, reduce bureaucracy and limit stigmas associated with old age or disability.

Others felt that two specialised systems would create more equity and potentially deliver a better service, accounting for different needs.