On Wednesday the Health Secretary Andrew Lansley announced the Government’s measures to reform social care in England. In fact a number of documents were published simultaneously; the White Paper, the draft Care and Support Bill, a progress report on the future funding of social care (Dilnot), a response to the Law Commission recommendations and finally a response to the Health Select Committee, not to mention plethora of equality and impact assessments.
Most of the news headlines are about funding. However, there is much to welcome in the body of the text on the document. The new system will:
- focus on people’s well-being and support them to stay independent for as long as possible
- introduce greater national consistency in access to care and support
- provide better information to help people make choices about their care
- give people more control over their care
- improve support for carers
- improve the quality of care and support
- improve integration of different services
The Caring for Our Future engagement exercise has led to the Government taking on board a number of the problems highlighted by stakeholders, including WRVS. For example, too often the system only reacts to a crisis, people do not have access to good information and advice and society does not make the most of the assets embedded in communities. In addition access to care varies from authority to authority. All of these problems are magnified as the population ages and lives longer in the absence of no new thinking.
The Government now fully recognises that not enough is done to intervene early to support people to remain independent and healthy. Failure to support people at an early stage means that many people are needlessly admitted to hospital because they have an accident or crisis and lose their independence. This is wasteful in so many ways.
The White Paper states that loneliness and social isolation remains a huge problem that society has failed to tackle. Up to 16 per cent of older people in the United Kingdom are said to be lonely, potentially leading to poor physical and mental health, including depression. The White Paper also cites that more than a million people over the age of 65 report feeling lonely often or always, and a similar number report feeling trapped at home.
The Government concedes that social isolation is not something that they or services can tackle on their own, but that action can be initiated to recognise and identify the most isolated people. The work led by the Campaign to End Loneliness, of which WRVS is a founder member, has important contribution to make in this area. The 2013/14 Public Health and Adult Social Care Outcome Frameworks, will set out how the Government will measure the effects on well-being of social isolation, and will work with the care and support sector to establish measures of loneliness that help to identify isolation.
Another key policy to retain an older person’s independence is making prevention and early intervention a core local authority role. The White Paper includes a duty on local authorities to commission and provide preventive services in the draft Care and Support Bill. Local authorities will work with their communities to commission support that helps to keep people well and independent. This means that local stakeholder will need to engage with the local commissioners. How this will work in practice and what controls will be in place remains to be seen, but the sentiment is right.
Over recent years eligibility criteria has been tightened, with now over 82% funding substantial or critical needs only. It’s become a post code lottery with a widespread feeling that the system is confusing and unfair. From 2015, the Government will introduce a national minimum eligibility threshold. Once implemented, local authorities will be free to set their eligibility threshold at a more generous level, but will not be able to tighten beyond the new national minimum threshold. Entitlements to care and support will be much clearer and fairer, reducing the variations in access that currently exist between local authorities. The introduction of a national minimum eligibility threshold will help to overcome some of the barriers that people face when they wish to move home.
Many older people are carers too, often to their spouse or a relative. The White Paper sets out plans to identify and support carers by legislating to extend the right to a carer’s assessment, and provide an entitlement to public support for the first time. This will remove many of the limitations in current law and means that carers and people who use services will have equal access to an assessment, with greater consistency in the way that carers are treated.
There will be a ban on age discrimination in health and social care services from October 2012 and dignity and respect will be at the heart of training for care providers.
There is a further desire to give people more control over their care. This means providing them with the correct levels of advice and information in a clear and accessible way. The White Paper makes further commitments to better integration and coordination between health and social care services. A further £300million is being transferred from the NHS to social care by 2014/15 over and above the £2.4billion announced in the 2010 Spending Review to help ease the implementation of the new reforms .
The White Paper is clear that it is not intended to set out a funding settlement for care and support in future years. It believes that the outlined reforms will ensure that resources – from both individuals and the taxpayer – are used in the best possible way to promote people’s well-being and independence. Future decisions on the overall funding in the system will be taken alongside other funding decisions at Spending Reviews.
The Accompanying impact assessment estimates that the costs of all of the measures in the White Paper taken over a 10 year time frame (2012/13-2021/22) amount to £2.112billion. The savings over the same period amount to £178million. This would seem to suggest that a substantial amount of the transfers will be eaten up by the policies in the White Paper unless further tranches of money are made available in future years to ease the transition as local finances remain squeezed and demographic changes continue take hold.
Posted by Steve Smith Public Affairs Officer (England) at 00:00
Friday, 13 July 2012.
Introducing a requirement for councils to invest in preventative practices and early intervention is a step in the right direction. But it is merely a step. As local authorities cut back on non essential services, the White Paper has failed to address the estimated £1billion shortfall that is leading councils to cut these vital services and leave older people vulnerable in their own homes. To turn the rhetoric into reality, the Government must put measures in place to ensure local authorities act on the White Paper advice and commission services that offer a standard of care to older people in their community that will enable them to live life instead of merely exist.
Some councils are already finding cost effective ways to implement support services without damaging the long term health of their communities but others seem to be making knee jerk decisions based on the pounds they will save in the short term without thought for the huge increases in costs they are storing up for the future.
The services WRVS’ 40,000 volunteers provide – a helping hand, a warm meal, a lift to hospital or a chat over a cup of tea – help older people stay independent in their own homes for longer and ensure they remain connected to their communities. Delivered by volunteers, they are cost effective and save lives as well as money for the taxpayer.