End of Care Direct nears as doubts and confusion shroud its replacement

A pioneering telephone advice service for older people is
“disappearing” in two months’ time, but confusion surrounds what
will replace it.

Care Direct projects were set up in six pilot areas during October
2001. The plan was to cover the whole of the south west of England
from October 2002 and to roll the programme out across England over
the next four years. But in August 2002, the then secretary of
state for health Alan Milburn, announced that the projects were to
close by the end of March 2004 and the Care Direct brand scrapped,
with the pilots’ “principles and successes” carried over into a new
service run by the Department for Work and Pensions. The second
wave of 14 sites never went ahead.

Now, just two months before the changeover, experts, staff and
users are still in the dark about the new project, known as Third
Age, with many not knowing what it will mean for jobs and services
(news, page 7, 15 January).

The Care Direct pilots in Somerset, Plymouth, Gloucestershire,
Bristol, Bournemouth and Devon, were the brainchild of the
Department of Health. By calling a freephone number older people,
their relatives and carers could get advice on local social care,
health and housing services and benefits. The government happily
announced that just three months after their introduction, pilots
were receiving about 1,250 enquiries a month.

There was no doubt that the pilots had been successful and were
offering an valuable one-stop service to older people. By November
2002, around one in six of the local over-65 population called the
national helpline number each year. Then, out of the blue, it was

Ministers took the decision before seeing the results of a study by
the Personal Social Services Research Unit at the University of
Kent at Canterbury, which was evaluating whether to roll it out

Andrew Bebbington, deputy director of the PSSRU, confirms: “The
decision to end Care Direct was apparently taken at ministerial
level before the interim report of the evaluation or any other
substantial evidence of its performance was available.” PSSRU’s
final report will be published in the next couple of weeks.

Like Care Direct, Third Age aims to better integrate health,
housing, benefits and social care services for older people. The
DWP has offered little detail on Third Age apart from stating that
it will “embrace a far wider concept than Care Direct, both in
scope and depth”.

Many of the project managers claim that you would be “hard pressed
to spot the difference” between Care Direct and Third Age, with the
pilot areas Community Care spoke to all planning to
continue running a form of Care Direct. They had little idea of
exactly how Third Age would differ from Care Direct.

Bebbington, who has carried out the evaluations into the Care
Direct pilot sites, believes there has been some conflict between
the DWP and the DoH. “The DWP feared it would conflict with its own
proposals for Third Age services and the minister at the time
[Milburn] didn’t particularly defend it.”

The DWP claims the overall budget allocation for next year has
actually increased “given that the initial Care Direct funding
facility was until March 2004”, but the project managers and
directors of social services tell a different story.

In 2003-4 the Care Direct scheme received almost £2.2m in
funding from the DoH. This has been cut to just £125,000 each
from the DWP for 2004-5, although four staff seconded from the
department will also help.

No other information on future funding arrangements for Third
Age/Care Direct services has been provided, except for the DWP
stating that it will be “for the local authorities to decide in
discussion with other partners including the Pension

In Bournemouth the Care Direct service had been contracted out to a
voluntary organisation but the “drying-up of funds” has forced the
council to bring it back in-house.

Pam Donnellan, the director of social services, said: “We have had
an unacceptable period of uncertainty which has prevented these
pilots from planning properly for the future. We have had to take
some hard decisions about the development of services. We are very
clear that the benefits of Care Direct services shouldn’t be lost
and we are having to work within existing resources.”

In Devon, Care Direct has fielded more than 50,000 phone calls over
the past two years and is responsible for £4.1m of additional
benefit successfully claimed last year in the area. Since
setting-up, it has received about half a million pounds a year as
well as staff secondments. The £125,000 from the DWP will
leave the service short and the council, along with partner
agencies, is having to raise £400,000 to keep it afloat.

Paul Searle, project leader of Care Direct Devon/Third Age, said:
“The funding after this year is obviously a problem. This county
has a particular problem with council tax and it has been difficult
for the local authority and other agencies locally to identify
resources to sustain the service. We are just taking things a year
at a time.”

Devon, along with the other pilot areas, had to submit a plan of
how it would develop Care Direct and Third Age to the DWP at the
end of last year.

“The government has given us very few details of what they envisage
by a Third Age service. For us, the Third Age service is a set of
principles which are not dissimilar to the underlying principles of
Care Direct. We haven’t got a written specification from the
government about Third Age nor is there any written project plan or
prototype,” Searle adds.

The DWP claims that it wishes to encourage the inclusion of the
voluntary sector within the Third Age Service and has made
£20m available to stimulate partnership working over the next
two years. But the voluntary sector has suffered as a result of the
change-over and uncertainty surrounding the programme.

Age Concern in Bristol was funded with £40,000 annually for
three years to take part in the area’s Care Direct pilot. The
charity provided information, advice and short-term “move-on”
services for those in crisis.

Age Concern also helped older people to fill in forms that they
felt too “flustered” to do over the telephone.

The chief officer Dianne McCarthy is now concerned that some
harder-to-reach older people may miss out on essential services.

“It’s very unclear now how the voluntary sector fits in,” she says.
“There’s concern about the way the voluntary sector was asked to
engage and was then told the whole thing was finished without any
recognition of what it had done.”

The DWP denies suggestions it has not issued guidance on Third Age
and that the establishment of nine joint financial and assessment
benefit teams is the “main building block” of the new programme.
These joint teams were set up in line with guidance which came into
effect in April 2003 that requires a benefits check to be offered
to service users whenever an authority makes an assessment of their
ability to pay.

But Bebbington still feels that “nobody knows” exactly what the
Third Age service will involve.

“Insiders I know don’t seem to be very confident about what it is
and DWP is certainly holding its cards close to its chest about
what will be proposed.” 

– PSSRU’s evaluation of Care Direct at www.pssru.ac.uk/

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