Services, but at a price

The Carers and Disabled Children’s Act 2000 promises carers
flexibility. But flexibility comes at a cost -Êlocal
authorities will be charging for carers’ services, writes Gideon

Tony Blair is often accused of wearing his heart on his sleeve,
so it will be no surprise that the government’s website for carers
features a personal message from the Prime Minister.

“We all may need care,” he says. “When I was a boy, I watched my
own mother care for my father after he had a stroke.” Carers should
be properly recognised and properly supported, he insists, “and the
government should play its part.”

The Carers and Disabled Children’s Act 2000, which comes into
force in England next month, has been welcomed by most carers as a
flexible friend. But while many carers organisations are looking
forward to the recognition and benefits the act will bring, they
are concerned that no new money has been allocated to pay for its

Given that local authority budgets are already under immense
pressure, could the UK’s estimated 1.5 million carers find
themselves properly recognised yet little better off?

On the face of it, the act promises to change their lot
significantly. For the first time, carers will be entitled to have
their needs assessed, whether or not the person they care for
chooses to be assessed or to receive services. For the first time,
carers can receive direct payments for the services they receive.
And 16 and 17-year-olds in caring roles will now be recognised in
law and their needs will be met. Direct payments for carers and
vouchers, which a disabled person can use to buy services to give
their regular carer a break, have also been welcomed by carers’
groups. Perhaps more fundamentally, the act is long overdue
recognition of carers’ value to the state.

Emily Holzhausen is public affairs manager at Carers National
Association (CNA), which campaigns for carers’ entitlement to
services. She broadly welcomes the flexibility in the act. “Time
and again, carers say they want flexibility and they want cash.
They want the control to buy the type of service they would like to
fit their needs.”

But many observers are concerned about the government’s failure
to back up the welcome measures in the act with new money. “They
have provided the legislative framework but not the means,” says
CNA’s Rory Hegarty. “Local authorities already have competing
priorities and are struggling for resources. Carers may have the
right to services, but it will depend on the local authority as to
whether they will come to fruition.”

Penny Banks is a health and social care fellow at the King’s
Fund, which has done research into local authority funding of
carers breaks. She says: “Some local authorities are doing well on
care issues, and some are not. There is lots of work still to be
done.” The King’s Fund wants to implement national quality
standards for services provided to carers.

Questions also remain over how the act will work in practice.
Direct payments can increase flexibility but the person purchasing
the service also becomes an employer. What looks good in theory can
end up being a trade off between flexibility and

Banks points to the slow take up of direct payments for disabled
people and says: “We will be looking to see how quickly these new
ideas take off.”

Another controversial aspect of the act is the principle of
charging carers for the services they receive. The Department of
Health will be issuing guidance on charging as the act is
implemented, although it has already made it explicit that carers
will not be charged for the services people whom they care for
receive, or vice versa. But carers’ groups are unhappy with the
principle of charging.

“Carers provide all this service, which would otherwise cost
billions of pounds. Now they can have services, they will be
charged for it,” says Peter Tihanyi, operations manager at the
Princess Royal Trust for Carers.

And while the arguments over who pays for what continue, local
authorities are being told to broaden the services they offer.

Policy manager for the National Carers Strategy at the
Department of Health, Tim Anfilogoff, told a Local Government
Association conference on the act that local authorities needed to
“stop thinking about what is already on the menu and look at what
people actually want,” such as providing mobile phones or driving

The key to the act’s successful implementation will be
consultation. The act was drawn up after consultation with carers
and carers groups. Carers’ groups want a similar level of
consultation during the act’s implementation.

Emily Holzhausen says carers may be experiencing some
consultation fatigue, particularly because they rarely see the
results of previous consultations. Only quality consultation, where
carers can see change, will make them feel better about it.

She also calls for consultation to be fully inclusive, saying
that carers from ethnic minorities and carers of people with mental
health problems are often sidelined.

As with most new policies, the final test of the new act will be
how it works in practice. Carers groups will be interested to see
how local authorities will cope with assessing carers for services
they cannot afford to provide.

If the government is serious about taking carers’ health and
well-being seriously, the part they play may have to involve a
financial commitment, which has so far been elusive.

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