Social care

ePolitix.com Stakeholders comment on the annual 'State of social care in England' report from the Commission for Social Care Inspection.

Government Response: Department of Health

A DH spokesperson said: "The CSCI report has rightly highlighted those areas where there is still work to do but we should not lose sight of the fact that the quality of social care services is continuing to improve.

"In 2005/06 the number of people receiving social care was still rising.

"An estimated 1.75 million clients were receiving social services in England during 2005-06, a rise of 2 per cent since 2004-05.

"In addition, since 1998, the number of households receiving intensive home care (defined as more than 10 hours and six or more visits) in England has risen by 62 per cent, to 98,200 households.

"We are concerned about the potential effect of rising eligibility criteria. 

"Local authorities need to put a greater emphasis on preventive services - helping people with lower needs to avoid admission to hospital or residential care.

"We would, of course, expect primary care trusts (PCTs)  to look carefully at joint arrangements with social services to ensure these provide value for money.

"However, it would be a false economy for PCTs to withdraw from jointly funded services which help people remain in the community.

"People with lower care needs who are unsupported are more likely to need admission to hospital or residential care and need more expensive NHS treatment.

"CSCI will focus the next State of Social Care report on eligibility criteria and access to services and we will carefully consider their findings."

Part Response: Conservatives

The Commission for Social Care Inspection, Shadow Minister for Health Stephen O’Brien MP said: "I welcome this wide-ranging and detailed report. It is a crucial insight into the sector.

"Whilst the overall picture is one of gradual improvement, it reveals many of the failures of government policy.

"Patricia Hewitt’s cash crisis in the NHS and the constant meddling with NHS structure, have adversely affected social care provision.

"Fewer people are receiving the care they need, and the pace of improvement is too slow.”

Party Response: Liberal Democrats

Liberal Democrat health spokesman Sandra Gidley said: "The government cannot keep kicking this problem into the long grass. 
 
"This issue is of fundamental importance because it will affect the one in four people who will require some form of long-term care in their lifetime.

"It will also increase the financial and emotional burden on the many overworked, and often unpaid carers, who are helping the elderly.

"Derek Wanless gave his chilling forecast on the looming crisis in social care last year and offered a range of solutions, all of which were ignored by the government.

"Councils around the country are tightening their qualifying criteria - meaning that those in need of care will have to reach a desperately needy state before they get any help.

"This could mean years of requiring help and not getting it.

"The financial and human cost of not tackling these pressures early on will be huge and cannot be ignored."

Stakeholder Response: CSCI

A spokesperson for CSCI said: "Our report finds that more services are meeting minimum standards, but despite spending more, councils are tightening local rules about who qualifies for state-funded social care.

"This means that more and more older and disabled people either have to find and pay for their own private care or rely on family members or friends.

"As local councils support fewer people, informal carers have to fill in the gaps, with inadequate support structures to help them and no system in many areas to help people find the services they need.

"Those who have no one to rely on may have to make do without support until their situation becomes critical.

"The lack of ‘respite’ help for people who have caring responsibilities can affect their ability to hold down a job, fulfil other family responsibilities such as looking after children, and may damage their own long-term health and emotional well being."

CSCI chairman Dame Denise Platt added: "Social care services in England are gradually getting better, but only for those people who manage to qualify for help.

"As councils face an increase in the number of older and disabled people and in the costs of care, many have responded by raising the threshold people have to pass before they are entitled to a council-funded service.

"As a result, irrespective of the quality of social care services, fewer people are receiving services.

"Those who do qualify for care have a high level of need.

"The options for people who do not meet the criteria set by their local council are limited.

"In some cases, people rely on friends and family members.

"In others, they pay for their own care. Some people have no option but to do without.

"It is also clear that external pressures on the sector are hindering progress in making services better for the people who use them.

"In particular, NHS budget deficits in some areas are putting a strain on relationships at local level and potentially undermining essential partnerships in both adult and children’s services.

"The proportion of people in England who are over 65 is growing.

"Recent projections indicate a rise of 53 per cent in the number of older people with some care needs over the next 20 years; and a rise of 54 per cent in older people with a high level of need.

"The number of young disabled people is also increasing.

"The number of children under the age of 16 with disabilities rose by 62 per cent between 1975 and 2002.

"Many of those children will continue to require help and support as they reach adulthood in order to live their lives to their full potential.

"The report also sets out details of improvements in the quality of services, such as care homes and home care agencies, which are registered and regulated by CSCI."

 

Stakeholder Response: Age Concern

Age Concern director general Gordon Lishman said:"This is a damning indictment of a social care system that is failing older people.

"Not providing services for people with so-called moderate needs causes much anguish for the individual – but can also result in much higher and more expensive care needs in the future.

"The government has said it wants more care delivered at home – but this report just highlights that fewer and fewer people have been receiving social care in recent years.

"The government cannot afford to bury its head in the sand any longer.

"How we fund the system is one of the biggest challenges facing our ageing nation. We urgently need a mature debate about what the state will provide and what individuals need to do for themselves, similar to the successful debate we had on achieving pensions reform.

"Unfortunately this report just confirms the experiences of older people.

"Those receiving care at home have seen services withdrawn and prices increased, while those in care homes and their families often find themselves subsidising the pitiful amounts local authorities pay for care.

"Older people are also let down by the quality of care delivered in care homes.

"It is unacceptable that 61 per cent of care homes don’t meet minimum standards of managing medication safely and 57 per cent don’t ensure there is an appropriate care plan for its older residents."

Stakeholder Response: General Social Care Council

Rodney Brooke, GSCC chairman, said: "CSCI is to be congratulated on the report, which is a mine of essential information.

"We believe that the workforce is key to improving the quality of social care services and that registration is key to raising the status of the workforce.

"At the minister’s request, the GSCC has submitted proposals to the government on extending the benefits of registration to residential and domiciliary care workers."

Lynne Berry, GSCC chief executive, said: "We share the assumption of this report that services must be judged against what service users say they want and against the government’s reform agenda; both require a trained and trusted workforce delivering high quality services in ways that put service users at their heart.

"CSCI’s report gives cause for celebration and concern.

"It is great news that the percentage of those working in younger adults’ residential services who have met the training standard has risen from 49 per cent in 2002/03 to 73 per cent in 2005/06 and that the percentage of those meeting the qualifications standards in older people's residential care has risen from 47 per cent to 72 per cent in the same period.

"However a substantial number of home care services are not meeting standards relating to the selection of staff and supervision – key aspects not only of the National Minimum Standards (NMS) but also the GSCC’s codes of practice for social care workers and employers.

"In children’s residential services, although the percentage of people who are trained and competent increased from 46 per cent in 2002/03 to 70 per cent, this has been the same figure for the last two years.

"A third of children’s homes do not meet standards relating to health, safety, security and the adequacy of staff.

"In homes for younger adults, 53 per cent had insufficient verification of the suitability of staff through recruitment checks and references, as did 40 per cent of care homes for older people.

“Overall there is a great deal to welcome. Much has been achieved; quality is up.

"However the rate of improvement must be maintained.

"Good recruitment procedures, effective training, personal accountability and effective safeguarding measures are essential to achieving a respected and skilled social care workforce."

 

Stakeholder Response: Alzheimer's Society

Neil Hunt, chief executive of the Alzheimer’s Society, said: "This CSCI report is confirmation of what people with dementia and carers across the country know.

"The care system is in crisis with the government unwilling to ensure investment to help people with serious medical conditions.

"Additional investment in the NHS has not been mirrored in social care.

"Inevitably the result has been that as need increases, local authorities skew what care there is available to people with high levels of need.

"Thousands of people who need extra help to remain independent are being ignored.

"This trend is the opposite to the government’s stated policy to improve preventative and low level services.

"We are well beyond the need for policy papers and fine words.

"The government needs to prepare a rescue investment plan for social care services.

"Next month the Alzheimer’s Society will publish a Dementia UK report showing that the UK is facing a substantial increase in the number of people with dementia in the years ahead.

"It’s time to decide whether as a society we are willing to support some of our most vulnerable people or instead to force families to struggle on."

 

Stakeholder Response: Carers UK

Imelda Redmond, chief executive of Carers UK, said: "Today's report from CSCI gives an honest account of the harsh reality faced by carers across England.

"CSCI rightly describes social care support as 'patchy' and 'fragmented and limited'.

"We agree with CSCI that 'support for unpaid carers remains one of the biggest public policy challenges of our time'.

"We believe that the response to date from government and care service commissioners is insufficient to meet the rising need in the population.

"Carers are the mainstay of social care.

"Carers have been telling our helpline CarersLine for months that eligibility criteria are being tightened, leaving disabled and elderly people with reduced services and requiring families to meet the additional need from their own pockets.

"Providing limited services only to those in critical need is a firefighting measure that will not address the longer term needs of an ageing population with more complex needs.

"As the foreword to the report notes, 'the options for people who do not meet the criteria set by their local council are limited.'

"Too often carers are left to struggle alone, often putting their own health and wellbeing at risk.

"Carers are already more likely to suffer ill-health than those without a caring responsibility and one in five carers has been forced to give up work.

"This reduces their ability to build up pension contributions, putting them at risk of poverty in old age.

"Cutbacks to local services risk carers' abilities to live the normal lives which most people take for granted.

"Too few councils are taking a strategic approach to supporting carers and there is a lack of focus on equal opportunities.

"In many parts of the country support for carers needs to be radically re-thought."

 

Stakeholder Response: Disability Rights Commission

A spokesperson for the DRC said: "Britain’s social care system is close to the point of no return and needs urgent investment to reduce the unbearable pressure that its shortcomings are placing on disabled people, carers and families.

"The report paints a bleak picture of increasing demand for support against the backdrop of ever tightening criteria for getting it.

"What threadbare services there are contain massive holes that are claiming millions of families who are now at breaking point.

"The job of keeping many families together today rests on the shoulders of an informal army of relations and friends which includes thousands of children who provide over 50 hours of care a week.

"In a developed society this is nothing short of a disgrace.

"The current settlement we have is producing disadvantage and needless costs across society – to women who overwhelmingly fill the gaps left by inadequate social services, to the children of disabled parents who represent one in three of all children living in poverty, to the taxpayers who support the huge numbers of disabled people without the support to enter the labour market.

"Investment and reform to social care should be a top priority for the 2007 comprehensive spending review.

"Further neglect will only compound the pressures that families are already experiencing and store up even greater problems for future generations."

 

Stakeholder Response: Shaw Trust

A spokesman for the Shaw Trust said: "We would urge all authorities involved in commissioning social care to consider the full range of options available to them - including innovative systems such as Direct Payments - in order to provide the best quality of life for the greatest number of their stakeholders.

"Whilst uptake of Direct Payments is increasing rapidly, thanks to determined efforts by the Department of Health and service providers, there are still great strides needed to make sure that this cost-effective option is available to all.

"It is worth noting that, since December, the advent of the Disability Equality Duty means that council who restrict access to Social Care could potentially even find themselves in breach of the law."

Stakeholder Response: Anonymous

ePolitix.com received this response from a Stakeholder who wishes to remain anonymous: "My 90-year-old mother has recently experienced a very rapid onset of dementia, which has made her scared, confused and unsafe to live on her own anymore. 

"Her GP has been outstanding, as has the practice social worker. 

"The social services provision of home care support has been high quality, but is now no longer adequate. 

"So she is in respite care, while we seek a place in a residential home where she can be properly cared for.

"Our challenge is, of course, the position that the care she needs is deemed to be only 'social' rather than health-related, despite the fact that dementia is a medical condition. 

"This means that there is no immediate statutory duty for the health service to provide care, and we are dependent upon finding a residential home which caters adequately for people with dementia. 

"That in itself is challenging, but having identified one, we find that its weekly price is higher than the social services accepted rate, which would mean that she or the family would need to provide the difference between the two prices, as well as the means tested contributions she would have to make until her savings are reduced to around £12,500. 

"And there is no guarantee that once her savings are all spent on the price difference, she could continue to stay there.

"This seems very unjust, for a woman who served her community all her working life, as a community midwife and district nurse; and served as a military nurse during the War, incurring serious injuries when the hospital ship on which she was nursing was torpedoed on its way back from North Africa to Gibraltar. 

"She also brought up two children on her own, during a period when welfare benefits were severely limited. 

"Until the last short period of dementia, she has barely ever been a charge on the State.  Yet her needs are allowed to fall between health and social services. 

"We were interested in the recent test case, which established that dementia was indeed a health-related condition and that therefore the health budget should bear the costs of care. 

"If only this could be translated to local level! 

"Young people's and children's services are increasingly integrated. What is needed is similar integration for the elderly. 

"Where is a Connexions Service for them?"