Care Support Independence

Reform of the Care and Support System

North East Regional Stakeholder Event
Newcastle, 13th October 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.

North East Regional Stakeholder Event

This report summarises the event in Newcastle. In total 62 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.

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

It was felt that the Government needed to provide greater clarity over what it could provide, in order to aid people to understand what they would be entitled to.

More specifically regarding information, participants felt that improved guidance and advice services were key to ensuring that people were aware of the services on offer and which would benefit them most.

Participants felt that a flexible and joined-up service focused on individual needs would be required to deliver care in the future.

It was also felt that perceptions amongst the wider public need to change, especially in terms of their attitude to older and disabled people.

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

Participants felt that there needs to be a consistent standard of service across the country, and there needs to be improved interaction between different services.

It was also felt that the funding model needs to be simplified and made as efficient as possible, to aid joining up of care. Several points were made regarding carers and their training and development needs.

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.

There were a number of points made around the difficulties related to relying on personal assets to fund care in later life.

Families

It was felt that families could no longer be expected to contribute to care, as the nature of the family unit has changed and families are often far more geographically dispersed.

It was also felt that the family currently provides a great deal of support “in kind” to people in the care and support system and this needed to be better recognised.

For example, those families who wanted to provide care and support in kind were often unable to due to the low levels of carers allowance provided.

Employers

Some participants’ thought that employers should contribute to employees’ future care through the benefits packages they offer.

Everybody

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

Communities

Communities were felt to be in a position to take an increased role in the provision of care, taking on some of the roles that the family may not be able to.

The voluntary sector

Participants felt that the voluntary sector should continue to have a role in supplementing care and support, with some thinking they should have an increased role. It was also felt that they should receive more recognition for the work that they currently do.

Government

Participants felt that Government has a role in shifting perceptions in society, and encouraging people to take more responsibility both for their own health and for each other.

It was also felt that Government needs to consider its priorities, and decide whether increasing taxes is a realistic option. If a compulsory insurance scheme was decided upon as the means to fund care, it was also felt that Government would have a responsibility to guarantee it.

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

Just over 95% of participants agreed that everyone in society should pay more for care and support in the future. There was considerable debate around how best to strike a balance between those who plan responsibly for their future care needs, and those who do not or cannot.

It was felt that people could contribute through a system of taxation or national insurance. It was however noted that such a system would have to be transparent, and people would need to see where their money was going.

Potential financing mechanisms proposed included:

• Raising taxes
• Social insurance
• Government bond for care
• Improved use of and increased national insurance specifically to cover care
• Increased taxation of wealthiest members of society
• More funding from health to be allocated to care

Should we prioritise local or national control of budgets?

Almost two thirds of participants favoured national control of budgets, as they believed this would lead to consistency about decisions and a uniform standard of care. It was felt that local control of budgets could lead to inconsistent levels of care, confusion about entitlements, and a postcode lottery.

There was however considerable support for local flexibility, to ensure that different geographies and populations receive appropriate services. It was suggested that there should be mandatory national minimum care standards, with a considerable degree of local discretion to prioritise these services according to local need.

Should financial support be targeted to people with low income and assets?
Participants were almost equally split between those who felt that financial support should be focused towards those most in need, and those who felt that everybody should be treated equally (and should not be penalised for saving responsibly).

Some thought that care should be funded on a model like the NHS, and be free at the point of care need, and that means testing provided an incentive for people not to save.

It was felt that there should be a basic minimum level of care that should be provided, above which individuals could “top-up” if they had the means to do so.

While means testing was felt by some to be unfair and inconsistent, it was felt that if it were to be included in the new system great care would have to be taken to ensure that those on the boundaries and ‘cliff edges’ are not affected too heavily.

Should there be the same funding system for everyone?

Participants were slightly more in favour of a single funding system for everyone.

It was felt that a single system would be more focused towards individual needs rather than judging people on age, and it would not seek to categorise people. A single funding system was felt to be clearer and simpler administratively, and more transparent from the outside.

Some favoured a two system approach, as they felt it would cope better with the different circumstances of older and younger disabled people. They believed it would ensure that there was sufficient funding for younger disabled people, unaffected by the rising numbers of older people, and could encourage people to save for old age, while still providing support for more unpredictable life-changing events.

There were concerns voiced around the transition between the two systems, and that two systems would encourage ageism.