Meeting
the Needs of Our Changing Society
Jacqui Smith
MP
Report of constituency consultation
in Redditch held between April and September
2008.
Introduction
Our society is
going through huge change – care and support must change to meet
the challenge of the 21st century.
For instance we
have an ageing population and disabled people are living longer,
healthier lives. We
expect over 1.7 million more people to have need for support and
care from social services in twenty years time. The average man now spends nine
years living with long term limiting illness compared with just six
years in 1981.
There have also
been huge social changes in terms of what we value and what we want
from public services.
People want more independence, choice and control and government
must reflect on these demands.
A rapidly ageing
population means that in 20 years’ time a quarter of the entire
adult population will be over sixty five and the number over eighty
five will have doubled.
Millions of
people are involved in providing and using care and support
services. It is vital
that any reform process will end up better aiding people staying
active, caring for family members, retaining maximum dignity and
respect for individuals and providing the chance for the best
possible quality of life.
The government
launched a debate about the future shape of care and support
services in May 2008.
The intention was to develop long term plans for an affordable,
sustainable and fair way of delivering first class care and support
in the 21st century. The views of people were sought
ahead of a green paper to be put to Parliament.
As Member of Parliament for
Redditch I decided to hold a series of meetings across my
constituency to discuss the issue with residents. Questionnaires were distributed
to thousands of individuals with an invitation to contribute in
writing or in person at one of the meetings.
Redditch consultation
In all 115
attended the meetings and over 430 written comments were
received.
Meetings were held in Inkberrow,
Batchley, Winyates, Church Hill, Crabbs Cross, and Greenlands,
taking in residents from the whole of the constituency.
I was able to
lead every meeting.
Invariably good discussions took place and notes were
taken. Individuals
from each meeting were invited to consider this report in the light
of their experience.
Inevitably with
such a complex issue there were differences of opinion from
contributors.
However, themes emerged relating to funding and fairness and in the
availability of simple, accessible help for those that need
it. I hope that this
report gives a rounded summary of the views expressed in the
consultation exercise and at the same time highlights the
innovative individual suggestions that emerged.
Reporting
the findings.
The consultation
papers posed questions on six aspects of care – some of which
overlapped a great deal. Despite this groups kept to the
landscape of the six areas to summarise the contributions that were
made. The summary
will reflect the issues overall.
1.
Improving Care and Support – Better information and higher quality
services.
No
one learns about caring and getting older before it hits them and
it’s complicated!
Make it simpler and help easier to find.
It was strongly
felt that many people take up caring responsibilities during their
lives and they all seem to face the challenge of learning about
what help is available, practical, financial and emotional from a
standing start. They
also face a very complicated and disjointed landscape of
support. Health
departments, social services, benefits and the voluntary sector
appear to provide help that is uncoordinated, difficult to access,
requires a duplication of work for carers and is user
unfriendly. The
systems appear to be designed to serve bureaucracy rather than
carers and those they care for. Once support is requested /
needed it should be available quickly.
It was suggested
that a one stop shop (and a “no wrong door”) approach should be
adopted to coordinate and provide care services in a much simpler
way. A “no wrong
door” approach would mean that people are not pushed from one
department to another to get advice or access to help – item by
item, issue by issue.
A single effective assessment of
need would be one place to start.
Many benefits
and entitlements to support, medical check ups etc are age
related. It would be
helpful if as individuals approach these trigger points information
is supplied to them about their new entitlements and advice on how
to access them.
The management
of care arrangements can be an onerous responsibility. For instance the idea of filling
in employment forms, taking up taxation responsibilities etc can
easily overwhelm some. It was suggested that an
organisation such as Age Concern, Carers Care Line or local GPs
could be asked (and funded) to take up management roles for
individuals’ financial management
responsibilities.
It was also
suggested that a single Department of Care should be created for
this purpose.
One very
interesting idea was that of a Sure Start service for older
people. Just as young
families have specialist needs – so do older people and
carers. Perhaps an
extension of the Sure Start network would be appropriate or a new
network would need to be created - sited at doctor’s surgeries or
elsewhere.
Such centres could provide
opportunities for training and preparation for older life and
caring. They could
provide pro active support, health advice, help with managing the
challenges of caring and older life. It may be the one stop shop
point that many people said would be helpful. A place that could be a meeting
point for older people and carers with activities organised for
social support.
2. Improving
Care and Support – More preventative services and personalised
services.
Generally more care from neighbours
with a better community feeling. But where formal help is needed
it should be fast, flexible and appropriate to the individual and
not the system.
Help that is provided should inform
and be part of an individual’s long term personal care
plan.
Personalised services were thought
to be very important.
There was support for the idea of carers coming from the community
they served in – that this would reduce the “stranger in the house”
feeling that some who need care feel. It would also feel a friendlier
service rather than a formal service.
There were suggestions of
developing a “community volunteer service”. With local people, provided with
basic training to act as good neighbours, be a friendly pair of
eyes and ears in communities.
There was
concern that such a role should not be too formalised or
bureaucratic and other suggestions along the same lines were to
simply encourage more neighbourliness, a better community
feeling.
Given the more
disparate nature of family arrangements in Britain today – with
older people often living many miles away from their families –
there was a suggestion to promote an “adopt a granny”
scheme. Where by
local families might be encouraged to form relationships with
nearby older people.
It was thought that both sides to the arrangement would get a lot
from such links – role models, understanding, company, support and
advice for instance.
There was a
strong feeling that home visits by “professional” caring agencies
should fit in with what the cared for want not what fits in with
the carers schedule – bedtimes for instance should be more user
orientated.
There was
support for a MacMillan nurse approach to providing care to
individuals. Groups
thought that they would like to see what it was that MacMillan
nurses brought to their role that was so well thought of to see
what could be employed by home visiting carers.
Expanding direct
payments would give more people who needed care, more power and
control over who and what was provided.
Many respondents thought that there
should be more long term planning for the sort of care that
individuals may require. Regular health assessments were
supported.
However it was crucial that these checks did lead to advice about
more than “how to cut your blood pressure or lose weight” –
important though these are. The health checks are an
opportunity for individuals to make better choices about their
accommodation, adaptations, etc so appropriate advice and
information should be on hand.
The role of
national government in setting standards for care provided in
people’s homes was supported but it was thought that County level
support was sometimes too generalised and remote to provide care at
a community level and a more localised approach was
supported. One
point of contact by phone would be a great help for those with
questions about their situation.
The government
should insist on design of new homes being disabled friendly with
provision made for potential adaptations accounted
for.
To maintain
independent living for longer it was thought that more sheltered
schemes in the community would be a good idea. It was also thought that such
schemes help overcome one of the unmentioned scourges of old age –
that being loneliness. Giving opportunities for social
interaction that isolation in ones own home doesn’t
bring.
3.
How can we pay for care and support
today?
Clarity. Fair provision for those
who couldn’t save, some rewards and choices for those that
did! In the longer
term some compulsory contributions into personalised savings
accounts backed and partially matched by government – without using
discredited private schemes.
The
first point to make is that for each individual there appears to
be a myriad of
financing plans, schemes and wheezes available to them which is
very confusing coupled with complicated rules for who pays what for
which care.
There was a wish
for a “plain English” document setting out the responsibilities for
funding of care and what level of support that funding would
provide. The
matter of a single “department of care” – marrying health, social
service and community funding responsibilities would help with
simplification of the system.
The state should
recognise that individuals who have saved for their later years
should not be penalised for that. There was support for the idea
that the state should provide a basic level of care with personal
savings being used to top up to better services.
There was a wish
to expand non profit making schemes to enable equity to be released
from homes to pay for care in old age. However the schemes should be
made much simpler.
Given that we need more people to
save for their old age – incentives to do so need to be significant
and reliable.
There is and will remain for some
time a growing distrust of private savings schemes given the market
turmoil and shortfalls in schemes like endowment mortgages and
private pension funds. There was support for a
government backed scheme of compulsory savings for younger people
(over 25) into personalised accounts specifically to pay for care
costs, with the opportunity to
top up payments from individuals and government.
There were
suggestions too that employers should be encouraged / required to
play their part by supporting the caring needs of
employees. Schemes to
ask employees to pay a levy against such eventualities – matched by
contributions from government and or the company themselves would
help.
Retaining choices about when to
retire and being supported to stay in work later in life was
thought to be a cost effective way of keeping more older people
active and socially involved and contributing taxes into the
system. There was
specific support for part time and voluntary work to be made
available to older people. Coupled with this the benefits
system should recognise the gains in health and care outcomes that
individuals participating in such work makes to the
state.
There were
suggestions of a higher rate of VAT on luxury goods to raise extra
money. A 1p increase
in the rate of income tax if the proceeds were ring fenced for
Social Care and higher taxation for those earning over £60,000 per
annum to pay for more care.
4.
How much money should you have?
Higher allowances for capital held
by individuals
It was felt by
many that the capital allowance held in savings or in your house
set against funding for care was too low at £21,000. It was thought that more
emphasis should be put on the retention of capital assets by older
individuals if that suited them and perhaps rental income on their
vacant properties should be used to offset their care
costs. The low
capital allowance was seen as unfair by most but not all
respondents.
There was some agreement on the
idea that means testing sometimes leads to unfairness. There is always a cut off point
about which some will feel aggrieved. The general response was to
provide a basic credit or level of support and allow individuals to
top their provision from their savings.
5.
The Kind of support you need.
More respite care. Choices for individuals should
be respected where possible and front line staff should be
empowered with budgets to make decisions on care support, minor
adaptation and other matters.
Greater access
to planned respite care was thought to be one of the most
significant improvements in current arrangements that could be
made.
Choice is an important element of
the kind of support provided to individuals. There was support that
using new media could help inform choice and combat some of the
difficulties that living longer presents; isolation and the ability
to work.
It was thought that having care
provided by members of your community was more friendly, less
intrusive and more acceptable than remote “professional”
teams. It also
reinforces a good “community” ethic in the system
We should combat the stigma of
someone asking for help with information on care options and other
interventions available sooner. At the moment the bar to trigger
information and evaluation is too high for some - making the
eventual intervention less effective, the lives of the cared for
worse.
Front line staff in care agencies
should be empowered with budgets to make immediate decisions on
minor works and grants.
6.
Where you live.
A
mixture of provision is vital, tackling loneliness and inactivity –
crucial.
Isolation is an important
consideration for people as they get older. It was thought to be worse in
rural areas but it is clearly an issue in urban areas
too. Leisure
and social activities provided to overcome loneliness and keep
people mentally and physically fitter. In addition it was thought that
older people should be encouraged to take up caring
responsibilities in their communities as appropriate – a “buddy”
system was proposed to match up older people to support each other
from time to time.
A mixture of in your home care,
sheltered accommodation and care home schemes should be available
for individuals and their families to choose from.
There was particular support for
the idea of a sheltered “village”. An example of which is Terry
Spring Court in Redditch run by the charity Extra Care. It is based on individually
owned flats around a smart communal area with carers and services
provided on site. The
arrangement seemed to be a good example offering preserved
independent living (where ever possible) with the reassurance of on
site help at hand.
The communal activities - including entertainments, learning and
crafts opportunities seemed very attractive and socially
important.
There was strong support for the
government setting national minimum standards to ensure that
wherever you live good care is available.
Jacqui is pictured with local
residents one of the consultation gatherings
If you wish to contact Jacqui about this report - please email
her at smithjj@parliament.uk
| 
