Care Support Independence

The work of England’s care system reaches across every community in every region. From disabled people who want to find work, or need support to look after their children, to older people who want to remain living safely in their own homes, it enriches the lives of millions of people.

Yet all of these people are living and working within a system that is struggling to meet the challenges it now faces.

When the National Health Service was being designed after the Second World War, social care as we know it was not on the agenda. It was expected that women would look after elderly or disabled relatives while the men worked.

Society and expectations have changed enormously over the last 60 years.

Crucially, we are living longer. The number of those aged over 65 will increase by almost a third by 2020. Over 85s will double and over 100s quadruple. One in four of our children is expected to live to 100 or more.

We are living longer with disability. By 2040 the number of people with disabilities will increase by 2.9 million to 8.6 million.

However, healthy life expectancy is not increasing at the same rate as life expectancy. People are living longer with conditions – on average a man will have 9 years with long term limiting illness compared to 6 years in 1981.

All of these factors mean that there is a rapidly growing need for public services and for the informal care provided by family and friends. We expect 1.7 million more people will require care and support in 20 years.

Yet as need increases, the proportionate number of those paying for and providing state care is falling. At the turn of the century there were five people working for every one person retired. Now there are four for every one person retired, and the figure will continue to fall. If no action is taken, within the next 10-15 years the system will be unable to supply the services that people need and deserve.

Beyond demographic and financial considerations, people’s rising expectations are also behind the need for reform.

People are no longer passive receivers of care. Not only has new technology brought us better quality care through innovations such as stair lifts, pressure packs, sensors, motion detectors, telecare and self monitoring, it has also raised awareness of the existence of such things. It has empowered people to ask for them.

At the same time, the disabled people’s movement has succeeded in driving huge changes to the way we think about equality and opportunities for disabled people, emphasising the need for people to have control over their own lives.

The Government is tackling care and support reform through a two stage transformation strategy lead by two key publications, Putting People First to address the present situation and near future, and a care and support Green Paper to shape the future of the system.

Putting People First – Transforming adult social care, published late in 2007, set the direction for adult social care for the next ten years and beyond.

It reflects a cross-government ambition to radically reform public services in a way that will enable people to lead safe, healthy and independent lives supported by high quality services.

The paper identified four areas that councils and their partners should focus on to make services more personalised and help people get the right outcomes.

The areas are general support and services, early intervention and prevention services, choice and control, and the involvement of community groups such as faith communities and voluntary groups.

Transformation will be delivered through a new performance framework, with the engagement of a full range of local statutory, voluntary and private sector organisations, these will lead to Strategic vision and Commissioning strategies with a locally agreed approach, meeting local need.

The strategies will be wide ranging, for example aiming to provide people with the housing, adult education and employment opportunities, and feed into the area’s Sustainable Community Strategy.

In June 2008 came the next piece of the plan - the Carers’ Strategy. Caring with Confidence – An Expert Carers’ Programme recognises the importance of services for carers and made commitments to provide more support for them. It sets out the Government's short-term agenda and long-term vision for the future of carers, underpinned by £255 million to implement some immediate steps alongside with medium and long-term plans.

The three main initiatives are Caring with Confidence, emergency respite care and the carers’ advice/helpline run by NHS Choices.

In February we launched the Dementia Strategy, the first major piece of work in this busy year. Backed by £150 million over the first two years, the strategy is designed to increase awareness of dementia and remove the stigma associated with it as well as pave the way for better care.

The strategy will ensure early diagnosis and intervention, and radically improve the quality of care that people with the condition receive. New initiatives include the appointment of dementia specialists, better training for GPs, a network of memory clinics and dementia advisers in hospitals and care homes.

Sitting above all of this work is the main piece of work in this year of years in the Care Services, Local Government and Care Partnerships Directorate: the Care and Support Green Paper. This publication will spell out different options for a new care and support system in England.

Echoing Putting People First, the aim is to create a system which enables adult service users and their carers to stay healthy, support their families, be treated equally, and play an active role in their communities. At the core of the system will be the offer of a universal service, but with more help for those who need it most.

The process started in May 2008 with the publication of The Case for Change – Why England Needs a New Care and Support System, a document launching a large-scale public debate on whether there is a case for changing the current system. It argued for a new system, and set out the issues and trade-offs this would mean.

After publication, the Department of Health set out on a six-month engagement process. Discussions took place at nine regional stakeholder events and five events with members of the public. Thousands of emails and contributions were gathered via the Care and Support website. All of the responses will feed into the Green Paper.

We are currently writing the Green Paper, working cross government, testing funding models developed by the London School of Economics and looking at ways of improving how care adn support is delivered. 

Once the Green Paper is published the Government will consult again,  stakeholders and the public will again get the opportunity to respond to the models and ideas put forward, and test our ideas as we look towards putting them into practice.

There will be further pieces of work as the reform of England’s care and support system continues. An Ageing Strategy and the Housing Strategy for an Ageing Society are two of the pieces currently in the pipeline.

But the whole process is underpinned by two major pieces of work. Putting People First addresses the changes necessary to mend the failing system in the present and in the short term.

The care and support Green Paper will set the scene for long term reform and enable us to set up a sustainable, affordable and fair system for generations to come.