Care Support Independence

Reform of the Care and Support System

South West Regional Stakeholder Event
Bristol, 20th 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.

South West Regional Stakeholder Event

This report summarises the event in Bristol. In total 82 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 generally agreed with the vision, but many wanted more details about how it would be achieved in practice. There were some concerns that the vision set out expectations that were too high.

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

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

Participants identified the need for greater partnership working between services, at both a strategic and delivery level. Participants also highlighted the need to support informal carers, as well as to have safeguards for vulnerable people.

Some participants felt that younger people needed to take more responsibility for their future, and that some attention needed to be given to ensure this happened.

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 have a skilled and stable care workforce.

Participants also discussed whether individual budgets could create an equitable care system, and many felt this area required further exploration.

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, due to disability or care obligations, should not be penalised.

Families

Participants felt that the role of families should not be assumed. It was also felt that the increasing age of (family) carers should be considered in the planning of any future care and support system.

Everybody

Participants agreed that society as a whole should take more responsibility, and that we should value older people more. It was felt that everyone should contribute, and that volunteering should be encouraged.

Employers

Participants called for employers to be more flexible around recruiting and supporting employees with specific needs, and allowing people to continue working past 65. It was also felt that employers could contribute or help to collect contributions to care.

Communities

It was felt that communities should take more responsibility for those with care and support needs, although it was recognised that cultural change would be required to achieve this. Suggestions to achieving this included building up a sense of community spirit between neighbours and friends.

The voluntary sector

Participants acknowledged the role of the voluntary sector, but were concerned that it is facing increasing funding pressures.

Government

Participants thought the government should raise awareness of the issues, and help to tackle them through taxation, and making efficiency savings. Some thought the government should provide a savings vehicle for people to pay into.

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

90% of participants agreed that everyone in society should contribute more, and there was a general consensus that individuals should take more responsibility for their own care and support needs.

Participants felt that a change in culture would be needed: both for those who are accustomed to being in debt, and for those who are expecting to leave all their assets as inheritance.

It was felt people needed incentives to save and that the government could play a role by establishing a compulsory savings vehicle for people to pay into. It was felt that everyone should contribute something, even by volunteering if they were unable to contribute financially.

Should we prioritise local or national control of budgets?

Over 70% of participants were in favour of national control of budgets, because they thought it would be more consistent, it would provide better value, and it would help to prevent postcode lotteries. It was also felt that national control of budgets could help to improve geographical mobility of disabled people.

Many felt that local authority control of budgets would lead to politicisation of services, bureaucracy, and huge local variations. It was noted that richer areas would be more able to supplement services through higher taxes.

However, some thought that local control of budgets would be better, as it would be more flexible and adapted to the local area. It was also felt that local flexibility could create better accountability and help to re-build a sense of community.

There were also suggestions that a national set of minimum 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 the current system did not provide incentives to save, and that this should change. Many thought means testing was unfair, and some pointed out that they had already paid tax and National Insurance. 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 individuals should be assessed in terms of their potential to recover and contribute to society, and that people with low or moderate needs should receive preventative help, to stop their problems escalating.

Many felt that younger disabled adults should have higher priority than those who have had a chance to save money towards their own care, and that there should be transparency around such prioritisation and decision-making.

Participants were split almost half and half between a one-system approach and a two-system approach. Some felt that it did not matter which approach was taken, as long as there was a consistent standard of individual-centred care.

Almost half of participants favoured a single system, because they thought it would be fair, inclusive, based on a single set of philosophies and because it could be simpler and more cost-effective than two systems.

The slight majority of participants favoured two systems, as they felt that the two groups had very different needs, and that two systems would be a way of encouraging people to take responsibility for predictable needs.

However, some thought that a two-system approach would be ageist, and there were concerns about transition between the two systems, and possible inconsistencies between them.