The Secretary of State for Health, Andrew Lansley has today announced the publication of the Government’s plans for comprehensive reform of the social care system. The Department of Health have launched a website about the proposals, where you can find out more detailed information about these reforms, which are hailed as “the most comprehensive overhaul since 1948”. A white paper, ‘Caring for our Future: Reforming Care and Support’ has been published, alongside a Draft Care and Support Bill. These publications are not the final say on the reform of social care but represent an opportunity for people who need care, carers, professionals working in social care, researchers and the general public to give their feedback on the proposals. A white paper is an authoritative statement of intended policy, which will be refined before a Bill is laid before Parliament. Draft Bills are used to allow time for pre-legislative scrutiny by relevant select committees as well as feedback from the public. The Department of Health have launched a website where interested parties can provide comments on the Draft Care and Support Bill, and all of the documents and some factsheets are available to download online.
The white paper sets out the Government’s vision for a new system of care and support that rests on two principles: first “that we should do everything we can – as individuals, as communities and as a Government – to prevent, postpone and minimise people’s need for formal care and support”, and second “that people should be in control of their own care and support”. The Government seeks to do this through a range of key actions (listed on p. 12 of the white paper), which include supporting volunteering, capital investment in specialist housing, supporting people to stay active and independent, investing in online information services, extending carers’ assessments and creating national thresholds for support. There is also a major focus on direct payments and personal budgets as a means to achieve the second principle.
Many people will be disappointed that the white paper and draft Bill do not implement the recommendations from the Dilnot Commission, which recommended introducing a lifetime cap on contributions to care and a significant increase in the means-tested threshold for self-funding care. The draft Bill would keep the provision of care services as a means-tested service (clause 15), but does not specify what the threshold should be. Rather, the funding of all of these proposals is to be decided through the Government’s spending review process. By way of response to concerns about people having to sell their homes to pay for care, the draft Bill contains a clause which would allow people to enter into a ‘deferred payment agreement’ scheme whereby their home is not sold in their lifetime, but the costs of their care, plus interest, are recovered after their death through a legal charge on the property (clause 16). The plans do include other recommendations from the Dilnot report about introducing national eligibility criteria and portability of care assessments, but the failure to introduce a cap on individual contributions, or commit to raising the means-testing threshold has been described as a ‘massive failure’ by the Alzheimer’s Society.
There is a vast amount of information in the documents published today, and careful scrutiny will be required to ascertain whether the plans will meet the needs of people with dementia and those who care for them. In our ‘Duties to Care’ research project, we highlighted three key recommendations for reform from the questionnaire and focus groups research we carried out with carers of people with dementia. The white paper does seem to address each of these issues, to varying degrees.
We recommended that carers of people with dementia should be provided with a single, continuing, point of contact for services, advice and referrals. In the white paper, the Government have made a commitment to “develop plans to ensure that everyone who has a care plan has a named professional with an overview of their case and responsibility for answering any questions they might have”, and “improve access to independent advice and support to help people who are eligible for support from their local authority to develop their care and support plan and to choose how their needs could be met” (p.53). These are clearly a step in the right direction, but may not specifically address the complex needs of people with dementia and their carers, and professionals may not be available in a crisis situation, or out of office hours.
We also highlighted that policy makers need to facilitate more access to information, earlier, about legal and financial matters for people with dementia and their carers. The white paper sets out plans to: “establish a new national information website to provide a clear and reliable source of information on care and support;” and “support local authorities to develop new online services that provide people with more consistent and more easily accessible information about their local care and support options,” (p.29). Whilst information about care and support is clearly needed, the carers who took part in our study highlighted a lack of access to effective legal and financial advice, which is a somewhat different need. It can only be hoped that a national information service would also provide useful information about these crucial aspects of accessing care and support.
Finally, we recommended that policy makers increase the availability of planned respite to enable carers to cope better for longer. The Government has committed to “transform support for carers by extending the right to an assessment, and introduce a new entitlement to support for them to maintain their health and wellbeing.” (p.29). Again, it is difficult to see at this stage how these policy commitments will translate into practical help for carers, but the white paper does seem to recognise the huge contribution that carers make, and that they need to be supported to continue to make their contribution in the longer term.
Importantly, the publication of this white paper and draft Bill are the latest step along the road to much-needed reform of the complex and confusing legal frameworks supporting adult social care. I would encourage anyone with an interest to comment, and give feedback on the proposals, either individually or through charities and membership organisations. It is only by making our voices heard that we can influence the democratic process. Do you think that the Government’s proposals will help? Would they make a significant difference to you? Would they improve your life? Or would they have very little impact on you? Either way: respond to consultation on the draft Bill, write to your MP, do what you can to ensure that the opportunity to transform social care is not squandered on ineffective policy and half-hearted reform.