by Peter BeresfordThe prime minister's party conference commitment to introduce free home care for people with the highest needs has made a further mockery of the government's green paper consultation. This wasn't even on the menu. The government wanted the green paper to foster a big public debate. It seems only to be increasing controversy.
Already, thousands have signed up to a petition opposing the green
paper proposal to divert money from much-valued universal benefits,
such as disability living allowance and attendance allowance, into the
discretionary funds councils have to pay for care, to which people so
far have little entitlement.
Tax funding
Service users have made clear their concern about the green paper ruling out funding social care through general taxation. Many people consulted in preparing the green paper said they preferred this option. It describes it as probably the simplest and fairest option.
It has never been clear from the green paper what its calculations for the three funding options it offered were based on. All require people to make a contribution. But the sums people will have to pay seem suspiciously low. The full calculations have not been provided. How can we make a judgement on this basis? What starting point does this offer for a truly informed public debate?
Calculations
At a recent users' and carers' consultation organised by Hampshire Council, the Department of Health lead for involvement on the green paper team told me that the London School of Economics would this month publish the figures on which the green paper calculations are based.
This is perhaps the most worrying news of all. In effect, it means that the public, carers and service users will have less than one month to make an informed judgement about the maths underpinning proposals for the future of a policy serving more than one million people. Already underfunded, the demand for social care is set to increase enormously.
Consultation answers
How can this constitute a legitimate consultation? What basis does it provide for social care for the future, especially at a time when every major political party is talking public spending cuts? We need some serious answers rapidly.
With Conservative Party commitments also emerging, it now looks as though future social care funding policy has become part of the general election debate.
Suddenly, Labour has found new money for free care by borrowing from other budgets. If that's possible, now more than ever, the option of funding social care through general taxation must be re-examined.
Read about the Conservative plans for care
Peter Beresford is professor of social policy at Brunel University
Tax funding
Service users have made clear their concern about the green paper ruling out funding social care through general taxation. Many people consulted in preparing the green paper said they preferred this option. It describes it as probably the simplest and fairest option.
It has never been clear from the green paper what its calculations for the three funding options it offered were based on. All require people to make a contribution. But the sums people will have to pay seem suspiciously low. The full calculations have not been provided. How can we make a judgement on this basis? What starting point does this offer for a truly informed public debate?
Calculations
At a recent users' and carers' consultation organised by Hampshire Council, the Department of Health lead for involvement on the green paper team told me that the London School of Economics would this month publish the figures on which the green paper calculations are based.
This is perhaps the most worrying news of all. In effect, it means that the public, carers and service users will have less than one month to make an informed judgement about the maths underpinning proposals for the future of a policy serving more than one million people. Already underfunded, the demand for social care is set to increase enormously.
Consultation answers
How can this constitute a legitimate consultation? What basis does it provide for social care for the future, especially at a time when every major political party is talking public spending cuts? We need some serious answers rapidly.
With Conservative Party commitments also emerging, it now looks as though future social care funding policy has become part of the general election debate.
Suddenly, Labour has found new money for free care by borrowing from other budgets. If that's possible, now more than ever, the option of funding social care through general taxation must be re-examined.
Read about the Conservative plans for care
Peter Beresford is professor of social policy at Brunel University
This "big care debate" comes at a time when Labour and Conservative politicians are vying with each other as to how many claimants they can knock off existing disability benefits for people out of paid work. I wonder whether the authors of this 'consultation' factored in the increased anxieties that people with autistic spectrum conditions and/or mental illnesses such as schizophrenia or bi-polare disorder will face in the climate of fear created by such merciless cost-cutters?
Meanwhile, a National Autistic Society branch secretary has reported to me that authors of the Adult Autism Strategy Consultation asked extremely patronising and ill-informed questions that left the focus group of people with autistic spectrum she conferred with extremely agitated. (I can probably get you more info on this communications impasse if you like, Peter.)
The people most able to join in in any consultation such as "the big care debate" are more likely to be comparatively affluent, state sponsored service providers that have more staff involved in lobbying than in service delivery. Many of these 'service providers' -- as charities FOR elderly and/or disabled people also have conflicts of interest and questionable prices for their services. Eg, Age Concern Camden charges about £16 for a pedicure treatment.
The consultation will be the poorer for the comparative lack of input from the most vulnerable members of society, but Green Party councillors in Brighton & Hove are urging their council to get involved in the consultation. On Brighton & Hove Council, the Green Party IS a major political party, and there are over 100 Green Party councillors in England & Wales.
Hi Peter,
This has to be one of the best, if not the best, article about these issues that I have read for some time now.
If the govt ( and all parties ) were committed to having a true debate the consultation should have included ALL the proposals instead of the govt having pre determined the outcome by limiting it to the 3 options .
I attended one of these events and as much as David Behan explained everything in great detail, I felt unable at the end of the day to chose an option and I know some people chose one as they felt they had no alternative.You cannot build a whole new future for social care around choices made like that, wherein in a person picks something as the better proposal of the 3 but not what they actually want.
We are facing a General Election so who knows which Party will be pushing forward these proposals but they have all missed the ideal opportunity during their long recess to gather opinions from the very people that matter. How many people some of these proposals will affect actually been able to attend these ‘consultations’.Each MP should have held their own local consultation events too.Advertised in local press, council offices etc.That way members from all parties represented would have been left with no doubt as to the feelings of anger and also confusion.
The anger is self explanatory regarding the ‘vague’ proposals relating to the disability benefits.The confusion arises as the paper raises far more questions than the govt have answers . The Tories do not fair any better either.
All parties emphasie how the country faces a crisis in the future for those elderly needing care and yet for many families they are already in that crisis now.
The govt want a National care service, they already have the foundation of one with family carers.People mostly care as they LOVE their family member but they are sinking through the lack of support, be it financially or practically, such as respite,equipment,etc.
Councils tightening eligibility criteria means more pressure is being placed on families and as much as many carers want to remain in work/return to work, it is imperative that equal,if not more support is provided for the 24/7 heavy end carers ,many who are even providing what would be classed as specialised nursing care.
With some of the schemes the govt announce, with some of the pots of money, we are finding that it becomes lost in the system or by the time it reaches those intended for, the amount is minimal.
I don’t know anything about you Peter so don’t know if you have kids.However, any parent will know that when teaching a young child to build something, you start from the bottom up,you lay a strong foundation.Place your 1st block at the ‘ top ‘ and it falls in to fresh air.Nothing there to break its fall, it crashes.
That same principle applies here.Some would say naïve of me, too simplistic but if we build on family carers, fully recognise their worth for the work they do, in time the country would reap the rewards.The numbers needing residential care in the future would not be as great.
Already in many areas it is private companies that dictate the costs of care, whether it be within a residential place or the family home.The profits made are obscene.How long before they had full control. The money could quite easily be ploughed back in to services.Money that could in some cases provide care for those people in the lower categories of Moderate and even Low.
The steps being proposed now by the main parties will ultimately result in them not being held accountable if/when something goes wrong.They can blame the individual,the local authorites,the private companies.That is wrong.It starts and stops with whichever party in power.
Sorry Peter for going off track a bit, geordies do that a bit, but the picture is much wider than what this Paper suggests.
.
As you may know David Behan(Director General of Social Care at the Department of Health) has a blog attached to the Green Paper Consultation website.
This is my latest contribution to that blog in response to Gordon Brown's announcement and I would appreciate hearing your comments on this Peter, not least given even you appear to have missed the key Con in this new pledge by GB.
So much for consultation then!
How can we be expected to trust Government or Ministers given the following?
Speaking at the Labour Party Conference in Brighton, the Prime Minister announced that from 2010 the NHS will work together with local authorities to provide better care and greater protection of people’s savings.
“The best starting point for our National Care Service is to help the elderly get the amenities to do what they most want – to receive care and to stay in their own homes as long as possible. And we can start straight away,” said Mr Brown. “For those with the highest needs we will now offer free personal care in their own homes.”
Mr Brown announced that:
New measures will provide free care at home for upwards of 350,000 people with the greatest care needs who currently pay for services.”
One of the continuing battles I have been fighting over the years is that the official "fairer" guidance lays down that the NHS must check to see if any part of care they provide can be classed as "social" so they can then pass the buck to Social Services (and us and/or the local authority to fund that part of our care).
This especially applies to what is known as "Continuing Care" i.e. what happens immediately after having been discharged as an in patient.
So clearly Gordon Brown has now decided to buy the votes of those who fear they may lose out if their parents use up their savings by them contributing towards the cost of care, but it will be the rest of us (i.e. younger disabled people) that will end up paying for it, especially under the current unfair charging for care arrangements that already claw back most of our DLA and AA funding even before this new Bill.
From listening to GB's interview with Sky News the next day though this is actually just about providing about £750 million free home care to those with dementia and/or similar severe illnesses from existing NHS and local authority budgets over the next two years.
If this extra "bribe" to those with savings (and/or those due to inherit such savings) that might otherwise be asked to contribute towards the cost of their care goes through this means there will inevitably be £750 million less in the post for NHS and LA support for the rest of us given no extra funding is attached to his “bribe”.
So now not only those with more income than others will get their care free (one’s “earnings” or that of partners are completely ignored for care charging), but so now will all those with substantial savings over and above the value of their own home who previously would have been expected to contribute towards its cost.
In the meantime those on disability benefits and/or income support will continue to have to contribute a very high percentage of our already meagre resources towards the cost of our care and/or possibly even have all or at least part of AA and eventually even DLA taken away as well.
The cynic in me simply hasn’t ever seen any other motive for differentiating between social care and medical care as always having been linked to being an easy way out of the universal pledge by all political parties to protect the "Free at the point of Delivery" status of the NHS though.
The whole basis of the "fairer" charging guidelines (and why it came out from the Dept of Health), of course, is that it allows some services provided by the NHS to be charged for by declaring them to be "social" care.
Interestingly though there is absolutely no reciprocal requirement for social services to identify and then not charge for that proportion of the care they fund as clearly being for medical care and/or to avoid our going in to hospital. Given many now only get services if not getting them means hospital is the likely result that seems rather inequitable to me.
An interesting snippet of news that may have a great bearing on all of this and on the whole health care / social care debate within the green paper though is the recent story in the Telegraph.
“Alzheimer's carers awarded £300,000 after NHS refuses to pay care costs.”
“Three families looking after relatives with Alzheimer's have been awarded more than £300,000 after the NHS refused to pay for their care costs.”
http://www.telegraph.co.uk/health/healthnews/6053141/Alzheimers-carers-awarded-300000-after-NHS-refuses-to-pay-care-costs.html
So in this case the reality is that Gordon Brown is actually trying to claim credit for "giving" something away to voters the courts has already clearly said should have been free anyway. LMAO
But worse still even though the "claimed" plus side of this very unequal equation we are being sold in the green paper and his speach is now clearly a con we will all, none the less, still feel the negative impacts on us it will certainly have because of the current very unfair "fairer" charging system already in place for the rest of us.
As said, there is absolutely no reciprocal requirement for local authorities to assess if the care required by a disabled person, or any portion of it, should be considered as "health" care and so by definition should come under the NHS budget and more importantly be completely "Free at the point of delivery" rather than means-tested.
Will the Department of Health Guidelines on charging for care be revised in light of this new announcement and/or changes to the system as a result of the green paper, possibly along the lines outlined in my earlier submission in the Funding section of the Bill?
http://careandsupport.direct.gov.uk/greenpaper/execsum/funding-options/comment-page-1/#comment-870
And why was this aspect of the current system not covered in the Green Paper at all in any case?
Regards Peter aka "Sociable".
To add your own comments to David Behan's blog and/or comment on my contribution it can be found here:
http://careandsupport.direct.gov.uk/blog/2009/09/improving-benefits-for-everyone/comment-page-1/#comment-4884
I would also appeciate any comments or suggestions you or others have about my ideas for the future democratisation of disability representation as laid out in one of my contributions to the Prime Minister's Forward to the Green Paper available here:
http://careandsupport.direct.gov.uk/greenpaper/foreword-by-the-prime-minister/comment-page-1/#comment-4094
Many thanks in advance for your response and my apology for the length of this post.
Peter Farrington aka "Sociable"
i suffer bipolar disorder, and ME, and arthritis. as one blog said,the government has not considered the effect on those with severe mental heaith problems of the green paper.
it has horrified me so much i am on even more medication and my gp is asking me to come in regularly - so already costing more. am waiting for emergency psychiatric appointment - no idea when that will be, despite already being in system. care mostly provided by friend whose costs - transport, food - can be met out of my DLA.
social services are underfunded and practically useless in mental health - you get used to one social worker, but you get a new stranger every six months, and this causes people like me more distress. i have only ever had one social worker who truly helped me. i would rather keep DLA.
once, i asked the council for Direct Payments but was told quite bluntly that if i could wash my face, i was not entitled to any help. this is why goverment plans to transfer part of disability benefits over to local authorities scares the bejesus out of me.
PS, i have never had any formal help with physical difficulties, as attacks of ME and arthritis come and go. i do not think the national care service would come out as an emergency to people like me when we are suffering frightening hallucinations in the early hours, and are in danger of suicide to stop the suffering.
two of my friends who were under regular social work "care" died very young; i have no faith that "prevention" and "support" mooted by the government will stop unnecessary premature deaths in the mentally ill. quality of life will go down the pan, and many people in my position will take the horrible way out. of course, then, we will no longer be a strain on the public purse.
what did i do to deserve this? i was dragged fifty yards off a pelican crossing by a drunk driver when i was 18 and suffered multiple life threatening injuries plus a head injury; i struggled on with a degree, had a breakdown, and then part-time work. when i became a full time teacher for just three years my health problems overwhelmed me such that i could no longer go on; i was also costing the state several thousands of pounds per week for hospital admissions.
benefits give me some quality of life; they also benefit the taxpayer, by keeping me out of hospital - i cost the state less. i dread needing hospital again, because it is very difficult to get admitted, especially when severely psychotic.
is anybody listening. Is there anybody out there?
The Big Care Debate Conference
Park Plaza, London. 17th October 2009
A speaker at the conference justified the position of proposed removal of Attendance Allowance from some people’s pockets by drawing attention to those wealthy claimants who hoard the benefit cash ‘to pass on to their children’. She claimed to have been told this by someone at an earlier conference. The speaker didn’t feel it necessary to add that the miscreant had probably been paying tax for many years and felt it was her right to receive the benefit for good reason. I think that it is very poor for a government speaker to relay anecdotal evidence in the place of fact.
Later, a speaker (possibly the same one) told the conference that DLA would definitely not be removed from peoples’ pockets.
I had with me a letter from Jonathan Shaw MP, Minister for Disabled People, dated 29th September 09 in which he writes ‘we think there is a case for bringing some disability benefits and the adult social care system together into a single system’. Note the plural, ‘benefits’ which seems to indicate AA AND DLA.
I wanted to check this point at that part of the conference called ‘Q&A’ at the end of the event.
The conference was scheduled to end at 1.30pm and at 1.26 a speaker announced that there would not be the time for questions. (Special note: this meant that there were NO opportunities for questions put by attendees at any time during the event.) Ironically, there followed 12 minutes of final comments by the speaker!!
I put the issue of DLA to one of the speakers privately after the conference ended. She basically said that ‘Ministers aren’t speaking from the same songsheet as we are’. (my words but with exactly the same meaning). I was invited to ‘watch this space’ as definitive clarification would be given on this point within a week.
I also questioned why it was that at this conference the speaker addressed the unworkability of the tax funding option for ten minutes whilst at the Tonbridge event it was done in about a minute. The speaker told me that the conferences had changed quite a bit over the summer. Your telling me!
• open criticism of some AA claimants
• Anecdotal evidence in place of fact
• Definitive ‘DLA is safe’ announcement despite contrary correspondence from a minister
• NO questions from the floor and last but certainly not least,
• There has clearly been much feedback that many people see taxation, in some form, being a strong contender for funding social care
I would like to congratulate the organisers for providing excellent accessible material and PA support throughout the event.
End
DLA
Your DLA is safe, be happy!
In a recent statement from the Secretary of State for Health Andy Burnham said that the government has ruled out the possibility of integrating DLA into its proposed new social care system and wanted to close down the debate, as he put it, on the speculation surrounding this. Speculation, it has to be said, caused by a very ‘gray’ Green Paper on this issue.
The ‘your DLA is safe, be happy brigade’, were quick to announce his statement but should keep in mind that the Green Paper, although published by the Health Secretary, also contains implications for Benefits.
These benefits are the domain of the DWP. As mentioned in my blog here a few weeks ago, (please go there before reading on) I mention that I have a letter indicating that DLA is not safe. That letter is from Jonathan Shaw, Minister for Disabled People who writes under a ‘DWP’ letterhead.
Wo, hold on there… doesn’t that mean the letter comes from the DWP! Yes it does.
Duplicitous? At least, just keeping their options open! ‘Closing down the debate’? Perhaps the DWP could by making a similar statement as the Health Secretary.