Wanless one year on
25 April 2007 | Sir Derek Wanless, Author of King's Fund report on the funding of long-term careLittle has changed one year on from the publication last year of my review of social care for older people for the King’s Fund, except perhaps a greater awareness of the depth of the crisis. The challenges it posed have not been taken up with necessary urgency, and social care has missed out as attention and money have been directed elsewhere.
The current system is chronically under funded. Budget increases not even keeping pace with demographic change have squeezed care services, and people with moderate needs have suffered most. With little or no support, people’s chances of staying healthier for longer are reduced.
The system survives only because of the huge contribution made through informal care by families and friends. Their role is recognised in words and is likely to continue, but carers need more than the minimal help and support they get.
The funding system penalises people with moderate savings, a shock to many just when they are most vulnerable. If left in place, it will discourage hundreds of thousands from receiving support they need.
The postcode lottery is alive and well in social care, with large inequitable differences in local authority charging. There are perverse incentives encouraging excessive use of care homes rather than care at home. Poor people with assets less than £21,000 are left with £19.60 a week personal allowance after care costs. It is the exact opposite of the rhetoric about independence and dignity.
Today, up and down the country, relatively few older people are eligible for NHS continuing care. The benefits of ‘free’ care have been replaced by means testing. This shift began more than 20 years ago, but it is a policy largely introduced by stealth, noticed only when people need help.
As we await the Chancellor’s announcements on future funding of social care later this year, it is crucial to emphasise the urgent need for additional spending simply to prevent further deterioration. Furthermore, changes in the population over the next 20 years would demand significant increases in spending even if the present system is retained.
In the longer term a more enlightened system must be adopted. Central to finding the right solution will be agreeing, as a society, what outcomes we want to achieve for older people and what kind of care system we will provide them. A fairer, more rational system must be built on the foundation of a basic entitlement for everyone, calculated to reflect the level of care required rather than the financial means of the individual.
The other key question is ‘who pays what?’ The current complex funding and benefit regime must be replaced and the huge financial risk to people of extended and expensive social care must be pooled across the population.
The immediate reaction to my review when it was published suggested that we had reached a tipping point where government and opposition parties all acknowledged the major shortcomings in the system.
All of the leaders in the field seem to me to be ready for a frank and open discussion about the realities created by an ageing population, and the competing demands on the tax base. What they are all agreed on is the need for a system that ends the current shameful treatment of older people and transforms the rhetoric into a reality of dignified lives.
Sir Derek Wanless is a Senior Associate of the King’s Fund. In addition to his review of social care for older people for the King’s Fund, Sir Derek has also produced two significant reports for the government on the NHS. He was formerly chief executive of NatWest Group.
April 30th, 2007 at 9:58 am
In addition to the above comments I am finding that local authorities are resisting planning proposals for schemes such as care villages which could alleviate the overall burden of funding for fear that older people from outside their local authority boundaries will move into the schemes and potentially increase the requirement for local funding. Despite the acknowledged benefits that a a care village scheme will bring one local authority in London has put forward a recommendation that entry into a scheme should be restricted to those living within the local authority boundary even though this boundary is only 100 metres from the site of the scheme
May 24th, 2007 at 2:43 pm
I totally agree – the crisis for any type of care for older people just gets greater and greater. I worked for a local authority with responsibility for courses specifically aimed at older people but the ‘older people’ aspect was dropped after a couple of years. For some years older people in sheltered housing (I worked in partnership with Age Concern)and community settings benefited from a range of courses. The LSC has stripped funding for this particular area and I have recently had to take a very hard decision to leave and set up on my own to provide a service to vulnerable adults. Older people NEED adult-appropriate activities delivered by suitably qualified and experienced people if we are to prevent hoards of older adults having to visit doctor’s surgeries or end up in hospital – I don’t have to tell you about the studies that prove that everybody benefits from activities. I do worry whether I will be able to survive as an independent learning provider as I have no funding behind me. Every group I speak to would love to have me but cannot afford the fees – I’m going to have to go down the ’search for funding’ route – a really unpredictable way to live! Age Concern have commissioned me for 5 weeks at the moment and are desperately trying to raise more funds but it shouldn’t be this way. Our ageing community are the very people who paid into the pot for education – they’ve worked hard all their lives, anticipating the time they could retire and have a little back. Care staff, underpaid, undervalued, overworked and quite often inappropriately trained are expected to do all kinds of things apart from care – such as provide creative activites. No-one wants to take responsibility for paying for a holistic care package for older people. It’s all about being valued. Many older people lose their independence as they get older, particularly if they become immobile. Having structured activites are essential for so many reasons – giving a structure for the day/week, opportunity to socialise, learning something new, simply enjoying something and so much more. These activities are so important.I’m sorry if I sound frustrated but I am! I led a team of tutors and between us all we delivered a range of courses and activities that benefited people who wanted to come to classes to ‘keep positive and enjoy life’ or for us to go to adults unable to come to us. It’s all gone now. However, the few courses that will be funded by the LSC will have to be delivered in such a way that the learners have to bend to the needs of the funding body – not the other way round (you can tell I’ve been the ‘victim’ of ALI inspectors, can’t you!). Well, I could go on – as no doubt many of you could – I’d like to think that we’re fighting a ‘winnable’ battle rather than a losing one. Comments would be helpful from anyone on my website to improve. If I don’t start to make a living within this first year I’m going to have to give up and get a proper job! Sorry, that sounded more like a rant than a comment but I am so sad that people are not valued. I wonder how many decision makers will get old and then think ‘ah – I think I made a mistake in discriminating against older people’? Debz
August 20th, 2007 at 12:52 pm
In terms of holistic care. Homecare services are not equipped to take care of this aspect. With the restriction of time on each visit to someone living at home in community, community care is simply personal and practical care needs only. For a lonely frail elderly person this is simply not enough. The removal of the visiting warden system was the biggest mistake ever made in terms of providing vital emotional support.
In the area where I live many of the old mills are being revamped as apartments,many of which are atanding empty. Why can we not have a Government funded initiative to revamp some of these buildings as ‘very’ sheltered housing, with an activity manager and care support on site. Subsidised Apartments could then be sold to elderly people and bought with the proceeds of houses which are no longer appropriate for their needs. Security and support are the two most important needs of older people
October 7th, 2007 at 11:12 am
Some of the main points to the above article considering we are now 18 months down the line and still no one listening.
Little has changed one year on
the depth of the crisis
not been taken up with necessary urgency
social care has missed out
Budget increases not even keeping pace
With little or no support, people’s chances of staying healthier for longer are reduced.
The system survives only because of the huge contribution made through informal care by families and friends
The funding system penalises people with moderate savings, a shock to many just when they are most vulnerable
The postcode lottery is alive and well in social care
introduced by stealth, noticed only when people need help.
The current complex funding and benefit regime must be replaced and the huge financial risk to people of extended and expensive social care must be pooled across the population
The immediate reaction …..( how immediate a reaction when 18 months later nothing been done.)
All of the leaders in the field ……….What they are all agreed on is the need for a system that ends the current shameful treatment of older people and transforms the rhetoric into a reality of dignified lives.
( If they are ALL agreed why has no action been taken )
How many more reports are we to see that repeat the same information from as far back as 10+ years………..
October 11th, 2007 at 2:01 pm
Carers are in crisis and desparate for help. We want someone to listen but more importantly someone to take action and make changes. Not as things are now when carers are left to wait and wait. A little hope is given and then nothing follows through.
The overlapping benefit rules should be scrapped.
Carers allowance increased.
More respite available and when it is offered not cancelled at the last minute.
More help available at weekends instead of carers being told to keep the cared for in bed because there is no help available.
What is the point of having a carer’s assessment when there is not the money to provide the services required?
Heating allowance for carers, they dread the winter and the cost of providing warmth to loved ones.
Free prescriptions and glasses for carers.
More information available when you become a carer
Most of all a realistic documentary film to be made similar to ‘Cathy come home’, which would show some of the problems. Because carers are the hidden ones and forgotten.
October 11th, 2007 at 5:31 pm
The government have said they want all carers back in work-so CUK–PRTC etc etc are all saying that is what carers want!! The whole idea that most carers should be able to go out to work Is perpetuated by the local support groups who only cater for carers who are able to get to them for any support– the 24/7 carer never can do that.
So the general idea of a carer is someone who makes a cuppa or a meal for somebody or occasionally checks to see if a person is ok. Anybody who needs more care than that is ignored- kept out of sight in case it frightens newly diagnosed people.
I’m sure it’s the same for all serious illnesses, but I can only speak about MS. Local branches of the MS Society tend to totally ignore patients who are at the worst stages of MS.
Even the National Society with the latest adverts only show the lightest cases–”you may not be able to wear high heels”-and “you will still be able to have sex but you may shake and jerk about”–what the hell is that all about???—Yes the more severe end results are not very common but they do happen- and the MS society may as well be saying ” when things get really bad, we won’t be capable of helping you- neither will the NHS-nor Social Care”.
As 24/7 carers we are isolated-ignored-forgotten—because nobody wants to admit that we or our carees exist.
What I am about to say may not go down too well in some quarters but I honestly believe it to be true. The Government, the NHS and all the so called Care services would prefer it if all people at the worst end of all serious illnesses were just left to die, because they can’t cope with them alive.
This is why I am always trying to get CUK and the others to put a real 24/7 carer in front of the media-not the chosen ones they put up now who agree to work to their script. The public need shocking by seeing just how bad things COULD get if they became a carer– only then will we get that public’s support we so badly need to improve our lives>>.
October 13th, 2007 at 10:02 am
OUR FRAIL AND ELDERLY SHOULD BE FUNDED BY THE NHS UNDER THE LAW OF THE LAND.
It amazes me how the NHS continue to break the law to wriggle out of paying for our sick and elderly.
The Core Principles of the NHS can be summed up as follows: To provide care which is free at the point of need, meets the needs of everyone and is based on a patient’s clinical need not their ability to pay.
Tony Blair said at the Labour Party Conference in 1997 that he didn’t want his children brought up in a country where pensioners had to sell their homes to pay for long term care.
Since then approx 700,000 homes have been sold to pay for care.
This applies to sick people of all ages. These people have paid taxes and national insurance all their lives, then suddenly they get taxed again when they become ill by funding their own long term care. What an absolute disgrace!!!!!
In 1999 a lady called Pam Coughlan won her case against the NHS in the Court of Appeal and set a precedent in law for Fully Funded NHS Continuing Care. Since then the government have ignored this judgement and the NHS continue to delay, lie and cheat, hoping that you will just go away.
I am fighting for my brother who has had two brain haemorrhages, is paralysed, doubly incontinent and in constant pain etc. etc. He has been paying for his own care in a Private Nursing Home for eighteen months now and you would not believe the underhand tactics the NHS have used against me.
We have now engaged expert solicitors to fight his case which is going to cost us thousands of pounds. We shouldn’t have to do it, and on top of my brothers illness, fighting the NHS has almost destroyed me as well.
Kind Regards,
Stephen (Johnson).
October 14th, 2007 at 4:52 pm
I’ve just got back home from collecting my mother from the LA run residential home where she has been in respite care.
This is the fourth year she has stayed in this RH, its always been ok in the past. Big difference this year the whole building stinks of urine, obviously cut backs have delayed refurbishing, or the standard of cleaning has deteriorated which ever it is I am extremely sorry for anyone who has to live and work daily in such a vile smelling home.
This country, this government, my LA should all be thoroughly ashamed of them selves.
The dreadfully inadequate state of care support services, the NHS, the way Carers are ignored, and used as cheap labour by this appalling hardhearted useless government
makes me ashamed to be a resident/citizen of this country.
I am thoroughly sick of the the spin and twaddle from the Ministers of Health, the DWP, and most of the Primeministers who are being paid to work by the tax payers of this country, God alone knows what they are doing with their time because they are certainly not applying themselves to addressing and solving the increasing downward spirel of this countries problems.