Last month the Department of Health announced that it intended to ‘co-produce’ the proposed social care reform white paper. This month, on the 15th of September it has launched an ‘engagement’, entitled ‘Caring for our future; shared ambitions for care and support’ which is intended as the first step toward making good on this commitment.
The content of the engagement reveals that the scope of reform is meant to go well beyond responding to the proposals of the Dilnot Commission on long term care funding or the Law Commission review of adult social care law. However the government does ask for people’s views on the recommendations of the Law Commission and the Dilnot Commission ‘and on ‘how we should assess these proposals, including in relation to other potential priorities for improvement’. So the DH is still thinking about the extent to which they intend to implement the proposals of the two commissions.
The engagement focuses on six key areas. These are;
- quality – including improving quality and developing the future workforce;
- personalisation – giving people more choice and control and helping them to make informed decisions;
- shaping local care services in order to ensure a wide range of innovative and responsive services;
- prevention and early intervention;
- integration, in particular better connections between the NHS and local services; and
- the role of financial services.
The engagement runs for three months. There will be a series of events and meetings which will be attended by six ‘discussion leaders’ drawn from the ‘care and support community’ – one for each of the six key areas. The discussion leaders come from a variety of backgrounds representing service providers, local authorities and the NHS. Jeremy Hughes from the Alzheimer’s Society and Imelda Redmond from Carers UK represent service users and carers. There will also be a web based feedback form that people can use to respond directly. This can be found at www.caringforourfuture.dh.gov.uk. Written comments must be sent to the Department of Health by December 2nd.
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Last Thursday four disability groups demonstrated at Kensington Town Hall in support of Elaine MacDonald. Ms MacDonald has recently, following a Supreme Court judgment, been told that the local authority is entitled to withdraw her night time care and to require her to wear incontinence pads even though she is not incontinent.
The four groups have raised some important concerns about the review process that led to the withdrawal of Ms. MacDonald’s services. A leaflet for the demonstration says ‘the ruling has accepted that reviewing care plans can be treated as a reassessment of need. Therefore any contact with social services, even a phone call, could lead to detrimental changes to a disabled person’s care package’.
This is indeed an issue. One of the five Supreme Court judges, Lord Kerr, concluded that, even though although two reviews of Ms MacDonald’s care were not intended to be reassessments, they yielded sufficient information to enable the council to legitimately change the way that it met her needs.
Obviously if this was correct it would have a knock-on effect in that if the local authority was not intending to assess the person’s needs they would not tell the person that they were being assessed. The fears expressed by the four disability groups therefore seem well justified.
Age UK was also concerned about the review process in this case, as it falls short of being a decent assessment of need in one crucial respect. Ms MacDonald’s original assessment follows the guidance (Fair Access to Care Services as it was then) by setting out risks to independence and what services are needed to reduce these risks.
However the subsequent review just recorded that Ms MacDonald’s needs continued to be critical and substantial but did not analyse why. The local authority subsequently reached the conclusion that the ‘underlying need’ was to keep Ms. MacDonald safe – which resulted in other needs identified by the initial assessment – such as psychological wellbeing – being seen as of secondary importance.
If the review had done what the initial assessment had done and set out the reasons that care was being provided it is quite possible Ms. MacDonald would have been able to use this to challenge the idea that her need was simply to be kept safe. Continue reading