Care Support Independence

Reform of the Care and Support System

West Midlands Regional Stakeholder Event
Birmingham, 6th 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.

West Midlands Regional Stakeholder Event

This report summarises the West Midlands Regional Stakeholder Event held in Birmingham. In total 40 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 David Behan, Director General for Social Care, Local Government and Care Partnerships, and Alexandra Norrish, Head of the Social Care Strategy Unit and Green Paper Team.

Key Themes from the Table Discussions

Do you agree with the vision?

Participants agreed that the vision was broadly right, although they felt that some of the language and specific terms used required further clarification, particularly around the terms “independent living” and “family unit”.

There were also concerns about how the vision would be delivered.

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

Greater transparency and consistency was called for, both in terms of what the government could provide, and what its priorities were.

Participants felt that a flexible, holistic, joined-up and person-centred service would be needed to deliver care in the future. They suggested pooling budgets to achieve this, as well as involving children’s services.

It was felt that the Government also had a role to play in supporting and enabling communities to work together.

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

Participants felt that consistent national standards, as well as a general simplification of the system would help. It was felt that services should be proactive, with a greater emphasis on prevention and early intervention.
Several issues were also identified around carers and their support 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, but acknowledged that the correct education, information and delivery vehicles had to be in place to achieve this.

Families

It was felt that the nature of family units had changed, and that families could no longer be compelled to contribute to care or make decisions about it.

Employers

Participants thought employers could do more to help disabled people and carers to find and sustain work. It was also thought that employers could help to collect or contribute towards employees’ future care, as well as helping with prevention work.

Everybody

There was a strong preference for a fair system, where everyone contributed in some way, even if they were not working.

Communities

It was felt that communities should take on the role that the family traditionally played, in helping to support people through community-based services and networks.

The voluntary sector

Participants thought the voluntary sector should continue to have a role in supplementing care and support.

Government

Participants felt the government needed to reallocate funds towards care, and reduce duplication to make efficiency savings. Higher taxes were suggested.

It was felt that local authorities should take a longer-term view when making care decisions.

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

Over 80% of participants agreed that everyone in society should pay more for care and support in the future, although there was debate about achieving a balance between meeting the needs of those who plan and prepare, and those who do not.

It was felt that people needed to be encouraged to save for their future care needs, and that there should be clearer mechanisms for doing so.

Alternative financing mechanisms were also proposed, including:

• Raising taxes
• Raising the pension age
• Reforming the benefits system
• Diverting money from health services to care

Some delegates wanted to see a culture shift about the use of inheritance, as currently some give away property or money as they get older in order to avoid inheritance tax. Reforming or abolishing inheritance tax may disincentivise this so that people have more money and assets available to pay for their own care and support needs in older age.

Should we prioritise local or national control of budgets?

Almost 80% of participants favoured the prioritisation of national control of budgets, as they believed this would lead to consistency about decisions and a uniformly high standard of care.

Many felt that local control of budgets would lead to inconsistent levels of care, confusion about entitlements, and a “postcode lottery”.

It was acknowledged that there would be the need for a certain degree of local flexibility however, to ensure that different geographies and populations receive appropriate services.

It was suggested that there should be mandatory national minimum care standards, with a degree of local discretion to top-up these services according to local need. Ring-fenced local funding was also suggested as an option.

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

Participants were almost equally split between those who thought society had a responsibility to look after those in need, and those who felt that it was unfair for people who had worked hard to be penalised.

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 a perverse incentive for people not to save.

Some thought 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. Others thought there should be a means testing system, as the only other alternative was seen to be higher taxation.

Should there be the same funding system for everyone?

Participants were slightly more in favour of two funding systems, and many noted that this was already the case.

It was thought that a two-system approach could deliver more individualised care that would be more flexible and faster to meet changes in need. It could also help to encourage people to plan better, as well as providing a variety of different pathways for different needs.

However, it was also identified that a two-system approach could be quite complicated, and that there could be issues around eligibility, and transitions between the two.

A single system approach was favoured by some, as they thought it would simplify existing services, and encourage joined-up multidisciplinary and multi-agency working.

It was identified that there would be many technical and cultural barriers to be tackled for this to be effective, and there would also be additional costs associated with a single system.

It was felt that regardless of whether there was one system or two, individuals should feel they have choice and control over the services they receive.