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Social Care FUNDING : GREEN Or RED HERRING PAPER ? Various Schemes And Utter Madness : All Together In This Thread - Page 14 - Carers UK Forum

Social Care FUNDING : GREEN Or RED HERRING PAPER ? Various Schemes And Utter Madness : All Together In This Thread

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Social care is a complex, human challenge. No wonder the Tories aren’t up to it.

A Lords report has called for general taxation to fund adult social care. But Jeremy Hunt has a better idea.

My mother has an informal patchwork of care arrangements, most of which she pays for herself. Some – a woman who perambulates her up the road and back – is provided by Age UK, and they’re all extremely nice, but none in the skill region of, say, giving a person a bath.

So the other day I asked if we should look into the local authority’s domiciliary care arrangements. “Jesus, no,” she replied operatically but also very quietly (she genuinely is pretty ill). “Just kill me if I get to the point of needing anything like that.” “Obviously I’d love to help,” I replied, “but I’m not allowed to do that.” She gave me a look like I’d refused to break into a building that had a cat stuck in it. “Where’s Harold Shipman when you need him?”

Was there ever anything easier for a politician to ignore than the subject nobody wants to talk about anyway? It’s like re-evaluating council tax bands so they actually make sense and are fair: only local authorities ever bring it up, and then everyone ignores them.

Yesterday, a cross-party Lords report did make some concrete proposals, however: £8bn to be spent immediately on social care, then a move over five years towards free personal care, as they have in Scotland, to be funded by general taxation. It has such an old-fashioned ring about it, that phrase: we have, over the past decade, become so accustomed to higher taxes as the ultimate unsayable that every new idea is either cost-neutral or funded by some peculiar and, latterly, often fictional windfall.

That report had many good things in it, but Jeremy Hunt, prospective (in his dreams) prime minister, had a better idea. People should be incentivised to save for their care in old age, he told the Today programme yesterday. The immediate problem, it struck me, was that the generation he’s talking about currently can’t even afford to save for their pensions. How the hell do you incentivise your way out of that?

As unlikely as it sounds, there is a much deeper flaw: the Lifetime Isa (Lisa) scheme already exists, introduced precisely to provide such an incentive. The government adds 25% each year, with a drawdown of the invested sum possible either when you buy your first home (a financial asset that could pay for care later) or at 60.

Under the current Treasury rules, only those who are already financially secure could ever use the scheme. Once you reach £6,000, that takes you above the limit where any universal credit you may claim starts to get cut until, at £16,000, you get nothing.

What Hunt was suggesting, in other words, was a policy that not only already exists, but that implicitly excludes the millions of adults in receipt of benefits, including in-work and housing benefits (except state pensions). Indeed, for those in receipt of benefits, this link between savings and eligibility already operates as the starkest possible disincentive to save, and exacerbates insecurity and debt by making it impossible even to build a cushion to set against a crisis.

It is increasingly clear that the Conservative party has done more than write off those on low incomes; it has simply ceased to see them as full citizens, with destinies and challenges and futures like anybody else. It’s quite chilling, when you dwell on it.

It is plain, too, from the sheer, divisive toxicity of the policy wheezes – from these incentives to Theresa May’s dementia tax – that the Lords are right on this. Adult social care must be funded through general taxation. Nobody can predict what their old age will look like; very few could sail financially through a long illness; misfortune makes no sense, financial or otherwise, when a society will not meet it shoulder-to-shoulder. These are obvious truths that the people of this country have a long history of comprehending and respecting, even celebrating, from the introduction of national insurance to the establishment of the NHS.

Lacking any real determination to tackle this, members of the current government approach adult social care like a game of musical chairs, their only real strategy to grab themselves somewhere safe for when the music stops. Jeremy Hunt said he’d only been responsible for it as secretary of state for six months of his tenure at health – in fact, while the department name changed six months before he left, but it had been within his purview for far longer.

In fairness, all the leadership candidates were pathetic on the matter. Most of them spun a Rory Stewart – appearing to talk turkey but saying nothing beyond “I am a person who talks turkey”; Mark Harper vowed, with comical limpness, to take another look at the Dilnot report that’s been on the back burner for the past eight years. Boris Johnson, with his aversion to detail and love of the quick fix, has nothing in his repertoire. A government that places such low value on maturity will never be equal to this complex, human task.

• Zoe Williams is a Guardian columnist


A letter in today's Guardian ... most of which I could have written myself :

Your editorial highlights “the problem” of social care – ie funding – but it is not the only one. In reality, there are several others as important.

First, social care is almost wholly located in the private sector (for profit), often of poor quality and usually distributed in geographical areas wealthy enough to generate it – if not, private providers move off to other more lucrative settings, leaving councils holding the baby with the financial burden on them and the NHS, increasing year by year.

Second, as long as local authorities are responsible for its funding (for those meeting the means test), councils will fall prey to the depredations of unfriendly governments bent on shrinking the state – forcing councils to deny support to needy citizens. It means that, currently, integrating social care with NHS services (with consequent savings and other efficiencies) is impossible because the two funding streams are different, with each system defending its own territory in hard times.

Finally, the issue of who pays then comes into play. Means-testing council services has always been permissible while the NHS has always been free at the point of use. Bringing social care services themselves (not just their commissioning and purchasing) into the public sector would mean that there was no such difference. Funding would come from a common source (from central funding via general taxation) and wholescale planning to meet demand, fairly distributed across the country, becomes feasible. Put simply – bring social care into the public sector and “the impasse” you describe will be broken.




Key findings

The social care system is also 70 years old this year but unlike the NHS, its anniversary will pass largely unnoticed. The fault line established 70 years ago between health care which is free at the point of use and social care which is means-tested, remains a fundamental source of inequity and unfairness today.

New polling suggests that the majority of the public (56%) think that individuals having to use their housing assets to pay for care is at least somewhat unacceptable, compared to 25% who think it is at least somewhat acceptable.

Adult social care spending in the UK has fallen by 9.9% between 2009/10 and 2016/2017.

An ageing population and younger adults with disabilities living longer are pushing up the cost of caring for older and disabled people, placing the social care system under huge strain. Based on current spending, a UK funding gap of £18 billion will open up by 2030/31.

Impact of not enough funding for adult social care in England

In England the financial thresholds to access social care are 12% lower (in real terms) in 2018/19 than they were in 2010/11, meaning fewer people are now eligible for publicly funded social care.

About 400,000 fewer adults received social care services in 2013/14 than in 2009/10, as local authorities have had to prioritise funding for people with the most severe care needs.

The care home market is unstable. According to the Competition and Markets Authority (CMA), care homes that have more than 75% of local authority funded residents are most at risk of failure and a quarter of UK-wide care homes fall into this category.

There was a 6.6% vacancy rate for the adult social care sector in 2016/17 and particularly high turnover rates for care workers.

Informal carers continue to absorb the bulk of the pressure – 75% said they had not received any support or service which allowed them to take a break of between one and 24 hours from caring in the last 12 months.

Cuts in local authority social care spending have led to increased use of A&E services by people aged 65 and over.

Delays to dementia care reforms " Costing patients £15 billion of their own money."

Charity says wait for green paper is leaving many out of pocket by paying for their own care.

People with dementia have spent almost £15bn of their own money in the last two years waiting for government care reforms, a charity has claimed.

The Alzheimer’s Society said the government must now publish details of how spiralling social care costs will be met in order to prevent people with dementia draining their own resources.

In March 2017, ministers promised a social care Green Paper by the summer, but it has now been delayed several times.

The latest from the government is that it will be published at the “earliest opportunity”.

Analysis by the Alzheimer’s Society shows that, since March 2017, people with dementia have spent more than one million unnecessary days stuck in hospital beds, despite being well enough to go home, at a cost to the NHS of over £340m.

It also said the number of over-65s diagnosed with dementia has increased by 33,000 in England since that time.

It has published a new photo exhibition of people affected by the delays, including a woman who had to ask passers-by to come into her house to help her lift her husband off the floor, and a woman who could not leave hospital because she still did not have a care assessment after a year of waiting.

According to the charity, people with dementia typically spend £100,000 on their care.

Jeremy Hughes, chief executive of the Alzheimer’s Society, said: “This shocking sum of money spent by people with dementia over the last two years trying to get access to the care and support they desperately need is utterly unacceptable.

“And the amount and quality of care they’re getting for it – those who can afford it – just isn’t good enough. The results are people with dementia and their families falling victim to this dreadfully broken system.

“Like the families in our exhibition, hundreds of thousands of people affected by dementia in this country are facing financial punishment, just because they happened to develop dementia and not some other disease.

“The evidence of the gross inequity continues to pile up, and yet still the government does nothing.

“We need an immediate cash injection through a dedicated dementia fund, while the government works out a long-term solution to finally end this crisis in care.”

NOT a dementia tax , Jeremy ... funded through GENERAL taxation.

Back to my hypothetical patient suffering from cancer and dementia.

Both are illnesses / conditions ... the treatment for one is free ... the other ? ... name your price !

( " Some good news and some bad news , squire. We have spent £ 200,000 curing the cancer. Another £ 50,000 has been
spent assisting you with the dementia by providing mainly social care. We had to sell your house. Not for the cancer
treatment ... that was free ... but for the dementia. " )

Why so ?
Having posted the momentus news from New Zealand , I came across the following publication from the Kings Fund in
New Zealand ... 64 pages in .pdf format :

https://www.kingsfund.org.uk/sites/defa ... sept13.pdf

The quest for integrated health and social care.

A case study in Canterbury, New Zealand.

Maybe 13,000 miles between us but ... our minds think similarly ???
Lord Forsyth ... Lord Forsyth of Drumlean is a Conservative peer and chair of the Lords Economic Affairs Committee :

https://www.politicshome.com/news/uk/he ... care-needs

Lord Forsyth : Social care needs a cheque, not more delay.

Social care is chronically underfunded and undervalued. It needs an immediate cash injection to bring it to an acceptable standard, and then urgent reform, says Lord Forsyth

On Thursday the House of Lords Economic Affairs Committee published our report on social care funding in England.

Like others, we were shocked by underfunding in the system. The number of people who need care but aren’t receiving it is increasing. Age UK estimate that 1.4m older people have unmet care needs. Many working-age people also have unmet care needs, and care for working-age people constitutes nearly half of all public social care expenditure. Unpaid carers, usually family and friends, are providing more care with less support.

Local authorities are struggling, with many overspending their budgets or using their reserves. The market for care is starting to collapse, with local authorities unable to pay care providers enough to cover their costs. And the care workforce continues to be undervalued and underpaid. One care worker told us she was tired of hearing colleagues describe themselves as “just a carer”.

We often hear about how difficult it will be to fix the social care crisis, but the problem of underfunding should not be conflated with other more complex flaws in the funding system. Fixing underfunding is simple: we need to spend more money. The Health Foundation and the King’s Fund estimate £8bn would return the system to 2009/10 standards. This won’t be perfect – 800,000 people had unmet care needs in 2010 – but it will be a marked improvement.

There are other flaws in the system.

There is a postcode lottery in social care funding. Local authorities rely primarily on business rates and council tax, which vary according to local economies, to fund social care. Care needs also vary between local authorities. This means different local authorities have very different amounts to spend per head. Social care should be funded by a national grant, distributed to local authorities according to local care needs and their ability to raise other funds.

There is also a ‘condition lottery’.

Someone diagnosed with cancer receives free treatment on the NHS.

If they are diagnosed with dementia they have to pay, sometimes hundreds of thousands of pounds.

( Someone else been reading this thread ??? )

This is clearly unfair.

Everybody should be entitled to a level of personal care—help with essential daily activities like washing, eating and dressing—free at the point of use. Individuals would still pay for accommodation costs and other care needs themselves, though the government should explore a cap to protect people from catastrophic accommodation costs. The King’s Fund and the Health Foundation estimate this would cost £7bn. We recommend the Government introduces free personal care over the course of five years.

This may sound like a lot of money. But if we cannot find money to provide basic support to the most vulnerable in our society, what is the state for? The government has recently found an additional £20.5bn to spend on the NHS—more than total adult social care expenditure.

We have been waiting for two years now for the Government to publish a Green Paper consulting on social care funding, but we have already had decades of discussion on social care. The government needs to bring this crisis closer to resolution and produce a White Paper with specific proposals for reform.

Clearly some level of political consensus will be needed to find a sustainable funding arrangement. Our own cross-party committee, which includes two former Chancellors, two Treasury permanent secretaries and a former Cabinet Secretary, agreed its conclusions unanimously. Last year’s joint Commons Committee report also proposed free personal care.

Think tanks as varied as the IPPR, Policy Exchange and the Centre for Policy Studies have all proposed some form of free care entitlement in recent months. Free personal care is both the fairest solution and the only solution attracting cross-party consensus.

It is not hard to see why – it has long been agreed that the state should provide a safety net to protect the most vulnerable in society.

Lancashire ... red rose country ... momentum is growing :

Should Lancashire's elderly get free personal care ?

Personal care should be provided free of charge to those who need it, Lancashire county councillors have said.

The radical policy revamp won cross-party support at a full council meeting – but the power to implement any change lies in Whitehall, not County Hall.

The authority will now write to government calling for an overhaul of the personal care system, which helps elderly people with basic needs like getting washed and dressed, going to the toilet and preparing food.

The move follows a recent House of Lords select committee report which concluded that personal care costs should be scrapped within five years. It also echoes a campaign by the charity Independent Age which wants to see people provided with support to remain in their own homes for longer – and to reduce the risk of their property having to be sold to pay for it.

Currently, personal care is paid for by the individuals who need it if they have income and savings totalling more than £23,250. Beneath that figure, costs are shared with the council on a sliding scale until a person’s level of income and savings drops below £14,250 – at which point the local authority pays in full.

The value of an individual’s home is not part of the means testing process for care provided within their own four walls.

However, the worth of their property is considered when determining whether they are eligible for financial support to live in a care home – and, crucially, there is a personal care element to the cost of a residential care place.

Labour opposition leader John Fillis led the call for a rethink of how the country treats its elderly residents.

“[They] should be supported with dignity at all times and they should not have to pay out their hard-earned money to cover that dignity.

“I believe anybody in this chamber would support [that intention], but the question is – where is the money coming from?

“We have international internet companies who siphon off billions in profits every year. They should be made to pay.

“We have offshore companies again siphoning off millions – they should be made to pay.

“We all pay and the people we represent pay – but these people avoid tax by [avoidance] schemes and moving away,” County Clr Fillis said.

He found support from the ruling Conservative group, with cabinet member for adult services, Graham Gooch, agreeing with much of his analysis.

But County Cllr Gooch said the authority should not simply sign up to a charity’s campaign on the subject – and instead needed to send a specific message to the government about the direction which it should take.

He put forward an amendment calling on ministers to scrap the current means testing regime and no longer take into account the value of an individual’s capital, such as their savings and income. Means testing for social care costs – both domestic and residential – should be limited to a person’s income, County Cllr Gooch said.

“Lancashire is not in the crisis position of some other parts of the country and I don’t want it to get there.

“The welfare state that we’ve had since 1948 was based on the premise that we would accord to the biblical standard and expire after three score years and ten. However, we are disobligingly living much longer – and I’m hoping to continue that trend.

“There does seem to be support for [the move to free personal care] from across the political spectrum – Cllr Fillis and Jacob Rees-Mogg are singing from the same hymn sheet,” County Cllr Gooch said.

Speaking after the meeting, the cabinet member suggested that he would like to see a wholesale review of social care which considered making all residential care costs free.

The government’s promised green paper into the future of the social care system has now been delayed by more than two years.

Independent Age claims that the care needs of 1.4 million people across the UK are currently going unmet.

George McNamara, Director of Policy and Influencing at the organisation, welcomed Lancashire County Council’s decision to write to the government.

“Thousands of older people across Lancashire are being let down by a social care system that doesn’t work for them.

“Free personal care is the best and most effective way of ensuring all older people are given the help they both need and deserve, and would virtually eliminate catastrophic care costs that many hard-press individuals and families have to face when paying for care. This would take a huge burden away from them and their families, and would show older people that society values their dignity and independence.”

“Having the council’s support will play an important role towards putting pressure on the government to end the unfair lottery of care which older people face. The more councils, like Lancashire, that get behind this campaign, the more chance we have of showing the government that the future of social care is in making personal care free at the point of need.”


The value of an individual’s property is incorporated into the means test of their ability to pay for social care only if they move into a residential home – not if they continue to live in their own.

But because there is a personal care element to the cost of a residential placement, the charity Independent Age claims that making personal care free would reduce the bill for those living in residential care by more than a third – meaning it would be less likely that people would have to sell their own home to cover the costs.

County Cllr Tony Martin told the County Hall debate on the subject that the change could not come soon enough – but, for his parents, would be too late.

“My father died two years ago – his care costs were £60,000. My step mother is now in a care home and her costs are currently running at £40,000.

“And they are in the lucky position of having savings, but the value of their house is already gone – it’s a shame and a tragedy.

“I think some of this could have been avoided if, collectively, government had implemented [reforms suggested by a previous commission on the issue].

“This is a step forward and hopefully the pressure [for change] will mean my generation won’t face the same difficulties as my parents’ generation did,” County Cllr Martin said.


A commission looking into the social care system was set up within weeks of the coalition government coming to power in 2010. When the group – led by Lord Andrew Dillnott – reported a year later, it suggested an increase in the threshold of savings and assets which a person should be able to hold before having to pay full residential care costs from £23,250 to £100,000.

The commission said the threshold for personal care should remain at £23,250 and also recommended a cap on lifetime care costs – other than those for general living – of £35,000.

The proposals were accepted, but never implemented and, in 2017, the Conservative government said it would launch a review of the social care system and publish a so-called “green paper”.

During the general election the same year, Theresa May was heavily criticised for a plan to raise the threshold for all social care costs to £100,000 – but extend the means test for care within a person’s home so that it included the value of that property.

There was anger from some quarters that the proposal promised a floor through which income and assets would not fall, but no ceiling to cap total lifetime contributions.

The policy was dropped before voters went to the polls, prompting Mrs. May’s now infamous “nothing has changed” comment.

The green paper is now two years overdue.

Personal care has been free in Scotland since 2002.


£169.7m – Lancashire County Council’s adult social care budget (2018/19)

£2.6m – overspend in county’s adult social care budget (2018/19)

£8bn – extra investment in adult social care needed nationwide this year, according to House of Lords Economic Affairs Select Committee.


An individual has to pay the full cost of their care if they have income and assets over £23,250. The figure excludes the value of a person’s home if they are to remain within it. Earnings and some benefits are also discounted from the calculation.

If they move into a residential home, the worth of their own property is taken into account – but not if they have a spouse, partner or close relative still living there.

It is possible to set up a deferred payment agreement with the local authority to repay the costs of your care after you have passed away.


A spokesperson for Department for Health and Social Care the social care system should continue to operate on the “principle of shared responsibility – and that people should continue to expect to contribute to the cost of their care as part of preparing for later life”.

“Social care charging is based on a number of key principles, including that people should not be charged more than it is reasonably practicable for them to pay.

“However, those that need additional support from the state also benefit from the means-tested safety net, which is available to everyone, including those with dementia.

“Where a local authority choose to charge someone, they must undertake a financial assessment of what the person can afford to pay to ensure the approach fits with the principles for charging.”

The department added that it will set out plans to reform the social care system “at the earliest opportunity to ensure it is sustainable for the future”.

Lancashire County Council received the joint-largest share of a nationwide grant to ease pressure on adult and children’s services late last year. The authority was handed almost £15m.
Delays to social care bill blamed for " Nervousness " among health providers.

Repeated delays to a government paper about the future of social care funding has created uncertainty among healthcare companies, a senior council officer has suggested.

Andrew Balchin, from Wakefield Council, said that a lack of discussion about the issue in Parliament had led to "nervousness" in the market.

Around 6,200 adults across the Wakefield district currently receive some form of social care. About 1,000 of those are in residential homes, while most of the remainder are given support within their own properties.

But a report last week rated the state of services in the local private sector as a bigger challenge to the council than Brexit.

Mr Balchin said on Monday that there was "growing anxiety" across the UK about the increased costs of social care and how these will be met, particularly from families with relatives suffering from dementia.

Speaking at an audit committee meeting, he said: "We've been waiting for a green paper from the government for some time on the future of social care funding. There have been regular delays to that.

"Organisations within the care market, if I can call it that, have had to live with a level of uncertainty about what they can reliably invest.

"That uncertainty has led to nervousness about investment plans, and what those providers can afford."

Mr Balchin said that councils "just had to get on with things as best they can" until the government offered more clarity.

He said: "I think we've probably given up on getting an answer about when the green paper will be presented.

"We'll have to see see whether or not it will be one of the priorities of the government next few months. Whether it will be in the top few, we'll have to wait and see."

Meanwhile, an app which is helping elderly people give honest feedback about the care they are receiving, will be used more widely by the council.

The app, PerfectWard, is used by public sector bodies to help the likes of patients and care home residents answer questions about how they're being treated.

Their opinions can be submitted in confidence, with the authorities then able to deal with any problems.

Mr Balchin said: "We're going to be trialling that with a number of homecare providers so they can do their own assessments of quality of care.

"That will give us a way of allowing people to express examples of good practice, but also any concerns that they've got, so that we can then follow that up."
Retiring York NHS boss Mike Proctor urges Health Secretary to tackle social care crisis.

The chief executive of York Teaching Hospital NHS Foundation Trust, Mike Proctor, has urged the government to improve social care to help tackle the burden on hospitals.

Mr Proctor, who is retiring next week after an NHS career spanning 44 years, had a surprising message for the Health and Social Care Secretary in Prime Minister Boris Johnson’s new cabinet: “My message to Matt Hancock is to focus on social care.

“That might seem to be really strange for somebody in health to say that, but that will help alleviate the burdens that are happening in health.”

He told the Yorkshire Post: “We see, every day, the numbers of people that turn up to our accident and emergency department that are neither an accident or an emergency but are coming because they can't get services outside hospital.”

The period between April 2018 and March 2019 was the worst year on record for accident and emergency waiting times across the UK, with Scarborough Hospital -- part of York Teaching Hospital Foundation Trust -- particularly struggling. In the spring, more than a quarter of people who visited Scarborough Hospital’s accident and emergency were waiting more than four hours to be seen.

Because of a dire shortage of home care workers, patients who are not seriously ill are forced to use hospitals for basic care.

One of the problems, Mr Proctor said, was that health and social care policy was devised in London by people who have not considered the challenges in the north, particularly in rural areas.

“In a diversely sparse population, like the areas that we serve, it's not economically viable to have one person doing domiciliary care across a massive area because they can only do a very few visits a day.”

Care workers tend not to be paid for travelling time between appointment which means it can be hard to recruit staff in the countryside.

“It's not the same as an inner city where you can do eight or 10 visits a day but they still get the same rate. It just doesn't work, does it?”

Key to solving this is giving power to local areas to make their own decisions on social care.

“This might mean different types of care being delivered in different parts of the country. People would label that a postcode lottery but it isn't a postcode lottery, it's local people deciding how they're going to spend that money.

“The priorities in York and Scarborough are different from the priorities in Kensington.

“We'll often set priorities that make sense within the M25 that don't make sense to us.”

Having started as an operating theatre assistant in Sheffield in 1975, Mr Proctor worked his way up through the NHS to become head of a trust employing 9,000 people.

In the 1980s, unusually for a man at the time, Mr Proctor trained as a nurse.

“Amongst my friends, I was afraid to admit I was doing nursing,” he recalled, adding he was one of three men in a class of about 40 student nurses.

“We were very few and far between and treated with suspicion,” he laughed. However, attitudes have changed significantly since then.

“Those days have gone thankfully. I think men are now accepted as also having a caring side as well.”

Going on to teach nursing, Mr Proctor instilled a deep respect for patients and the NHS into everyone he taught. “One thing I always say is 'treat it as a privilege'. Because actually, we get the honour of touching people's lives in a way that not many people in other jobs do.

“What people evaluate about their care is whether we're kind to them or not.”

This attitude during his career was partly formed during a terrifying ordeal as a teenager.

“When I was a 14 year old boy, I'd had major abdominal surgery and I was really scared. It was an emergency operation, and it was pretty brutal stuff”

A nurse held his hand, bringing him immediate comfort. “I still remember it, it was 50 years ago. That nurse will never know what impact that had on me at the time, she'll never know that.”

Mr Proctor credited this background in nursing for his career success, adding every decision he made as chief executive had the staff and patients in mind.

He said he trusted staff to know what would improve services and, where possible, always tried to deliver what they wanted.

“Scarborough will be self sufficient for nurses and not have to import people from outside and therefore be sustainable in about two years time.

“That's going to be absolutely fabulous, because we never had enough nurses that have gone through York University that wanted to work in Scarborough so we're recruiting locally to Scarborough. It's a fantastic opportunity for young people and actually middle-aged people to become a nurse and stay in Scarborough and work in Scarborough for the rest of their lives and I'm really proud of that.

“We've worked hard to develop that, and the benefits won't be seen for a few years but they're coming, I promise you.”

Colleagues described Mr Proctor as a “hands on” chief executive who “will be missed”.

Deputy chief executive and finance director, Andrew Bertram, who has worked with Mr Proctor for more than 20 years said: “Mike has never been afraid to make key decisions and he has played an instrumental role in many of the Trust’s developments, changes and improvements over the years. His selfless approach to his work, his dedication to patient care over the past 40 years and his commitment and loyalty to our Trust has been nothing short of outstanding.”

Mr Proctor added: “I can't say I've enjoyed every day of my career, but I've probably enjoyed 90% of it. That makes me spring out of bed in the morning because I really enjoy what I do. And I'm going to miss enormously doing those things.”
Lord Forsyth : " Private insurance won’t fix the social care crisis. "

The Tory chair of the Lords economic committee warns the PM that only a taxpayer-funded solution will mend our system.

Michael Forsyth, chair of the House of Lords economic committee, is in buoyant mood, happily surprised by the positive response to the committee’s recent, pugnacious report into social care funding.

“I was astonished by the reaction, actually,” says the Conservative peer. Congratulations came from across parliament; and there were supportive emails from the public. They liked not just its bold call for a multibillion-pound, taxpayer-funded, NHS-style overhaul of adult social care, but its brisk frustration with the political failure of successive governments to address what it concluded (after a brief deliberation about whether such language was appropriately lordly) was a “national scandal”.

The solution was admirably simple: write an £8bn cheque to local authorities in England and Wales to pull adult social care budgets back to pre-austerity 2010 levels; and create by 2025 a £7bn a year system of free personal care to help people with daily tasks such as bathing, dressing, personal hygiene, going to the toilet, and meal preparation.

Importantly, the cash would be distributed via a central grant, removing postcode lotteries in standards of provision. Above all, robust action was needed, and quickly: as Lord Forsyth said at the launch of the report earlier this month: “Let’s stop faffing around.”

Any initial concerns the peers had that their demands for an extra £15bn a year by 2025 were unrealistic were quickly drowned out by copious evidence of a broken system, he says. About 1.4 million people are denied the social care they need because of cuts, rationing and means tests. Many more endured basic “clean and feed” levels of care.

The system is riddled with unfairness and inequality, and the gap between demand and resources is growing apace. People are suffering. “You would have to be blind and totally excluded from society not to be able to read or see that the system is failing. We all know the system is failing,” he says.

Equally, some will have been surprised by the enthusiasm with which Forsyth – a former minister in John Major’s government – embraced this most statist of solutions. Forsyth less so. “I’m regarded as a rightwinger, as a Thatcherite,” he admits. “I believe in politics that the first duty of parliament is the defence of the nation but also to ensure, as Winston Churchill put it, to provide a net and a ladder; a net below which people do not fall and a ladder to help them get out of the net. Here you have people who can’t climb ladders and the net is full of holes.”

The committee’s proposals were built on solid evidence, he says – “which I suppose these days is something of a novelty in terms of public policy”. So, social insurance solutions favoured by many in his own party were quickly dispatched, after the insurance industry told the committee they wouldn’t work.

Half the social care budget is spent on people of working age, so insurance schemes would not help them. They were just a diversion from the reality that a properly functioning social care system is the expensive duty of the taxpayer, not of markets, says Forsyth. “The people who are looking for some easy way out of this are in search of a holy grail which does not exist.”

If confirmation were needed that the system was crumbling, it came in the private testimony given to the committee by care workers, he says. He was struck by their dedication despite low pay, low status, the lack of a career structure, and the dearth of support available to them. You can’t blame employers for this, he says, “trying to squeeze a pint into a half-pint pot”. It all comes back to financing. “They [the carers] know that people are denied care not because the local authorities or anyone wants to be beastly but simply because they are having to ration resources in the face of increasing demands.”

The committee expressly set out not to produce yet another worthy social care funding report – there have been 17 in the last 20 years, all of which were ignored or abandoned – but to create a blueprint that was acceptable to both Labour and the Tories. He is conscious of the way both parties have weaponised social care reforms in past elections: Labour’s plans dubbed a “death tax” in 2010; Theresa May’s plans vilified as a dementia tax in 2017. May’s were “crackpot” proposals anyway, he reflects: “You don’t try and get a policy which requires consensus among the political parties and launch it in the middle of an election campaign.”

Several days after our interview, Boris Johnson promised in his first utterances as prime minister to “fix the crisis in social care”. There has been speculation that his plan may adopt an insurance-style approach. Forsyth said Johnson should take note of the committee’s emphasis on funding the social care needs of working-age adults, and the importance of paying for it through taxation, warning: “Any plan which relies mainly on private insurance will not work, even with a pensions-style auto-enrolment scheme.”

By convention the government must formally respond to the committee within eight weeks; and a debate on the floor of the Lords should take place before Christmas. Brexit or no Brexit, there is simply no time to waste, Forsyth says. If the government is serious about social care reform it cannot possibly avoid the committee’s conclusions. “This is a broken system, we are reaching the end of the road.”


Massive new report ... House of Commons Health and Social Care / Housing / Communities / Local Government Committees
.. Long-term funding of adult social care ... 27June 2019 ... 83 PAGES in .pdf format :

https://publications.parliament.uk/pa/c ... /76802.htm


For the deerstalkers amongst our readers , the following pages maybe of interest :

23 ( Our only mention ... in passing at that ! )

Nothing major in there that has not already appeared in this thread ... still talk of a Social Care Premium to operate in a similar
way to National Insurance contributions ... a far cry from what is really needed ???

Of interest is our own CUK's submission ... reported in full from the appendix to the report :

About Carers UK

Carers UK is a charity set up to help the 6.5 million people who care for family or friends. At some point in our lives every one of us will either need care or be involved in looking after an older relative, a sick friend or a disabled family member. Whilst caring is part and parcel of life, without the right support the personal costs can be high as it can affect your job, your health and your finances.

1.2 Carers UK is a membership organisation of carers, run by carers, for carers. We have almost 40,000 members and a reach of many more. We provide information and advice about caring alongside practical and emotional support for carers. Carers UK also campaigns to make life better for carers and influences policy makers, employers and service providers, to help them improve carers' lives.

1.3 Carers UK’s advice and information services answer around 20,000 queries from carers and professionals every year. Our website is viewed by over 100,000 people every month, 27,000 subscribe to our monthly email newsletters, and the combined reach of our online communities and social networks exceeds 38,000. We’re in regular contact with around 1,500 local organisations, including many run by carers, who are in touch with around 950,000 carers. Carers UK has offices in Wales, Scotland and Northern Ireland.

1.4 Carers UK and major businesses have set up Employers for Carers offering help to employers to retain the 1 in 9 employees who are caring for a family member. Employers for Carers is a forum of employers – large and small – supported by the specialist knowledge of Carers UK. Our Employers for Carers network is over 130 businesses which cover over 1 million employees.

1.5 The evidence provided by Carers UK comes directly from carers’ own experiences of the health and care system, including their experience at work and how it is impacted by social care changes. We also look at other external sources of key evidence.


Carers play a vital role providing care worth £132bn each year[1], but they cannot increasingly prop up a social care system in crisis as this brings with it significant costs in health, well-being and employment. The new cross-Government Carers Action Plan, currently in development, is recognition of the need to better support carers and may deliver some short term solutions for support, but wider support for social care is also needed.

2.1 The rationing of social care services due to funding cuts is resulting in extreme and unsustainable pressure being placed on carers, who are providing more care, for more hours than ever before. Since 2001, the growth in the number of carers has outstripped population growth by 16.5% and the number of people providing 20-49 hours of care a week has increased by 43%[2].

2.2 Many carers are caring without the support they need or are seeing reductions in the amount of support provided. The latest 2016-2017 data from NHS Digital on Adult Social Care Spending in England that the number of carers getting support or being assessed from local authorities has dropped by 5% since last year with spending on carers dropping by 6%.Spending on the respite services that give carers’ a much needed break from their caring has also decreased.

2.3 Carers UK’s own research with carers found that 1 in 5 carers who are providing 50 hours or more of care each week are receiving no practical support with their caring role[3]. The impact of providing care without the right support is vast, affecting carers’ health, finances and ability to have a life outside caring, as well as their ability to continue caring.

2.4 Underfunding of social care services presents risks for the wider economy. 1 in 9 people in the workforce combine caring with paid work. The availability, affordability, reliability and quality of replacement care services has a significant impact on carers ability to juggle work and caring responsibilities.

2.5 Carers need to know that their parent, child or partner is in good hands when they are at work. Yet evidence shows cuts to social care funding are impacting the quality of services provided. Local Government Ombudsman has reported a steep increase (29%) in the number of complaints and enquiries received about councils’ provision of home care. A high number of these complains (67%) were upheld[4].

2.6 Of those carers Carers UK surveyed who had given up work or retired early to care the majority of carers replying to our survey (62%) said it was the stress of juggling everything that meant they gave up work but over a third (35%) said that the care services they needed to continue to work and care were not suitable or were too expensive[5].

2.7 There is evidence to show that carers give up work to care. Carers UK research suggests that over 2 million people have given up work at some point to care for loved ones and 3 million have reduced working hours[6]. The current impact of staff turnover, absenteeism and stress as a result of juggling work with caring is already having a huge impact on business, estimated to be costing UK businesses over £3.5 billion every year[7].

How to fund social care sustainably for the long term (beyond 2020), bearing in mind in particular the interdependence of the health and social care systems

Publicly funded care provided by the NHS and local authorities comprises a minority of the total care provided in the UK. The majority of care and support is provided, unpaid, by family and friends and is worth a staggering £132 billion a year[8]. Yet for carers, getting the right support from the social care system has a profound impact on their ability to continue providing care.

3.1 To be sustainable, any long term settlement must have support for unpaid care at its heart and actively support families and friends to do the following:

Have a choice about caring and how much care to provide with the ability to have a life beyond caring.
Work in paid employment if they wish to and care
Have equal access to learning and education opportunities
Have equal opportunities to volunteer and contribute in other ways to communities
Have time to focus on other relationships – children, partners, grandchildren, friends, parents, siblings
Be able to maintain physical and mental health and wellbeing that is not affected by caring
Avoid poverty and financial hardship
Ability to access to suitable breaks from their caring role.
Have good quality and appropriate housing, including the right adaptations.

3.2. To achieve this we need a social care system that:

Recognises the huge existing contribution of unpaid care and the existing pressures on the sustainability of current levels of unpaid caring: Failure to understand competing pressures on people to work longer and the propensity of people to provide unpaid care will result in more pressure on the health and care system and on families.

Well-funded: By this we mean that there is sufficient funding in the system to ensure that people who need publically funded social care and their families and friends get it.

Sustainable: By this we mean that we can plan for the future knowing that the social care system will be there in the future to support us and anyone who relies on us for support.

Extends eligibility: Addresses unmet need by extending the right to publicly funded support to those with more moderate needs for care or support and raises the means test floor to enable more people to get support with the costs of care.

Pools risk: We need a social care system that pools risk between different groups of people. At the moment, those carers most at risk of catastrophic direct and indirect costs are:

Parents of severely disabled children whose packages of care are reduced as they transfer to adult social care
Families of people with long term significant or degenerative conditions who have many years or a lifetime of direct and indirect costs
Older people with severe conditions such as stroke, dementia, Parkinson’s Disease or Motor Neurone Disease – who stand to pay hundreds of thousands of pounds in care costs with little protection

Recognises that care services are a pre-condition for work - part of the infrastructure needed for participation in the labour market: Without a sustainable funding settlement the ability of the workforce to juggle work and care will decrease, with the likelihood of early exit from the labour market or reduced working hours and income. Our evidence suggests that carers leaving the workforce and having difficulties juggling work and care negatively affects the UK productivity rate.

Has sufficient resources to enable the delivery of consistent high quality care: by this we mean care that is defined by families and the people that they care for as good quality – well trained staff, appropriate care, punctual support, in order to lead a fulfilling life. The care needs to be readily available and affordable to families.

Funds the young as well as older people needing care: We need a social care system that looks at care across the life-course from people who have a disability from birth or childhood through to people developing disabilities later in life.

Harnesses the power of technology to support caring where it can and where this is desirable.

Invests in community capacity: The capacity of small and medium community voluntary sector organisations has been hit by spending cuts and a lower capacity of the public to donate in the economic downturn. According to the NCVO’s current projections, charities will be faced with a £4.6bn shortfall in income by 2018/19 - the result of cuts to government contract and grant income, low growth in donations from the public, and inflation. Small and medium-sized organisations saw an overall fall of 38% in their income from government sources between 2007/8 and 2012/13[9].

Without a healthy and resilient voluntary sector, people are less able to access low level support which can prevent support needs from developing or developing as quickly. For example, access to lunch clubs which can provide a break for a carer.

3.3 Potential measures that could have a negative impact on carers:

 Expectations that families will contribute more financially or in increased hours of unpaid care.

 Extension of the current residential care means test to domiciliary care

 Any reduction of disability/carer related benefits, including Attendance Allowance, as means of increasing social care funding. This includes any change in the delivery of these benefits that might undermine eligibility in the future

 Separate charging frameworks for older adults and younger adults that present a ‘cliff edge’ around age 65.

The mechanism for reaching political and public consensus on a solution

Political consensus:

To reach a political consensus on solution that will provide enough funding for a sustainably funded fair system for the long term, we need shared clarity and openness about the scale of the issue and that this will only be achieved with successive Parliaments working towards a common goal. To achieve this goal and start from a shared position we need to be clear about all of the following:

funding needed to fill the current funding gap
real investment to bring the standard of care up to a consistently high level
the increase in funding needed to support the contribution of unpaid carers, protecting their health, wellbeing and opportunities.
to cover any extra costs of reorganisation and integration of systems which might save money in the long term but need more investment in the short term
To meet the growing needs of an ageing society
A shared goal of ensuring that carers do not end up in poor health, poverty, out of work, etc. because of caring.

Public consensus:

4.1 A great deal of deliberate work was undertaken for the pension changes as part of the Turner Review which were significant and far reaching. Significant deliberate work was done by Government in 2009 and 2010 with the public on social care. More deliberative work with the public has been undertaken since by the Dilnot Commission and independently by others such as the Health Foundation, Kings Fund and the Nuffield Trust. There is already significant evidence on which a public consensus could be built.

4.2 Government needs to take forward action and not delay tackling social care funding in the short and medium term. Whilst the medium term will be discussed in the Green Paper on social care, the question of short term funding must be acted on. We cannot continue with the current situation of underfunding in social care where the poorest get increasingly less or nothing at all, and those with means above the threshold are facing ever increasing charges and payments – facing a limitless bill for care costs, whilst families are also under intolerable pressures.

It is quite clear that the above submission was made WITHOUT consulting with us.

Make of that what you will ... CUK will have to live with it.

In my view , I would be embarrased to submit a document that does nothing , not even an attempt to , ease our plight !!!

179 posts