by Ruth CartwrightWe social workers will be looking at this in two ways - as possible members of the National Care Service and as people who may ourselves be in need of care and support one day.
BASW welcomes this initiative to engage in a debate across society about how we as a society make sure that people who need care and support receive it in a 'fair, simple and affordable' way.
It is a great pity that the public engagement has not yet raised awareness that social care is presently paid for by the recipients and that means-testing takes place. So this debate happens in the context of 65% of people thinking that this care is free and that now we are going to be made to pay for it.
People are also unacquainted with the real costs of social care, so Andy Burnham and colleagues at the Department of Health have a lot of work to do over the next months.
The funding models
The green paper presents five funding models (although two are ruled out, this is a consultation so they can be considered as can completely new ideas.) Having worked in the field and seen the problems that can be caused when people enter residential care and the house has to be sold and the inheritance lost, I can see merit in everyone sharing the expense to the extent they can afford to do so. This is how we pay for medical care although some of us rarely visit a doctor or use a hospital.
One of the big issues the green paper throws up is who will allocate funding and decide how needs should be assessed. There is a strong move to have a common system nationally to end the 'postcode lottery,' but this could mean government takes over some of the local authority role. The best model would be one where there is a national offer but also scope for local flexibilities, and where the assessment process is based on the social rather than the medical model, carried out in partnership with service user, family and carers. And the 'minimum entitlement' has to be acceptable and not a poor second rate service for those without additional means.
Benefits and prevention
Another issue concerns benefits such as Disability Living and Attendance Allowances. These could be rolled into personal care budgets (whether administered by individuals or by the Council) but then would only go to people who were assessed as needing care and support. And if this money was handed over to councils would this be a fair deal? There were issues when DHSS money for residential care was passed to local authorities and didn't seem to go very far.
A further area to be teased out is what is meant when State funding would not include 'food and lodging.' At the moment those in residential care who have run out of their own money are left with approximately £21 a week 'pocket money' - this would not be enough to meet these costs so there would have to be some adjustment.
The emphasis on preventive care is welcome and of course most of the above is predicated on people being admitted into care homes, which only happens to a minority of the population. However, preventive care requires resources up front while acute needs have still to be met and the government has never resolved this 'double funding' dilemma. BASW repeats its request that a transfer of health funding be considered as preventive work and early intervention by social care saves the NHS a great deal of money.
The role of social workers
It is good that the Green Paper uses human rights terms like 'entitlement' and 'rights' and I believe its authors have striven to see people as active citizens rather than passive recipients of care.
What would social workers' role be in the National Care Service? Personalisation is supposed to underpin the reforms so our way of working with people and their families to ensure needs are met in an individual way should hold sway whatever the new system.
However, the government does need to consider how with any reform managers and policy makers often go with the letter of the law rather than the spirit and use it as a way to reduce services and staffing costs - FACS anyone?
The personalisation agenda
We cannot deny we are in recession and are likely to be facing budget cuts in social care, so there will be a strong motivation to implement any reforms in such a way as to save money, meet targets and let as many service users as possible fend for themselves.
The paper says services will be of good quality - nothing to argue with there but there are concerns around the personalisation agenda about where all the new individualised flexible services and workers are going to come from and whether it can just be left to market forces. Our commissioners often do not have social care backgrounds and are under pressure to commission for cheapness rather than quality in some areas.
There is no doubt that action needs to be taken - it is good news that people are living longer and that people with disabilities are surviving, but this does mean that care and support needs will increase. We have to think about this for ourselves and for our whole society and the government is right to raise this debate. We should all engage with it and I urge you to look at the green paper and consider the issues it raises (www.dh.gov.uk and www.careandsupport.direct.gov.uk) The consultation period ends in November and there will be some public consultation events so look out for the opportunity to have your say.
Ruth Cartwright is professional officer at the British Association of Social Workers
It is a great pity that the public engagement has not yet raised awareness that social care is presently paid for by the recipients and that means-testing takes place. So this debate happens in the context of 65% of people thinking that this care is free and that now we are going to be made to pay for it.
People are also unacquainted with the real costs of social care, so Andy Burnham and colleagues at the Department of Health have a lot of work to do over the next months.
The funding models
The green paper presents five funding models (although two are ruled out, this is a consultation so they can be considered as can completely new ideas.) Having worked in the field and seen the problems that can be caused when people enter residential care and the house has to be sold and the inheritance lost, I can see merit in everyone sharing the expense to the extent they can afford to do so. This is how we pay for medical care although some of us rarely visit a doctor or use a hospital.
One of the big issues the green paper throws up is who will allocate funding and decide how needs should be assessed. There is a strong move to have a common system nationally to end the 'postcode lottery,' but this could mean government takes over some of the local authority role. The best model would be one where there is a national offer but also scope for local flexibilities, and where the assessment process is based on the social rather than the medical model, carried out in partnership with service user, family and carers. And the 'minimum entitlement' has to be acceptable and not a poor second rate service for those without additional means.
Benefits and prevention
Another issue concerns benefits such as Disability Living and Attendance Allowances. These could be rolled into personal care budgets (whether administered by individuals or by the Council) but then would only go to people who were assessed as needing care and support. And if this money was handed over to councils would this be a fair deal? There were issues when DHSS money for residential care was passed to local authorities and didn't seem to go very far.
A further area to be teased out is what is meant when State funding would not include 'food and lodging.' At the moment those in residential care who have run out of their own money are left with approximately £21 a week 'pocket money' - this would not be enough to meet these costs so there would have to be some adjustment.
The emphasis on preventive care is welcome and of course most of the above is predicated on people being admitted into care homes, which only happens to a minority of the population. However, preventive care requires resources up front while acute needs have still to be met and the government has never resolved this 'double funding' dilemma. BASW repeats its request that a transfer of health funding be considered as preventive work and early intervention by social care saves the NHS a great deal of money.
The role of social workers
It is good that the Green Paper uses human rights terms like 'entitlement' and 'rights' and I believe its authors have striven to see people as active citizens rather than passive recipients of care.
What would social workers' role be in the National Care Service? Personalisation is supposed to underpin the reforms so our way of working with people and their families to ensure needs are met in an individual way should hold sway whatever the new system.
However, the government does need to consider how with any reform managers and policy makers often go with the letter of the law rather than the spirit and use it as a way to reduce services and staffing costs - FACS anyone?
The personalisation agenda
We cannot deny we are in recession and are likely to be facing budget cuts in social care, so there will be a strong motivation to implement any reforms in such a way as to save money, meet targets and let as many service users as possible fend for themselves.
The paper says services will be of good quality - nothing to argue with there but there are concerns around the personalisation agenda about where all the new individualised flexible services and workers are going to come from and whether it can just be left to market forces. Our commissioners often do not have social care backgrounds and are under pressure to commission for cheapness rather than quality in some areas.
There is no doubt that action needs to be taken - it is good news that people are living longer and that people with disabilities are surviving, but this does mean that care and support needs will increase. We have to think about this for ourselves and for our whole society and the government is right to raise this debate. We should all engage with it and I urge you to look at the green paper and consider the issues it raises (www.dh.gov.uk and www.careandsupport.direct.gov.uk) The consultation period ends in November and there will be some public consultation events so look out for the opportunity to have your say.
Ruth Cartwright is professional officer at the British Association of Social Workers
We need a comprehensive service to which we have all contributed at some point in our working lives, according to our means.
We need options to choose from. For example we need excellent, local supported living, so that when living in ones own family home is no longer viable, due to infirmity - size of house garden etc.) a transfer to a supported living situation with ones own front door should be possible.
We need support for carers so that if one is supporting ones spouse at home help is available as well as social work support to work through the emotions of loss, the tensions of care and devising a future for oneself following the death of ones spouse.
I am amazed that given the urgency and seriousness for this discussion that the report itself costs more than £26. If the government was serious about this consultation, it would be giving out free copies at all local libraries.
Jess's comment about when people can no longer remain in their own property highlights exactly why prevention is better than cure. no one should have to consider residential care purely because of the size of the house or the garden, these are easily rectifiable *if* if there is an affordable preventions service to hand.
residential care should be about when a person's actual care needs can no longer be met in their own home, not just about the "nuts and bolts" maintenance of their own home. why can't the green paper look at funding a handypersons service alongside other more "trad" forms of care, this way the person's garden and the practalities are taken care of at a much cheaper rate than shifting the poor soul into a care "home".
how many people are in residential care because they couldn't cope with running a house and sold up to go self-funding into care, only for the LA to have to fund them when the capital runs low? by then the psychological dependency on 24 hr care is well established. I can think of plenty of service users i've seen...
EB you have made a good point there about running and maintaining ones own house.
However as I check out with older people 85 plus, who are widowed, some of them say that the day to day work of looking after onself, shopping, cooking, cleaning, washing, getting repairs done on the house, sorting out the garden becomes too much, too stressful and take up so much energy that they have a dimished quality of life. One friend had given power of attorney to her daughter to sort out payments to plummers and legal arrangements over unsatisfactory work, so as to take the stress off herself.
My Great aunt born in the 1800's lived to be 99. for years she was one of 4 paying boarders with a land lady. She used to visit us twice a year.
My grandma came to live with us (my parent's home) once grandfater died and later so did his sister. Grandma died on holiday in the caravan with us and my grandfathers' sister at home with us.
Now with the next generation, my brother and his wife are looking after my mother who gave up her home 2 years after my father died. keeping the central heating going and carers coming in from a distance proved impossible for us. My brother's mother inlaw, who was given 6 months to live, gave up her home and came to join them. She has nowlived at least 2 years.
Basically looking after houses and onself in old age when one is widowed gets to be too much for some people as they grow older and frailer.
I am at present giving my brother and his wife respite by looking after the two ladies for a week. Both can climb the stairs but only once a day. I will not detail the routine. All the parties contribute to the rent, but once the landlord requires the house, bought for his retirement, then who knows what the future will bring as we are all retired people too!