Care Support Independence

Reform of the Care and Support System

Yorkshire & the Humber Stakeholder Event
Leeds, 21 July 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.

North West Stakeholder Event

This report summarises the event in Leeds. In total 76 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?

There was broad agreement with the vision and several tables felt that it was difficult to disagree with.

There was a strong feeling that the needs of carers need to be better taken into account, and a greater focus placed upon quality and preventative care.

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

The recognition, renumeration and career progression of care and support workers needs to be addressed if the system is to change, in that:

• The profession needs to be made more aspirational
• It is crucial for the workforce to be adequately skilled and that career paths are set out
• Need to encourage a culture of developing expertise

There is a call for better partnership working and for a united vision across the care, health and local authority sectors. Information and education were also cited as being very important.

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

More effective cross-governmental working, particularly between health and social care, was cited once again.

Other areas for strengthening included:

• Greater investment in preventative measures
• Support, training and funding for care workers needs to be boosted
• Investment in brokerage, signposting and advocacy
•  Community support to enable elderly and disabled people to live
  interdependently, as part of the community
• Minimum standards of care need to be implemented in order to avoid the postcode lottery that currently exists

What role should each of the following groups play in identifying and meeting care and support needs in the future?

Individual users of care and support services

Some felt that it was not viable to rely on individual resources but others thought it was a political matter and was dependent on someone’s view of the welfare state.

Families

Families were seen as having a role to play in care although it was recognised that families already do much to support relatives. It was also acknowledged that some people live far from their families, or do not have a family network at all.

Society

There was a sense that society as a whole should bear responsibility for care and support. This applied to both mandatory financial contributions akin to national insurance contributions as well as shouldering the burden of care. The funding of care provision was seen as akin to education which everyone pays for. 

There was a perceived need to develop a sense of collective responsibility and to get the wider community more involved in care provision.

Government

There was a strong feeling that government has a responsibility:

• for a minimum level of provision
• signposting available services to people
• taking a lead on recognising family carers

Employers

Employers were seen as having a responsibility to contribute to care through providing flexible working, care leave akin to maternity leave and also through making a financial contribution akin to national insurance

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

Overall, people did not feel that those who use care and support services should be expected to pay more because:

• Once you have care needs it is too late to save
• You cannot realistically expect people to predict their own care needs
• Those with longer term conditions would not earn enough to be able to provide for their own care

However, others thought that contributions should made by the individual user if they have means to do so.

Some felt that families providing for the care of relatives was the ideal but there was a recognition that this was not always possible as the nuclear family is no longer the norm and many people don’t have families, and the strain of family care can put undue pressure on family relationships.

It was widely held that everyone in society has a responsibility for contributing to care through tax. In terms of how the system might work in practice the following suggestions were put forward:

• Compulsory savings schemes should be introduced
• A care contribution akin to national insurance Taxation for care should be ring fenced
• Health and social care should be merged
• LETS scheme and time banking should be encouraged in order to engender stronger community links

Should we prioritise local or national control of budgets?

The consensus over the local vs. national issue was that there needed to be national control of budget, standards and assessment criteria with local delivery responsibility.

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

The overwhelming consensus was that financial support should be in proportion to the needs of the individual - each individual should have a needs assessment and funding should be according to need, and the same assessment should be applied to all.

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