Guest Blog: why I welcome the Government’s actions to overhaul social care system

This blog was contributed by Dr Dan Poulter, Conservative MP for Central Suffolk and North Ipswich and a member of the Health Select Committee

Yesterday’s announcement by the Secretary of State for Health on the Government’s plans to radically reform the way we support and care for our older people is both welcome and long overdue.

For too long, our frail older people have been pushed from pillar to post when attempting to navigate our unwieldy social care system. The Caring for our future White Paper shows that this Government is getting to grips with reforming the system of social care so that frail elderly people are treated with the respect and dignity they deserve.

Redesigning health and social care services to provide dignity in care for older people is the biggest human and financial challenge facing health and social services. Continue reading “Guest Blog: why I welcome the Government’s actions to overhaul social care system”

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.  

Guest Blog – Four things you never knew about social care ?

 This guest blog was contributed by Richard Humphries, Senior Fellow at The King’s Fund. Richard joined The King’s Fund in March 2009 to lead on social care. His professional background is social work, having worked in a variety of roles including Director of Social Services and Health Authority Chief Executive (the first combined post in England).

Age UK’s new report – Care in Crisis 2012– is the latest clarion call to sort out a care system which even Government ministers accept is broken. The report sets

Richard Humphries

out in stark detail just how many people are going without the care they need. Public spending on care for older people is actually going down even though numbers are going up – especially frail very old people who need the most care. England is no different from all advanced countries in the world that need to devote a bigger share of the national wealth to an ageing population – itself a sign of social and economic success. Yet we are finding it remarkably difficult to rise to the challenge.

Here are four things you may not know about England’s social care system. It has its origins in the 1948 National Assistance Act when the world was a different place, with much lower standards of living, health and wealth. 64 years on, the care system must be the only public service that has never been fundamentally reformed to keep up with changing times (although it has been frequently reorganized, which is not the same thing). We wouldn’t dream of running any other major service as though we were still in the 1940s. The system has suffered from years of policy tinkering instead of sensible long term reform.

Second, if you have savings or assets of more than £23,250, you will be entirely responsible for the full cost of residential care, a cliff-edge so steep it makes Beachy Head look like a gentle slope. Many people do not realize this until it is too late. Some think , wrongly, that the NHS will pick up the bill.

Third, that even if you are relatively poor, it is unlikely that your local authority will help you. 82% of councils limit the help they provide to those with ‘substantial’ or ‘critical’ needs i.e. you will need to have become very dependent indeed before you can get help. England must be unique in simultaneously restricting help to those with the highest needs and the lowest means.

And finally, that your chance of needing care and support in later life is much higher than you think – one third of men and a half of all women will have a significant care need at some point in their retirement. So we all have a stake in seeing a better system fit for the 21st century.

The King’s Fund has been arguing the case for change, alongside many other charities, since our major review by Sir Derek Wanless in 2006. Since then White Papers and Green Papers have passed like ships in the night. The Government pledged to set up an independent commission to look at how care is funded. It delivered on that commitment and the commission headed by eminent economist Andrew Dilnot has produced proposals that command almost universal support from organisations involved in older people’s care. We agree that they offer a sensible framework in which the costs of care can be met. But reform of funding must go hand in hand with reform of how care is delivered.

The Age UK report sets out seven major building blocks for change including quality, safety and dignity in care. The Government will soon set out its stall in a White Paper and accompanying response to the Dilnot report – its authors could do worse than make sure Care in Crisis 2012 is top of their preparatory reading list.

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

Care in crisis – urgent action needed

Last week Age UK launched its Care in Crisis campaign in order to highlight to Government to widespread support for urgent reform of the social care system.

Social care is currently in crisis and is letting people down.  Across England eligibility thresholds are being restricted, charges are increasing and services squeezed.

Currently around 800,000 older people in need of care and support don’t get any formal help. This shocking figure shows just how serious the crisis has become.

For those people able to access services, the support they receive is too often inadequate or poor quality leaving them without the care they need to live safely and with dignity.

Without urgent action this crisis will continue.

So last week Age UK launched its Care in Crisis campaign and petition urging the Government to grasp this opportunity for far-reaching and sustainable reform of the care system. Continue reading “Care in crisis – urgent action needed”

A long way from home: the challenge of end of life care

Professor Sheila Payne’s recent Knowledge Hub article lays out some of the challenges of achieving a good death for older people (The lure of dying at home: an impossible dream for the oldest old?). In particular, Professor Payne highlights how the aspiration of helping more people die at home is not a straight-forward one.

What the aspiration itself tells us about how people want to die is perhaps more interesting than the specifics of location.

In the first instance, a failure to die at home can indicate poor planning and a lack of appropriate services when people most need them. It is a frequent story to hear of someone’s condition change in the middle of the night and for family or carers to have no support or preparation to deal with a moment of crisis.

The outcome is often an ambulance ride to hospital only to die on a ward.

Older people will often have to deal with pain and have multiple support needs in the last weeks and months of life. These could well be dealt with at home yet the resources and appropriate professionals are not put in place or the GP is not always confident to provide the right support.

Again, the aim is simply to be comfortable and assisted when needed yet people are not able to expect this outside of a formal care setting.

It is for these reasons that many people see dying at home as a proxy for indicating better quality end of life care. Partly on this basis, the previous Government had aimed to set a target for increasing the number of home deaths.

In opposition, the current Secretary of State for Health, Andrew Lansley MP, rejected this notion, in part simply a rejection of targets. The approach the Coalition Government have taken is to propose a tariff for end of life care that would enable people to exercise more choice over how they are cared for at the end of life.

Following a review, the Department of Health has this week opened applications for piloting a new approach to palliative care funding. What the review had grappled with is how to fully support people at the end of life when a large proportion of care comes from social care and, where available, the voluntary sector in the form of hospices and home care support.

Professor Payne highlights this challenge when she dispels the notion that everyone has a comfortable house and loving family to look after them. Simply providing more health care will never be enough to help people have a good death.

However, exploring preferences with individuals and making a realistic assessment of need that takes in all aspects of a person’s life will help to improve their experience of care, regardless of their circumstances. Central to this also means substantially improving the care available to people in care homes.

Truly person-centred care must be the guiding principle not assumptions about what people want or what social resources they have available to them.

This is something the new Health and Wellbeing Boards (HWB) the Clinical Commissioning Groups (CCG), proposed in the Health and Social Care Bill, will need to grapple with. So far, the priority, for the former in particular, has been on improving public health, naturally a vital area of focus.

However, they must not forget their obligations to people at the end of life nor the distance that needs to be travelled to improve outcomes for older people more generally.

Joint health and wellbeing strategies, which the HWBs and CCGs will need to co-produce must include provisions for end of life care. Importantly, they must cover the breadth of services and potential interventions including, for example, housing and benefits support as well as health and social care.

Help the Aged, one of Age UK’s legacy organisations, commissioned research to explore what older people want at the end of life. One participant neatly sums up many of these issues:

“In the end, I asked to take him home. But I had to battle and involve the social worker. Many people want to come home [at the end of their lives].They do better. But I had to battle. Why is it so hard?”

Read Professor Sheila Payne’s guest article

Find out information related to older people in our Knowledge Hub

Growing pains – health and social care bill debate in the House of Lords

The Health and Social Care Bill has its second reading – a debate on the general principles of the Bill – in the House of Lords on Tuesday 11th and Wednesday 12thOctober. More than 90 Members of the Lords have put their names down to take part in the two-day debate. Two Peers have tabled amendments to try and force extra scrutiny of the Bill because of concerns that the Bill was rushed through the House of Commons. Labour peer Lord Rea, a former lecturer at St.Thomas’ Hospital Medical School and GP, has tabled a motion that, if passed, would mean the Bill would go no further in the House of Lords and could not pass into law in this session of Parliament. Lord Owen, a Crossbench peer, physician and former Parliamentary Under-Secretary for Health, has tabled a motion that would have the effect of sending certain clauses of the Bill to a select committee. In particular Lord Owen wants to see extra examination of changes the Bill makes to control of the NHS, the role of the secretary of state and the plans for Monitor, the new NHS regulator.

 The Bill, which has completed its progress in the House of Commons, aims to change how NHS care is commissioned through the greater involvement of clinicians and a new NHS Commissioning Board; to improve accountability and the involvement of patients in their care and to give NHS providers new freedoms to improve quality of care.

 Age UK wants to see the Bill act as a catalyst to improve health services for older people. Throughout our work with parliamentarians during the course of this bill we have been pointing out the problems older people face in accessing health and social care services. Too many older people in the UK experience poor practice and ageist attitudes when it comes to care which can put their health at risk.  Older people often struggle to access the basic care they need as the NHS continues to under-commission essential preventative services such as falls prevention, continence care and audiology. These types of services make a huge contribution to keeping older people well, independent in their own homes and helping to maintain a decent quality of life.

 NHS reforms will impact on everyone to a greater or lesser extent but they are likely to be most keenly felt by older people; patients over 65 account for around 60% of admissions and 70% of bed days in NHS hospitals. Our ageing population means it is more and more important for the NHS to meet the needs of older people. We want the new NHS commissioning board to instigate a fundamental review of how the NHS and local authorities assess, prioritise and commission services to meet the needs of an ageing population to make sure NHS structures, particularly the new commissioning bodies understand and know how to meet the needs of older people across the UK.

Read our Health and Social Care Bill briefing