This consultation, Caring for our future: shared ambitions for care and support, is intended to gather responses to the recommendations of the Commission on the Funding of Care and Support and of the Law Commission’s recent report on social care. It introduces a number of topics which the Government believes should be priority areas for reform and invites views on the way forward. Summaries of the issues on the Department of Health website give some indication of government thinking and are likely to be of great interest to local government.
Councils will wish to respond to the consultation as they see fit and may also wish to facilitate public discussion and local responses. The consultation will end on 2 December. The Government has made a commitment to producing a White Paper in April 2012. Responses to the consultation can be made online at:www.caringforourfuture.dh.gov.uk
The consultation lists six ‘priorities’ also described as ‘discussion areas’ which the Government considers to have the greatest potential to make improvements to the system and which it wishes to engage public discussion. These are discussed on the website and specific questions are posed to consultees. The website discussion is supported by videos eg of David Behan, the DH Director of Social Care and of Care Minister, Paul Burstow. Each of the six areas also has a ‘leader’ who will promote discussion of the issues.
In summary, the six areas and related questions are:
(Leader: Imelda Redmond, Chief Executive, Carers UK)
a. Should there be a standard definition of quality in adult social care? How could we use this definition to drive improvements in quality?
b. How could the approach to quality need to change [sic] as individuals increasingly fund or take responsibility for commissioning their own care?
c. How could we make quality the guiding principle for adult social care? Who is responsible and accountable for driving quality improvement?
d. What is the right balance between a national and local approach to improving quality and developing the workforce?
e. How could we equip the workforce, volunteers, carers and social care leadership to respond to the challenges of improving quality and responding to growth in demand?
f. How could we improve the mechanisms for raising and addressing concerns about the quality of care?
(Leader: Jeremy Hughes, Chief Executive, Alzheimer’s Society and Chair, National Voices)
a. How could we ensure the benefits of personal budgets, including direct payments, are made available to everyone in receipt of community based social care?
b. What support or information do people need to become informed users and consumers of care, including brokerage services?
c. How could the principles of personalisation be applied to people in residential care?
d. How could better progress be made in achieving a truly personalised approach which places outcomes that matter to people at its heart?
(Leader: Geoff Alltimes, Chief Executive, Hammersmith and Fulham Council and Dr Robert Varnam, GP and Head of Policy for Royal College of General Practitioners Commissioning and Learning Faculty)
a. Where are there good practice-based examples of integrated services that support and enable better outcomes?
b. Where should services be better integrated around patients, service users and carers – both within the NHS, and between the NHS and local government services?
c. How can integrated services achieve better health, care and value for money?
d. What barriers to integration should be removed, and how can we incentivise better integration?
e. Who needs to do what next to enable integration to be progressed?
f. How can innovation in integrated care be identified and nurtured?
(Leader: Alex Fox, Chief Executive, NAAPS)
a. What do good outcomes look like? Where is there practice-based evidence of interventions that support/enable these outcomes?
b. How could commissioners and providers in all relevant sectors be encouraged and incentivised to work together and invest in prevention and early intervention including promoting health and wellbeing?
c. How could we change cultures and behaviour so that investment in prevention and early intervention is mainstream practice? How could we create mechanisms that pay by results/outcomes?
d. How could individuals, families and communities be encouraged to take more responsibility for their health and wellbeing? How could we promote better health and wellbeing in society?
e. How could innovation in prevention be encouraged, identified and nurtured?
(Leader: Peter Hay, Strategic Director for Adults and Communities, Birmingham City Council and President, ADASS)
a. How would you define the social care market? What are the different dimensions we need to consider when assessing the market?
b. How could we make the market work more effectively including promoting growth, better information for commissioners, improved quality, choice and innovation?
c. Does there need to be further oversight of the care market, including measures to address provider failure? If so, what elements should this approach include, and who should do it?
d. What could be the impacts of wider reforms on the market? What possible effects would the following have on the market: the recommendations of the Dilnot Commission’s report, the roll out of personal budgets and direct payments, and the drive to improve quality and the workforce?
(Nick Kirwan, Assistant Director of Health and Protection, Association of British Insurers)
a. What are the main barriers to the development of financial products that help people to plan for and meet the costs of social care?
b. To what extent would the reforms recommended by the Commission on Funding of Care and Support overcome these barriers? What kinds of products could we see under such a system?
c. What else could the Government do to make it easier for people to plan for social care costs?
d. Would a more consistent system with nationally consistent eligibility criteria, portability of assessments and a more objective assessment process support the development of financial products? If so, how?
e. Would the reforms recommended by the Commission on Funding of Care and Support lead to an overall expansion of the financial services market?
f. What wider roles could the financial services industry play? For example, in:
- raising awareness of the care and support system?
- providing information and advice?
- encouraging prevention and early intervention?
- helping people to purchase care, or purchasing it on their behalf?
- helping to increase the liquidity of personal assets?
The summary of the issues given for each discussion topic is worth reading, as it gives some indication of the Government’s thinking on each issue and, to some extent, the direction in which it is likely to go. For example, it is clear that the Government wishes to support the development of private sector financial products such as insurance, annuities and equity release. The intention of drawing in the private sector as a way of encouraging and perhaps requiring people to plan the funding of their own care is underlined by the appointment as ‘leader’ of a representative of the industry who has won awards for promoting private health care. It is also clear that a strong focus in the ‘personalisation’ agenda will be pressure to increase the number of personal budgets and direct payments – a move which has been welcomed by some users and carers, but disliked by others for the additional burdens it places on them to manage their care and that of people they care for.
Local authorities should take the opportunity to respond in detail to this consultation, citing their own experiences in the areas highlighted. This consultation and the reports which have led up to it provide almost the final opportunity to influence the direction and funding of the social care system for years to come.