Care Support Independence

Reform of the Care and Support System

North West Stakeholder Event
Manchester, 16 June 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 West Stakeholder Event

This report summarises the event in Manchester. In total 81 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?

Overall there was broad agreement with the vision and people felt that it was hard not to agree in principle. The major challenge was how this is then implemented.

What are the key things that need to change? What else would you like to see happen in the future?

There was a need for clearer information, better dissemination of information and greater support for people to understand the options available to them in a system with more personal choice.

It was strongly felt that there needs to be better joined up working, particularly between health and social care.

Other areas in which people would like to see change in the future included:

• Moving away from a culture of dependency
• Shift in society’s attitudes towards care
• Addressing the fragmentation of funding and greater transparency in the way funds are spent
• Increase in early intervention
• Investment in the third sector
• Clarification of the role of carers, and recognition of informal carers

What role would you like to see for individuals, families, society and the government in the future?

Individuals

There was a strong sense of the importance of the individual’s responsibility for their own actions and that there needed to be a move away from a culture of dependence.

The importance of individual choice and control over the source and type of care received was highlighted.

Families

There was some agreement that the nature of the family unit has changed. It might incorporate a much wider circle of carers including aunts, uncles, cousins, neighbours.

Some felt there was a moral obligation for families to shoulder the responsibility for caring for relatives.

Others felt that the family unit should not be thought of as the primary care
mechanism as it might not exist in the future, and cannot always be relied upon where it does exist.

Society

Community involvement was seen as desirable. A role was seen for educators, the media, neighbours, the third sector and employers.

However, there was a feeling that changes in society were detrimental to care provision, in that individulas were becoming increasingly selfish and less interested in the well-being of others.

Government

There was a strong feeling that government should offer more support to families providing care and nurture the family unit.

It was also felt that government should:

• Work to change the mindsets of people about the importance for saving for care and investing in heatlh
• Provide information and advice to support decision making
• Incentivise and encourage people to take responsibility for their own care

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

It was widely felt that care should be paid for through increased taxation although there were different views about what this should look like:

• A premium for those over 40/50yrs old
• A premium earlier in life
• Based on ability to pay
• Included in national insurance contributions
• A medical insurance premium that should be made compulsory
• A private budget that the individual pays into, and then has control over how it is spent
• Should be distributed on physical rather than financial needs

People are happy to pay more as long as there are clear improvements in services. Some people felt that care provision should be delivered according to the same principles as the NHS – everyone contributes equally but receives according to need.

Some stated that the government should ensure that existing funding was spent efficiently.

Should we prioritise local or national control of budgets?

Consistency in care provision between different regions is an issue and the current system needs to be addressed.

National allocation with local control of budgets was felt by many to offer the most appropriate formula for success.

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

There was a relatively even split of opinion over whether there should be one system for everyone or different systems for people with different needs.

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

The strongest message to come through from the tables was that the government should be responsible for providing a basic entitlement that is available to all regardless of income and assets.

There was a strong feeling that any system should be fair and should not penalise those who have saved all their lives.