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Age of uncertainty - Care system - Carers UK Forum

Age of uncertainty - Care system

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http://www.yorkshirepost.co.uk/opinion/ ... 4002147.jp

We can't afford to ignore the crisis in a care system at breaking point

THERE is a growing consensus that the UK care system is in crisis. Under-funded and misunderstood – the system is not fit for purpose.
The problem is most acute when it comes to caring for older people. A growing "care gap" exists between older people who need care and are entitled to receive it, and those who actually receive state support. Half of those who qualify for help are being turned away: dwindling budgets means councils cannot afford to assist them.

This year offers a unique opportunity to strike a new deal for social care. The much anticipated Green Paper on the funding of adult social care is expected later in 2008, following the publication before Christmas of the "Putting People First" declaration, which established the Government's shared vision and commitments to a transformation of the style of adult social services. In theory, by the end of the year, we shall have the principles in place that will shape the new social care model, and a proposed blueprint for how they can be paid for.

Getting this right means improving the quality of care for thousands of people now and in the future. The UK has an ageing population, and our aspirations for later life are increasing. The next 30 years will see a doubling in the number of people aged over 75. Now, more than ever before, we must lay down the foundations for a social care system that will stand the test of time.

David Cameron's comments at the Yorkshire Post's "60 against one" event last week on how best to fund residential care costs are a welcome addition to the debate. Residential care is one of the most high-profile services provided by the social care system, and can represent a catalytic cost for the individual involved. Moreover, the cost of a place in a care home is set to double over the next 20 years.

But, this is only one of many aspects of social care at breaking point – the lack of funds in the system is having a devastating impact across the board – three-quarters of councils now provide care to those living in their own homes only if their needs are deemed "substantial" or "critical", leaving those with lower levels of need to fend for themselves.

We must be brave enough to put every aspect of our current system under the microscope. This means looking not only at funding residential care, but how we pay for all social care. There must be a national debate about more than finance, but also about the quality and style of care we provide – looking at everything from commissioning to provision.

This debate must include not only politicians and policy makers, but care users themselves.

It's good to hear the Conservatives talking about partnership schemes for funding long-term care. The model Cameron mooted, whereby those living in a care home pay for their place for a period of time and the state pays for the rest has its merits. But this system of funding would not work in any other aspect of care and is hard to implement fairly in care homes.

The long-standing difficulty with this model is working out when people start to need care. This is seldom a precisely defined moment. People tend to drift into dependency and presenting high level needs, and measuring their physical or mental capacity to manage independently is a very imprecise science.

It is one of the problem issues which contributed to the demise of long-term care insurance (offered by the private sector in the 1990s, but now more or less unavailable in the UK) and it will bedevil the time-limited partnership model which Mr Cameron seems to be espousing.

A partnership between the state and the individual is the way forward – neither the state can contemplate the cost of meeting every single care need, nor can the individual. But the balance is unlikely to be struck fairly by developing a pattern which switches on or off a care clock, with the state paying for a partof the time and the individual
for another part of the time. The deal cannot be struck around such a simple concept, which is unlikely to be real and relevant to the lives of most people who have care needs.

The Right care Right deal campaign, a partnership between the charities Help the Aged, Carers UK and Counsel and Care, has been launched to build public awareness and support for the need for brave and innovative solutions for the social care system.

Right care Right deal believe the model of funding proposed by Derek Wanless, which provides for a universal basic level of care and shares additional costs between the individual and the state, is the best way to achieve a fair and sustainable system that can deliver into the future.

At present, relatively few people know at first hand the full extent of the chaos within long-term care. As our population ages, more and more people will be confronted with this uncomfortable truth. Now is the time to discuss honestly and openly how best to develop a system that will work for all.

Getting the balance right on who pays for what is the first step.

It's vital that the Government works to resolve the crisis in funding. Failure to act now means storing up problems for the future, with yet more people denied the care they need because of financial constraints.

Developing a transparent and just funding settlement for adult social care is crucial to transforming our ailing care system into one that is personalised, easy to understand and accessible.


Mervyn Kohler is special adviser to Help the Aged


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For much of the past 20 years (since the Griffiths report on the future of Community Care) the debate about what constitutes a health care need, and what is a social care need, has consumed vast management and research resources, with no solutions in sight. To the top managers heading up the NHS, social services and special care housing, with responsibility for budgets of hundreds, sometimes thousands of millions of pounds, the impossibility of unraveling this Gordian knot became an excuse for continued defensive behaviour. Rather than see funds transferred between agencies (and entire empires diminished), the budgets were stripped and pared back to the bone. The ability - not to manage constructively in partnership, but to be defensive and obstructive - became the key criteria of "management success".

Some of the attempts to solve the problem were almost laughable - people at the top vacillating between providing cosmetic but hollow local solutions to local needs like the fundholding GP scheme, to pulling everything back into the centre again with yet another grandiose plan. Agencies were restructured endlessly, forests cut down to produce more White Papers, luxury hotels booked solid for endless residential conferences and power breakfasts. Management consultants earned millions. All at the taxpayers expense, naturally.

It's time, I believe, to take the resources back into the hands of local communities. Community care should be just that - care by the community for the community. But it will only work if local communities are given the responsibility for the whole care budget and local co-operatives of GPs, carers, and local elected members can determine local commissioning and support arrangements.

Back to the Danish model - they have been doing this for decades.
In a rush so have not looked at above in detail .


As ive said many times over the last few months the care system is beyond repair and we carers who care for our elderly and young disabled relatives within our own homes should be rewarded for keeping our relatives out of the care system by looking after relatives at home we save the local authority scial services and n.h.s. billions but the powers that be just cant see beyond their cheque book if every carer was to stop overnight the whole n.h.s. and local authority care system would be in chaos for years .

The sad thing is we all know we will never get an increase in the allowance and will just keep ploding along from one crisis to another.


GEORGE.==========