Will Adult Social Care Reform Stall?

younger hand and older hand

The Health and Social Care Bill currently limping through Parliament is a mess. Even though I try to take an active interest in its progress, even as someone who is desperately concerned and involved (working, as I do, in an NHS team), I lose heart at trudging my way through some of the details which have been changed, adjusted and repackaged beyond the level of human (oh, ok, maybe it’s just me!) comprehension.

I was baffled though by this piece which turned up on the Guardian website yesterday.

Announcing that Lansley, having been stung and having lost credibility as his health reforms (hopefully) hit the buffers, is going to be delaying his announcement of reform in social care.

The article states that

The Observerhas been told that No 10 has “seized the reins” on social care from Lansley, the health secretary, and called in experts to ask their views on what should be in a much-delayed white paper. “No 10 know they have to ensure this is not another disaster like the health bill,” said one.

One of the concerns is that plans to give more elderly people their own “personal budgets” – sums of money with which they can buy in social care from private providers – might open up the government to more damaging accusations of the “marketisation” of health services.

This made me (proverbially of course!) hit my head against the desk. It is such wrong and muddled thinking. Plans to give more older people personal budgets have been ratcheting up over the past few years. What we actually NEED in the sector is better use of these systems, not more of the same.

Now, currently, today, we have in place systems for everyone who receives social care regardless of their age to receive personal budgets for social care. It is the way that these budgets are delivered that is wrong sighted and potentially discriminatory as the greater flexibility is afforded to those who are able to best engage in the process and advocate for themselves (or have families to do so).

What we in the sector, really really don’t need is for the government to stall with this where we are at the moment because, in a sense, we have the worse of all situations where older people suffer from institutional discrimination because the systems don’t exist to ensure that they best benefit from the extension of personal budgets as fully as younger adults have done.

The article goes on to explain

Lansley’s plan to give every eligible person a “personal budget” through a direct payment by April 2013 has also raised concerns. Under the plan, first introduced by Labour, people’s needs are assessed by local social services. They are then allocated a budget, paid as a direct cash payment, with which they can buy care. Currently, personal budgets cover 340,000 people.

Opponents of the system argue that personal budgets will be inappropriate for huge numbers of elderly people who will not be able, or want, to manage their own funds, particularly at times when they are in greatest need of care. Critics also say people’s needs will change and the system may not allow them to switch providers quickly enough if contracts have been signed.

Another head meet desk moment. I am not an ‘opponent of the system’ although I have real concerns about the current systems we have in place. ‘Personal Budgets’ exist now for older people and for everyone. It is the different means of delivery which is confusing as direct payments are not the same as personal budgets. As for the statement that they are inappropriate, that’s irrelevant because they are a current reality. This is not the proposed change. My hope is that any changes would include safeguards to ensure that those for whom access to direct payments has been more difficult – whether due to lack of capacity or desire to  manage direct payments – and thus ensure that ability to choose and prefer particular providers, rather than be tied into the decisions of distant commissioners (sorry, guiltycommissioner, if you’re reading, this isn’t personal!) that make no allowances for personal preference.

Today, there’s a joint letter in the Guardianfrom the heads of various charities urging the government to act on reform of adult social care. The letter emphasises the need for more money. I was delighted to see advocacy organisations involved in this as I truly believe that it is a way of improving access and equity across the system.

But if  Lansley delays the Social Care Reform, mark my words, it is  not because of the mess he’s made of the Health and Social Care Bill – it’s because he wants to avoid making difficult and potentially more costly decisions related to long overdue reform of Adult Social Care.

photo Pesbo/Flickr

4 thoughts on “Will Adult Social Care Reform Stall?

  1. I too was very confused by yesterday’s Observer article. Especially as I work in an adult social care team which spends a lot of time giving personal budgets to older people.
    So I don’t quite understand why the debate is about when to extend the system, when we are pretty much there already – if my LA is doing it then legislatively there is already nothing to stop every other LA.
    There are much more pressing questions than the rate at which people are switched to PBs. I would prefer to see something done about the scandal of residential care cost for example. While most people know about the heavy fees charged to those who have property or savings (which is bad enough) there seems little reporting of the ‘top-up’ fees charged to families of care home residents. Few homes are accepting new residents at the ‘banded rates’ of LAs, so families are not only losing their inheritance, they are being charged substantial amounts from their own incomes. It is already the case that older people rarely enter residential care unless there is no other option, so for families with someone needing residential care the push for more PBs will make no difference at all to their circumstances.

  2. Hi Robert. Thanks for your comment. Interestingly, we don’t have a big issue with top ups possibly due to the area I work in. Most of the people I place either don’t have families or don’t have families that are in a position to make any payments whatsoever. We are restricted to placements in the few homes that will take LA rates.
    But – and here’s where it all falls into place and I should have written more about this in the main piece – I suspect the PB/DP stuff is a smokescreen and you and I and anyone working in the sector knows it’s already all in place. What the government really want to do is avoid the Dilnot proposals which will deal precisely with the costs of residential care – if they can blame this on ‘listening’ re: health bill, they will be able to divert attention from the fear of just having to pay more for an equitable system of payments for residential care.

  3. Ah well that is an interesting theory about the smokescreen… you may well be right (and my usual default attitude to the government is suspicion!) but I wonder whether they are in fact just ill-informed, incompetent, and feel impotent when it comes to resi care.

    I’ve only worked a handful of such cases. . . perhaps 10. .. but although i work in a deprived area where families typically can’t afford top-ups, homes still ask for them.

    Dilnot’s recommendations, as far as I understand them, would be an improvement but are they radical enough to fix a rotten system?

    There was a suggestion some while ago that there should be a National Social Care Service, based on the same lines as the (pre-Lansley) NHS. . . that would be the best solution!

    ps *still* sceptical about PBs. . .

  4. I agree re: Dilnot – I hardly think it is a panacea in itself and don’t think it necessarily goes far enough but we can’t overestimate how far much some people are attached to the thought of inheriting from their parents at the expense of paying for care they would otherwise be able to afford. My own solution which would be hideously unpopular amongst the middle classes and will therefore never happen, would be the so-called ‘death tax’ – a massive increase in inheritance tax to subsidise care for the living on the basis that large inheritances create larger imbalances across society.

    The National Care Service was something the last Labour government was working on but it was proposed too late in the political process for it ever to have any real legs.
    The difficulty I have is persuading people that care is actually a chargeable service and can think of numerous examples where people have refused services that I felt they needed on the basis of the amount they would be charged for it.

    I understand the scepticism about PBs because honestly, anyone working in adult services in a local authority will know exactly what the reality of PBs is – some people (mostly younger people or those with very strong support networks) do very well but for many of the older adults we work with, they have ‘managed’ PBs which are exactly the same as they ever were – imposed agencies working to regular ‘care schedules’ with little or no flexibility at all. It has made no difference to the lives of many people we work with and is only a veneer of ‘choice and control’ with no real changes taking place. That’s why I feel so strongly that the system of delivery has to change and has to pay more attention to the needs of those who don’t want to manage DPs.

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