2007 is shaping up to be a critical year for social care as the transfer to more client-centred services gains momentum and the pace of integration quickens. But there are some areas where services are standing still or even going backwards. Natalie Valios and Anabel Unity Sale talk to social care leaders about their hopes for the next 12 months
Last year was a big one for social care. There were some significant pointers that will determine the shape of future services: the joint health and social care white paper Our Health, Our Care, Our Say; the blossoming Independence, Well-being and Choice adult care agenda, including the success of the In Control pilots; a new Mental Health Bill; the looked-after children’s green paper Care Matters; and the launch of the government’s Dignity in Care campaign.
This year will see the unveiling of the comprehensive spending review and the creation of the Commission for Equality and Human Rights. Workforce changes are also keenly awaited. Here, social care leaders anticipate developments over the months ahead.
Anna Reisenberger, acting chief executive, Refugee Council
“We will have to tackle many issues this year. First is the increasingly serious issue of destitution among asylum seekers – the focus of our new campaign Just.Fair. More and more are being made homeless, as the government uses destitution as a tool of policy to try to force people to return home. We remain very concerned about the regulation introduced by the government in 2004 to deny refused asylum seekers secondary health care. All those who have been made destitute are no longer entitled to hospital treatment, and some have become very ill as a result.
Another serious issue is the detention of asylum seekers, particularly families with children. And finally there is the range of problems facing separated children, from being age-disputed to coping with what happens when they turn 18.”
Sandy Buchan, chief executive, Refugee Action
“Major issues facing asylum seekers and those who work with them will include further restrictions on legal aid due this month, which will have an impact on the quality of advice people receive. Internationally, the worsening situations in regions such as the Horn of Africa, Iraq and Afghanistan means that the government will be grappling with the backlog of people who have been refused asylum.
Many are too afraid to return because they fear persecution or war and it is impossible to remove large numbers of people to countries in such turmoil. Unless some form of temporary leave to remain is granted to people in this position, homelessness and destitution will lead to increasing pressures on the voluntary and statutory sectors.”
Sheila Dent, director of policy and operations, The Princess Royal Trust for Carers
“Most carers want to continue working for as long as they can and from April carers of adults will have the right to request flexible working. Social care workers need to be familiar with flexible working and, more importantly, help and encourage carers by ensuring the care package in place for the ‘cared for’ supports this.
The comprehensive spending review could have a big impact on carers – more pressure and any reductions on budgets for social care and health may have a knock-on effect for carers.”
Andrew Chidgey, head of policy and campaigns, Alzheimer’s Society
“Carers will be moved up the political agenda in 2007. The National Institute for Health and Clinical Excellence 2006 dementia clinical guidelines will become a key document that will drive policy change. Specifically, the guidelines have re-emphasised the need for carers to have an assessment of their own needs as highlighted in the Carers and Disabled Children Act 2000 and the Carers (Equal Opportunities) Act 2004. The guidelines also recommend that carers who are experiencing stress be granted better access to psychological services.
Now that health minister Patricia Hewitt and care services minister Ivan Lewis have both committed to a government-backed public debate on who pays for care, we will be pressing to have this debate soon.”
Bert Massie, chair, Disability Rights Commission
“The Disability Equality Duty is going to affect all public authorities over the next year and it should change the way they plan and deliver services to disabled people. From next year the DRC will start using its own enforcement powers. With disability discrimination legislation you have to have the discrimination before you are recompensed, but with the equality duty the public authorities have a duty to promote equal opportunities for disabled people and have to draw up policies and strategies and involve disabled people, not just consult them.
The DRC can inspect equality plans and if we’re not satisfied we can put a compliance order on them. If that doesn’t work we can go to county court and the chief executive can go to prison. It should encourage them to take it seriously.
Also, disabled people are disproportionately represented in all poverty indices. Unless we deal with disabled poverty we won’t hit other poverty targets.”
Chris Brace, deputy director of campaigns, Radar
“Independent living will be a theme that will run through 2007. Lord Ashley of Stoke’s Independent Living Bill is currently awaiting a second reading in the House of Lords. It encompasses the vision of full human rights for disabled people and guaranteeing independent living would be a giant stride towards true equality.
The Welfare Reform Bill is likely to be passed before the end of this financial year. Radar believes it should be amended to ensure there is no distinction between “can” and “cannot work”, a commitment to work with current claimants, informed and encouraged voluntary participation for all, and a commitment from the government to work with employers.
Also on our mind is the dissolution of the Disability Rights Commission and the creation of the Commission for Equality and Human Rights. It is important in the transition that the voice of disability is not lost.”
Graeme Brown, director of communications, policy and campaigns, Shelter
“All the evidence suggests that housing will be a major political issue this year. A recent Prime Minister’s Strategy Unit paper highlighted housing issues. These included demographic change, with more people living longer and living alone, as well as a lack of housing and house building. Let’s also not forget that chancellor Gordon Brown has been dropping clear hints that social housing will be a key political priority in the comprehensive spending review this July. The Commons select committee endorsed Shelter’s call for 20,000 extra social rented homes, and 120 MPs have now backed a motion calling on ministers to deliver them. This will be the crunch year for the future of housing in this country.”
David Orr, chief executive, National Housing Federation
“A stable home is key to offering vulnerable people greater choice, control and independence in their lives. The federation will be lobbying intensively to secure additional resources for housing from the forthcoming comprehensive spending review. Also, the future funding and stability of the Supporting People programme will remain a concern.
A new area of great significance will be where supported housing sits within the strategic vision and delivery framework of a new communities agency, should the anticipated merger between the Housing Corporation and English Partnerships go ahead.”
John Kemmis (pictured), chief executive, Voice
“There is a recognition that the state has a unique role when it takes on parental responsibilities.
As parents we put our children first – if the state is to act like a true parent then this requires a real shift in priorities and resources. In 2007 we will need to focus on the key changes that will actually make a difference and make the care system work as it should. These must include allocation of substantial resources to improve the quality of care and make inroads into the preventive agenda, as well as resources to skill up the workforce. Children will need to be empowered to participate in the decisionmaking process and their access to advocacy must be broadened.”
Paul Fallon, co-chair of the ADSS children and families committee
“The first few months of the year will involve making sense of the Care Matters consultation and the output of its four working groups. The issues in Care Matters that will make the biggest difference if they are properly resourced are the workforce, including foster carers, and developing local placement choice, particularly in the big cities so that we can achieve greater continuity of care.
The rest of the green paper will work only if we can improve these areas. But while we are confident that outcomes for looked-after children will continue to improve, if we are successful with earlier prevention that means fewer children coming into care. Those who are in care will tend to be the ones who have suffered the greatest disadvantages. That means that if the numbers begin to fall but the complexity of their needs continues to increase it may be that outcomes don’t improve that much because we are dealing with kids with more challenging needs. So we have to be careful about how we interpret the data as the care population changes.”
Rob Greig, national director of learning difficulties
“I’m expecting that the Department of Health response to the Disability Rights Commission’s report into health inequalities [Equal Treatment: Closing the Gap] will lead to a programme of work nationally and locally that will do something about changing those inequalities. After the Cornwall case the Department of Health (DH) announced ways it will address the underpinning causes of the abuse and one of these was that ministers asked officials to bring forward proposals for strengthening the lead role for local authorities in commissioning learning difficulty services. This will happen early in the year and I’d hope to see better commissioning as a result so that the number of outdated NHS institutional services continues to reduce.
Also the Department for Work and Pensions is changing approaches to the employment of disabled people. I look forward to the outcome of that and to ensuring that people with learning difficultiesbenefit in practice.”
Jo Williams, chief executive, Mencap
“We hope there will be something for disabled children and their families in the comprehensive spending review – a recognition that as a group they need additional resources. And in the adult world we have heard of significant cuts in services and we know that the number of people requiring support is growing which is why the financial situation is so vital.
If we don’t get the right allocation of resources into the world of learning difficulty, I fear that some people will be forced to go into institutional care and have less choice. That’s the danger factor.”
Moira Fraser, head of policy, Mental Health Foundation
“The implementation of the Mental Capacity Act this coming April will have a profound effect on all services – not just mental health. It will mean a host of new services and procedures, new advocacy services and new appeals processes. More fundamentally, it will shift the focus away from making assumptions about how people who lack capacity should be treated – often resulting in providing the cheapest or easiest option – to actively considering in every case what they would have wanted, and what’s in their best interests.”
Neil Hunt, chief executive, Alzheimer’s Society
“The Mental Capacity Act coming into force is a massive step forward in improving the civil rights of people with mental health problems. It is going to increase the requirement for all of us working across health and social care to understand the needs of people with mental health problems and support them to make decisions.
The NHS financial crisis is already resulting in money being siphoned off mental health trusts and this may continue to hinder the ability of the mental health sector to develop services in 2007.”
Jonathan Ellis, senior policy manager, Help the Aged
“A big theme will be the whole question of capacity and resource within social care services. 2007 is going to see the new spending review settlement and that will throw the spotlight on how much or how little councils are going to be able to deliver for older people. This will spark a much wider debate, taking on Wanless, about what the state will or will not provide for older people in the future and how we are going to pay for that.
Choice and control are another theme: for example, how individualised budgets shape up and what that’s going to mean for the way services are organised and provided in the future.
Ageing issues will be one of the biggest themes within the care world next year: age’s time has come in terms of that bigger policy debate.”
Jane Ashcroft, managing director care services, Anchor Trust
“Three key themes are critical for this year. The first is funding, which is always an issue for services for older people, particularly because of the comprehensive spending review. The aspirations coming from government and providers to improve services need to be tied in with the funding agenda.
Aligned with funding is the issue of the workforce. The quality of services is entirely linked to the quality of our workforce. We welcome [future] registration of care workers with the General Social Care Council. And Ivan Lewis, care services minister, has been talking about the [DH’s] Dignity in Care campaign. I hope it will raise the profile of respecting older people generally, not just older people in care homes.”
Andrea Rowe, chief executive, Skills for Care
“A lot depends on the registration by the General Social Care Council of the wider social care workforce. At the point of registration or re-registration there will be training issues. Also, Our Health, Our Care, Our Say gives a firm role for service users to decide what training requirements they want for the social care workforce.
Increasingly, service users have more complex needs and this pressure tends to fall on front-line workers who will need their training to be adapted. We will see a shift from generic to specialist training.”
Lynne Berry, chief executive, General Social Care Council
“Registration has raised the status of social workers, acknowledging them to be highly trained and accountable professionals.
The new framework will ensure that service users get what they have asked for: a trained and trusted workforce. The challenge for continuous professional development and training will be to embrace this new partnership approach. It needs to be embedded in the sector, and I expect it will be reflected in the outcome of the review of the roles and tasks of social work, which the GSCC is leading, so that this partnership will inform the future of the profession.”
This article appeared in the 4 January issue under the headline “What are the prospects?”
This weeks other feature articles
Award winners: Family Days scoop the top prize. How did they do it?
Workplace stress and how to avoid it
Teenage pregnancies: how one east London project is involving teenagers in child care to discourage pregnancies