Care Support Independence

Reform of the Care and Support System

South East Regional Stakeholder Event
Brighton, 10th 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 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 aim 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.

South East Regional Stakeholder Event

This report summarises the event in Brighton. In total 91 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 broadly agreed with the vision and many felt that progress was being made towards realising such a vision, however it was felt to lack detail in certain areas and participants sought clarification of terms such as ‘independence’, ‘family’ and ‘personalisation’.

Participants also felt some key aspects were missing from the vision, including a greater emphasis on individual choice, personal responsibility, involving communities, more joining-up of services, national consistency and a greater focus on the workforce.

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

Many participants felt that a cultural shift was required to encourage people to take responsibility for their own care and support needs from an early age. Many participants saw employer and government flexibility as a crucial factor in realising the vision.

Some participants placed community at the heart of realising the vision and suggested that communities should be better equipped to deal with the needs of older and disabled people living within them.

Participants also identified the need for better access to information and independent advocacy for service users.

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

The need for prevention and early intervention was highlighted, as well as the need to raise the overall profile of carers within society.

The need to develop a consistent, fair and transparent approach to funding care and support was also discussed.

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 their own future care needs, and that they should be compelled to save. It was felt that those who could not save, for example disabled people or people with care obligations, should not be penalised.

Families

Participants felt that the role of families should not be assumed. It was felt that relying too heavily on family support could disadvantage those without families or with families who lived far away. Equally participants felt that those families who chose to care for relatives should be encouraged and supported to do so.

Everybody

Participants agreed that society as a whole should take more responsibility and that this should be achieved through encouragement rather than legislation. It was felt that everyone should contribute, and that volunteering should be encouraged.

Employers

Participants called for employers to offer more flexible working patterns for carers. It was also felt that larger organisations should encourage and fund employees to volunteer. Some participants identified employers as a possible source of care and support funding.

Communities

Participants felt that communities could only be expected to offer informal and voluntary care and support and could not be obliged to do so.

The voluntary sector

Participants acknowledged the amount the voluntary sector contributes to care and support and felt that volunteers should be encouraged by communities and more formally within the care and support system.

Government

Participants suggested that overall responsibility for financing and delivering care and support services lies with the Government. They also highlighted the role the Government should play in improving and simplifying services. Many participants felt that the Government should invest more in care and support.

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

87% of participants agreed that everyone in society should contribute more, and there was a general consensus that individuals should take more financial responsibility for their own care and support needs.

Participants felt that a change in culture would be needed to help people understand the need save to support themselves in later life. A system of ‘credits’ was suggested so that contributions would not have to be financial (e.g. for those who were carers themselves).

It was felt that it should be compulsory to save if possible in order to create a fair system.

Should we prioritise local or national control of budgets?

82% of participants were in favour of national control of budgets, because they thought it would be more consistent and would help to prevent postcode lotteries.

It was also felt that national control of budgets could help to improve geographical mobility of disabled people, while preventing certain areas becoming over popular for their services.

Some felt that local authority control of budgets would lead to politicisation of services, bureaucracy, and huge local variations. However, some thought that local control of budgets would be better, as it would be more flexible and adapted to the local area.

There were also suggestions that a framework of consistent national standards be combined with a degree of scope for local flexibility.

Should financial support be targeted to people with low income and assets?

Participants were split almost fifty-fifty on this issue. Many thought that a means-tested system did not provide incentives to save, and that this should change. Some pointed out that those who saved had already paid tax and National Insurance and would therefore be penalised twice. It was felt that everyone should be encouraged to save more, although those who were unable to save should not be penalised.

Participants were in favour of a basic minimum level of service, which could then be topped-up from individuals’ savings. It was suggested that those who could not contribute financially should be able to earn top-up credits through volunteering or caring.

Should there be the same funding system for everyone?

Participants felt that the system should be focussed around an individual’s need regardless of the two groups - whether the need arises due to older age, or less predictably at an earlier age. Participants also noted that people’s care and support needs change and develop over time and so it is difficult to split them into two groups.

Many participants highlighted the fact that young disabled people and older people have very different care needs and that the cost of caring for young disabled people is higher. All felt that if possible one group should not be favoured over the other.

Two thirds of participants favoured a one-system approach because they thought it would be fair, simple to understand and more cost-effective than two systems. They also felt that one system would be more responsive to the changing needs of individuals requiring care and support. Many felt that a single system was better suited to the move towards individual budgets.

Those who favoured a two-system approach felt that the two groups had very different needs, and that two systems would allow people to plan for more predictable future needs. However, some had concerns about transition between the two systems, and possible inconsistencies between them.