The Queen’s Speech and Adult Social Care

The Queen at the State Opening 2009

I was expecting little from the Queen’s Speech in relation to adult social care and I was exactly right in my assumption.

The one line

‘A draft bill will be published to modernise adult care and support in England’ made my heart sink from the outset.

‘Modernise’ is one of those words that could mean anything. Sure enough the details followed.

The Department of Health website expands on that sentence.

The main elements of the draft Bill are:

  • modernising the legal framework for care and support, to support the vision of the forthcoming White Paper on care and support
  • establishing Health Education England as a non-departmental public body
  • establishing the Health Research Authority as a non-departmental public body
  • creating a London Health Improvement Board
  • carrying out engagement and pre-legislative scrutiny on the draft Bill, as many in the social care sector have called for, to enable government to listen to people with experience and expertise, to make the most of this unique opportunity to reform the law

What is missing is more important that what is contained in that short statement from the Department of Health.

We knew already that the Law Commission report was likely to be incorporated into legislation. I feel confident that there will be a streamlining of legislation and systems around them which will be positive.

As well as improving (or ‘modernising’ as they like to call it) the hotchpotch of legislation into one Act, the recommendations, lest we forget, include strengthening safeguarding processes for adults and imposing duties on local authorities to provide services for carers.

Which brings me on to the part that is missing.

Funding.

There was no mention of tackling the immense funding gap in these proposals. There is talk about rolling out ‘choice and control’ but without knowing that this will be funded (which it won’t – we were always told this would be zero cost process of change) it leaves a bitter taste in the mouth.

The Department of Health talks about ‘building on progress’ of personal budgets and my hope that will mean plugging that gaps that were introduced in the first place. I have my doubts as plugging those gaps will lead to significant funding increases as it will mean investment in statutory advocacy to extend the same levels of choice to wider groups of users.

My concern is that what will actually happen is that we will be given more meaningless targets to reach that will be very beneficial to the few  but will leave a large swathe of people behind as the pot of money available for care simply runs out.

One of the ‘benefits’ the Department of Health elucidates is

simplifying the system and processes, to provide the freedom and flexibility needed by local authorities and social workers to allow them to innovate and achieve better results for people

Now, if anyone can translate this ‘policy speak’ into real language for me, I’d appreciate it.

I read it personally as a push towards ‘social enterprise’ type operations which push social workers away from local authorities but I could be totally wrong on that.

‘Innovate’ like ‘modernise’ is an easy word to throw around, especially by those who have no conception of the actual meaning of the word. Innovation needs a lot more than the proposals on the table. It needs much more inventive and open thinking from areas outside the Department of Health. I’d like to see more emphasis on co-production. We want users to have the flexibility to innovate rather than necessarily the social workers. And I say that as a social worker.

I will wait with interest to see the coming White Paper on Social Care. I set my expectations very low. But I do expect a lot of words like ‘choice’, ‘modern’, ‘innovative’ with no mention of funding at all.

photo via parliament_uk flickr

Reforming Care

There’s a good piece today in the Telegraph by Liz Kendall the Shadow Minister for Care and Older People about the need for the government to push through reforms to the system of funding (and provision) of social care in this country.

The timing is pertinent of course although the message seems to have been around for decades. Tomorrow will be the Queen’s Speech and the government will set out its legislative programme for the next year. With the Dilnot Commission reporting last year it seems that the need for changing the means of funding social care support would be something that may appear tomorrow. My own gut feeling is that it won’t but I’m happy to be wrong on this.

There are two connected but separate issues to the ‘care reform’ debate. One relates to the way that care is funded and that is the issue that Dilnot specifically refers to.

Currently, each Local Authority has it’s own ways and means of determining charges although there is a threshold capital limit of £23,500 above which a person may be liable for charges. There are various computations and methods that these levels and charges are managed but the fact is that means testing is by no means consistent across England – nor is quality and level of provision.

£5000 towards care in Manchester may buy something very different to the same in Chester or Westminster or Norfolk.

There is anger about the ‘working hard all their lives to buy a house and then needing to sell it instead of leaving it to the kids’ argument that I have less time for as I think the exponential rise in property values is less about working hard and more about luck, employment opportunities and an odd housing market but if you are going to deprive people of assets which by default is going to happen as social care won’t be fully funded, it should be done in a fair, equitable and transparent manner.

Currently, I find it almost impossible to explain to someone what charges they may be liable for and it shouldn’t be like that.

Dilnot proposes a cap (which may be changed according to the government) on the amount that would be charged to the individual needing care and I can appreciate that. It is a sum which could be insured against and it is a sum which can be planned for.  However, it would need increased capital funding from central government and there’s the rub.

As for the process of improving quality of care and choice in care. it’s separate but linked. The ‘system’ is starved of cash injection at the moment. Cost has overtaken quality in terms of contracts being meted out by local authorities and choice is a luxury for the few rather than an option for the majority.

The government has been ruthless in their decimation of budgets to local authorities and while we’d all like to think the NHS and local social care budgets are intrinsically linked – the reality is different and the shifting of cost and responsibility between health and social care ‘pots’ is damaging to those who need to use these services.

Work has to be done on the fundamental basis of the way that social care is delivered in terms of ensuring that rights and particularly the right of access to well funded care is open to all. While money will always buy more choice and better facilities (that’s the point of ‘working hard all your life’ if you want to follow that argument) – the provisions meted out to those who are unable to pay ‘top ups’ or arrange their care independently cannot lag behind.

There has to be a more cooperative flow of budgets between health and social care and they have a symbiotic partnership and while there is division, there will be increased costs.

Integration is seen as a ‘watch word’ but to date there has been little in terms of actually working on it in a practical and innovative manner from bottom up.

It becomes an easy word to through around and everyone around the table can nod and smile and say ‘yes, we need to do that’ but what is needed is solutions not a continual detailing of problems (although problems do need to be identified of course – but sometimes I feel that’s all that happens!).

So let’s watch and see if the government do pick up the challenge tomorrow – I suspect we won’t see any changes but I hope to be pleasantly surprised..

It is worth remembering though that the provision of Dilnot would appeal to the demographic the government wants to attract but it would be at a considerable cost.

I will watch with interest.