What is our society’s vision for social care?

This article was originally posted at Left Foot Forward.

Social care is currently in crisis due to lack of funding. The number of older people needing care is growing but rationing through eligibility criteria means fewer and fewer are qualifying for local authority support. There are few services aimed at preventing those with low-level care needs from reaching a crisis situation. The £2bn “additional funding” announced in the Comprehensive Spending Review barely covers the CSR-created hole in local authority care spending and so we predict a small overall drop in funding over the next four years, threatening to turn this problem into a disaster. Reform to the care system is urgent.

The recent announcement A Vision for Adult Social Care: Capable Communities and Active Citizens, forms a part of the Government’s longer-term plans for reforming social care in England. As such, it builds on Coalition Agreement commitments , and provides a steer to the two major reviews currently in progress, these being the Law Commission review of adult social care law and the Dilnot Commission on the long term funding of social care. Following these reviews the Government plans to publish a white paper late in 2011 leading to an adult social care reform bill in 2012.

The vision sets out values and principles that the Government believes should underpin social care. The values are ‘freedom’ (which in practice refers to choice in a ‘vibrant plural market’), ‘fairness’ involving a lasting settlement to the question of how we should pay for the care, and ‘responsibility’ which is seen as lying with communities and with wider civil society and not just with the state.

A ‘Big Society approach to social care lies at the heart of the Government’s vision’. One of ‘community action working alongside statutory services’. Although many Big Society initiatives may have contributions to make which we welcome, they cannot be a substitute for appropriately trained professional staff.

The vision states the Government’s strong commitment to personalisation and intends that all social care and support users should hold personal budgets, ‘preferably as direct payments’. Information, support and assurance are seen as being particularly important for older people. ‘Strengthening the voice, choice and control of older people with high support needs will’, the report says, ‘take time and effort to achieve’.

From this it seems that the vision envisages that people who live in care homes and those who do not have mental capacity should be offered the same opportunities for choice and control as anyone else. However, older people face particular difficulties in using cash payments to buy support services. Older people often obtain help following a crisis such as a hospital stay, at which point they may not feel well enough to think about arranging their own care. In many cases, their main carer will be a wife, husband or partner who may be overwhelmed by the responsibility and work of looking after their loved one without adding the anxiety of managing a budget. So whilst some older people will want direct payments many will not, regardless of how much support is offered. We are therefore concerned that older people will be pressurised into accepting cash payments. Personalisation means that the older person’s preference should matter, not the Government’s.

We are concerned that many of the component parts of the system that the Government envisages will protect social care service users are currently, or have in the recent past, experienced substantial cuts in funding. This is particularly true of regulation, but many community organisations that could provide information and support and contribute to the ‘vigilant society’ are also being cut.

The vision acknowledges the importance of carers, and rightly so. Any cuts in funding for care support inevitably heap more work onto the shoulders of informal carers who often experience poor health themselves. Age UK has pushed for greater financial, practical and emotional support as part of our Older Carers Campaign – the increased budget available for respite care is a good first step. Carers often make great personal and financial scarifies to care for their loved ones, savingthe economy an estimated £87billion a year.

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