Author Archives: Stephen Lowe

Care in Crisis 2012; the Architecture of Reform

Age UK’s Care in Crisis report is not only focused on the current funding crisis in social care; it also sets out what Age UK wants to see from a reformed care system. This vision has its origins in the detailed consultation and engagement which we undertook with older people in the run up to the 2010 social care white paper.

Vision is that everyone who uses care should be able to say the following;

  • I receive the care and support I need with no chance of being left without it:
  • My care and support services are high quality and safe:
  • I am able to live safely and with self-respect:
  • I am able to plan in advance before needing care:
  • I am able to pay for care in a fair and transparent way:
  • The system is clear and easy to understand:
  • No family member or friend is forced to sacrifice health, career, social life or future economic security to care for me

These priorities are based on the belief that older people, like everyone else, need to change, to grow, to adapt and to play a full role in society as citizens. The current system all too often seems to assume that all of this ends at the age of 65, after which care and support just needs to keep people safe.

In reality, however, many people face major transitions in older age. The onset of illness or disability, being diagnosed with dementia, loss of close family members, or entering a care home are all major trials of life which call into question people’s identity and future aspirations .  Care and support should be available to support people at all stages of their lives and to help people to manage transitions and life changing events.

Older people who need support may want to move to be nearer to relatives. However if someone depends on local authority care and support, moving to another local authority area can be a bureaucratic nightmare; so care packages should be portable.

Older people still want to be active, to be involved in society, the community and family and to make a contribution. Being able to achieve these aspirations is often important to people’s self image, and to their conception of dignity. So care and support should help older people to live with dignity, to be part of a community and to maintain family and social relationships.

People also need to be active as citizens. In our society, in theory if not always in practice, people should be able to challenge arbitrary decisions by the state. For people who need care and support it is particularly important that decision making is transparent and open to challenge, as the results of poor decision making by public bodies can be catastrophic for the individual. So the recommendations of the Law Commission review of adult social care law – which are to a large extent about clarifying and rationalising decision making by public bodies – should be fully implemented.

No one should ever be refused care without a proper individualised assessment of their needs, and it must be clear where accountability for decisions made by statutory bodies lies.

Many older people welcome the opportunities to manage their own care and support (though others may not). So people should be able to obtain appropriate information and support to negotiate the system and if they wish, to arrange their own care. This includes access to advocacy, and to new roles such as support brokers or care navigators.

The full set of policy calls are set out in Care in Crisis 2012.

Age UK are calling on the Government to reform the adult social care system. Find out more about Age UK’s Care in Crisis campaign and how to sign up to our petition.

Read Care in Crisis 2012






Health Select Committee report – a compelling case for change

The Health Select Committee report on Social Care is clear and unequivocal in saying that current funding for social care is inadequate, and that planned efficiency gains cannot be achieved without fundamental reform. We agree.

The reforms which the committee has in mind are nothing if not radical. A single health and social care system for older people is proposed, with a new legal framework which should cover both health and social care.

To achieve this the committee proposes a single local commissioning process. This should set its sights beyond just health and social care to include other services such as housing. Integration of commissioning would be led by a single high powered commissioner, whose role would be to overcome conflicting local priorities and to ‘create agents within the system who have both the ability and the incentive to drive the necessary process of fundamental change in service provision’. The commissioner would be accountable to NHS Commissioning boards, Local Authorities, service users and to local democratic arrangements.  A single outcomes framework would replace the current Adult social Care and NHS outcome frameworks.

Integration is seen as being not an objective in itself but ‘an essential tool to improve outcomes for individuals and communities’. A pragmatic approach to integration, with the emphasis on integrated processes and outcomes, is very welcome. Proposals that the commissioner should be accountable to the local community and to services also deserve strong support. We look forward to taking part in the debate that this report is sure to stimulate.

In the meantime, we hope the government heeds the commission recommendtion that it should press on with reform, and should implement the Dilnot Commission’s recommendations on care funding as a matter of urgency. We couldn’t agree more.

Age UK are calling on the Government to reform the social care system. Find out more about Age UK’s Care in Crisis campaign and how to sign up to our petition.  

Citizens or consumers? How older people can influence care and support services

About fifteen years ago I worked for a local authority developing a ‘user involvement’ strategy for social services. It wasn’t an authority noted for gung ho radicalism, so I had to put my disability rights background on one side and adopt a ‘total quality’ approach focussed on how user empowerment could be part of a wider quality system.  I was then completely wrong footed when the Director of Housing and Social Services pointed out that in housing the local authority had been much more radical than anything I had advocated and were putting real power in the hands of residents by transferring all housing stock to a tenant management co-operative. The co-operative would take decisions about resource allocation including potentially sensitive issues such as which housing stock would be refurbished first.

So, fifteen years later, how far have we moved on? Are people who use social services in control of how those services are planned, managed and commissioned? The Joseph Rowntree Foundation published a new report ‘Involving Older People in Service Commissioning – more power to their elbow’’ last week.  ( The report concludes that, despite increased policy emphasis on user voice and choice, there are few examples of older people having a real say in commissioning or service planning.

Perhaps the most interesting part of the report is it’s analysis of how local authorities are involving older people. This analysis argues that, broadly speaking, local authorities take one of two approaches, viewing older people either as citizens or as consumers. Citizen involvement seeks to involve the whole community, including older people who are now in good health and might find it difficult to anticipate future needs. It is not focussed on services but on how councils can promote continued independence and wellbeing. In contrast consumer involvement is more limited. It seeks to involve existing service users and the focus is on improving the quality of services. Consumer user involvement is usually initiated and led by service providers.

Current government policy does indeed seem to reflect a dichotomy between ‘democratic’ involvement. Involving the community (citizens) in decision making as part of the localism agenda and a ‘consumerist’ approach to personalisation, turning ‘service users’ into ‘budget holders’ who will be able to exercise power as customers. Reliance on the latter approach alone has been criticised by some, including Age UK, for failing to take account of the imperfections of social care markets or the barriers to service users acting as empowered consumers. It’s also a far cry from the emphasis on mutual and peer support which underpinned the philosophy of ‘independent living’ developed by disabled people from the 1960’s onwards.

The other problem with this dual approach, based on wide democratic involvement and consumerism is that it leaves out a third group – people who do not meet eligibility criteria for local authority care but who need support to remain independent or know that they are likely to in the near future. This group do not qualify as ‘service users’ but neither is their perspective that of the general citizen – the availability of good social care services is a much more important and pressing issue.

The Rowntree report includes in depth studies of two local authorities, Salford and Dorset, who are seen as models of good practice. In both cases one of the keys to bridging the gap between ‘citizens’ and ‘service users’ seems to be the involvement of Older People’s forums and of organisations arising from the ‘POPPS’  (Partnerships with Older People Programme) projects. Older people were involved  influencing the planning and development of extra care housing, helping to redesign older people’s mental health services, and redesigning hospital and community services.

So there are a whole range of ways in which older people can take control of services. Rights, democratic control, involvement of service users and of groups representing a broader range of older people, personal budgets, good quality systems,  with effective mechanisms for giving a voice to service users, mutual and peer support, and outright service user control should all be on the agenda.

Care providers demand more regulation shock

What do care providers want from regulation? Less of it might be a glib answer, and in the past there might have been some truth in this. However the new Care Provider Alliance ‘vision’ of social care regulation is in many respects a plea for more and better Regulation.

Inspectors should look, say the Alliance, not just at whether services are fit to be registered, but at quality, and should grade services on the basis of quality and of the outcomes they achieve. Regulation should be sufficiently rigorous to stop local authorities feeling the need to carry out their own inspections of services that they contract with. Regulators should take time to talk to service users and their families, whose views should form the basis of inspection reports.

Inspectors should be prepared to consider individual complaints from service users and their families. There should be a national framework of regulation in order to prevent local inconsistency in regulation. Local links between providers and inspectors, fractured by reform of the system should be repaired. Poor performing providers should pay more towards the regulatory system.

All of this is strikingly at odds with the views of the current government (and in it’s latter years, the previous one) that providers simply want reduced ‘regulatory burdens’, that the market will drive quality, and that inspection and regulation is a prime area for making cuts. As a result of successive cuts in funding the current regulator, the Care Quality Commission, operates on a much reduced budget of £164.4 million in 2009-10 compared to the £240 million spent by its predecessor organisations in 2005.

The Health Select Committee report on the CQC concluded that the CQC should have been more vocal in pointing out that it did not have the resources to carry out its statutory duties.

CQC has asked for 10% additional funding to carry out it’s duties and seems to be gaining allies in unexpected quarters. However supporters do want improved performance in return for more resources – the Care Provider Alliance wants the CQC to take some of it’s own medicine and to publish evidence that it is meeting it’s own quality standards.

Find out more about our care in crisis campaign

Read our briefing on the Dilnot Commission report on social care