The reform of social care will take more than money

The House of Lords Economic Affairs committee has called for free personal care in England, on lines similar to the system in Scotland.  “Under free personal care individuals would therefore only receive funding for support with these basic activities of daily living, based on the minimum threshold of eligible needs as defined by the Care Act.” They are recommending a major increase in the funding for social care, so that care can be delivered on much the same terms as health care.  However, they accept that people should pay accommodation costs themselves, with means-tested support, and they recognise that this might entail “catastrophic accommodation costs” which might have to be subject to a cap.

This has been welcomed as a radical proposal, but it doesn’t touch on most of the problems that go with social care.  We’re still thinking of social care as a set of needs which can be satisfied by specific cash payments.  The Lords report explains:

“Personal care means essential help with basic activities of daily living, such as washing and bathing, dressing, continence, mobility and help with eating and drinking. It does not include other areas where support might be needed, such as assistance with housework, laundry or shopping.”

I don’t believe that a system based on this approach can ever deliver what people want to see.  I don’t believe people want, or are comfortable with, successive 15 minute visits from a team of people who bathe them, or dress them, or help them to bed.  I don’t believe that what most people really want in life is to manage a rota.  I think that providing for a series of events, sold as if they were commodities, meets people’s human needs.  What we should be allocating is time with a person, and that calls for a different approach to assessing needs from one that focuses on whether or not someone needs help with brushing their teeth.

One thought on “The reform of social care will take more than money”

  1. Agreed. However can’t see any government adopting such a wide view as too scared of the potential costs? Also, historically official attitude has been to regard over 65s as only needing help with washing, dressing etc whilst under 65s also got help with social stuff such as going out (albeit restrictive assessments etc)? In Scotland there is more money/free personal care (if assessed as needing it) but very much a rationed system. So much professional time and effort (including my own) spent/wasted over the decades formulating and seeking ways round legalistic, bureaucratic & conflicting definitions of “medical need”, “personal care” “social care” “housing support” etc etc just to fit whatever funding criteria applies at the time. On a personal level, my mother (90, dementia, virtually blind): receives Attendance Allowance (defined as personal care/attention under the benefit rules); free personal care x 15 hours per week (defined under Scottish care legislation and based on social work assessment, £250 per week or £12,900 per annum); 2.5 hours “support” (cleaning etc; she pays for this at £34 p.w/£1,760 pa). She also pays £240 p.w./ £12,500 pa for rent in sheltered housing which includes two meals per day provided in a dining room (this is not classified as care but as rent/HB albeit she does not qualify for HB). She is fortunate to have access to on-site care staff (funded by Council) from 0800 to 2200 7 days/365 per year. There is no on-site staff during the night (up until June 2017 there was on-site night cover but this was funded generically as “support” from the old Supported Housing budgets which are now effectively redundant). If she goes in to hospital she continues to pay all of the above for a certain period but is not charged for being in hospital. If she ever has to go in to nursing care (again via an assessment process and very few places) she would, as a “self-funder” be paying out approximately £1,000-£1,500 per week until her money falls to £28.000 or she dies. I have a another relative who is currently in this situation and whose money will run out in a matter of months; then the council will start to fund some of her costs in addition to the free nursing care element. Now, I have worked in this sector for most of my life and find it confusing. What chance the average carer/family member of understanding all of this complex mis-mash?? I haven’t even touched on things like self directed support, the practicalities of getting the right paid help in rural areas, the moral “blackmail” placed on carers/family members; the restrictive nature and low rate of Carers Allowance etc etc!

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