The Socialist Health Association welcomes the opportunity to participate in the Government’s consultation exercise on their vision for the future of social care for adults in England as the latter plays an increasingly important role in our society. This response has been developed as a result of a conference we organised in Birmingham on 22nd July at which a wide range of providers and users of services were present. People at our conference representing voluntary organisations expressed disappointment that the hard copy of the consultation document cost nearly £20 and restricted their ability to distribute copies to their members who did not have access to the internet.
1. We are pleased that this represents part of a policy initiative which is sustained, but we would like to know more about how it relates to policy initiatives in health care. We are pleased to hear that the ideas in this document are to be further developed in the impending consultation about health services outside hospital, and we hope they will not be crowded out by consideration of healthcare policy, which have received a great deal more attention over the last 50 years. It is not clear to us how, for example, these proposals can be applied to services for people suffering from mental illness.
2. We are concerned that such radical changes proposed for social care services by the Government can be viewed as being cost-neutral. It is our experience that major changes in the restructuring and delivery of health and social care delivery inevitably lead to increased costs, some of which cannot be predicted. Extending services on a preventative basis to a much larger group of people is likely to lead to greater expenditure in the short term even if it reduces demand in the long term. In addition local authorities are expected to make significant cost and efficiency savings as suggested by the Gershon Report and these may reduce scope for more flexible thinking.
3. We do not want to see a barrier develop between services for children and those provided for adults. The needs of children often arise because of problems in the wider family. It is not clear to us how the developing division can be managed effectively.
4. We are concerned by the potential dangers of vulnerable people becoming exploited by the unscrupulous as they become more independent in their choice of services and their use of individual budgets. Examples could be people providing care to someone who is frail, or has a disability, in exchange for accommodation in their own homes, or of the expansion of direct payments to enable people to employ their own carers. This will need to be carefully monitored and may require an expansion in the work of the regulatory bodies. One of the reasons for the low take up of direct payments is the fear by vulnerable people of taking on more responsibility for their own care and their consequent reluctance to take advantage of the payments. The Green Paper recognises these reservations amongst service users and professional workers who advise them. We think the Government must give greater reassurance to potential users and carers and professional workers that users and carers will be given considerable support on a regular basis in order to monitor and regulate direct payments.
5. We have reservations about the Government’s enthusiasm for direct payments although we do agree that there is scope to widen their use. Competition between small providers may not lead to an improvement in quality of service provided in all situations. In rural areas there may be no alternative providers of services for a dissatisfied customer. In some situations it may be the providers of high quality services who select their customers, rather than the other way around, especially as some are limited in their ability to pay and others are not. There should be a flexible approach so that services can be provided by a reliable agency who could supply a substitute should a colleague be unavailable. Too much control of how direct payments can be used reduces their attractiveness. It should be for the user to decide which of their needs should be met and how. The service user should be able to use their independent and informed judgement to insist that they do not want direct payments or individual budgets. We welcome the proposal that people lacking the capacity to make a decision about their care and direct payments could have an agent to act on their behalf. Such a role would need to be closely monitored and regulated and the agent must not be put under pressure to ensure an increasing number of direct payments are made each year.
6. There are still problems to do with charging which are not addressed in the green paper. We think there is a need for a more coherent approach across health, social care and benefits which might make co-operation more straightforward and we trust that the work being done in the DWP over the future of benefits for people who are sick or disabled will help to develop policy in this area. We are surprised to see that there is no discussion of financial input from the NHS into care packages and no mention of care by family members, which of course outweighs all care provided for money several times. We would like to see benefits for carers approached in a more coherent fashion.
7. We welcome the greater involvement of service users and carers in the planning and delivery of services. The proposals to have single assessment documentation for someone seeking services whatever their disability or needs is also to be welcomed. It should lead to greater cooperation between agencies which can only lead to a better service for the individual or their carer. We would like to see much closer working relationships which should include the DWP, which in the past has not always shown capacity for a partnership approach in this area. It is hoped that greater cooperation can lead to a simplification of the benefits system and a reduction in duplication in bureaucracy by, for example, having common application forms used by different agencies including central government. We do not think that it is a good use of the time of district nurses, for example, that they should have to fill in lengthy forms applying for Attendance Allowance for their clients because no-one else is prepared to do so. We would like to see the officers of the DWP accepting judgements made by their colleagues in health and social care about the needs of disabled people. We see possibilities in the use of information technology as NHS records become centrally available.
8. We want to see a right to independent advice and advocacy, which should not be provided by agencies supplying or paying for services, who may well have interests of their own. In a more commercial environment impartial and accurate advice may be hard to come by. We also want to see more substantial measures to encourage people to complain about the care they get, whether under these innovative arrangements, or under the existing model. There is still extensive fear of victimisation among many service users, especially older ones, whose expectations are distressingly low.
9. We welcome the emphasis on the social model of disability. This will put a renewed emphasis on Local Authorities to ensure that facilities and services of all sorts are accessible to all their population, whether or not they are targeted at people with disabilities. We are concerned, for example, that funding for the maintenance of local roads and pavements is in some areas insufficient to ensure that disabled and frail people can move about without excessive risk. Without attention to such important basic services more ambitious provisions will be inaccessible. We would like to see more resources for scrutiny of local services to ensure that they are fit for purpose.
10. We welcome moves to strike an appropriate balance in managing risks between individuals, the community and the social care worker. It should be for the individual, not the state, or their family, to decide what level of risk is acceptable except in the rare case where someone else might be at risk. We urge caution that resources are not diverted in excess, as appears to be the case in mental heath services, on protection of the public from a tiny minority of service users at the possible expense of the majority. We would like to see more priority given to the needs of people who want to be able to work but need support to be able to do so. We regard present means-tested funding arrangements as a considerable barrier to the employment of more severely disabled people.
11. We believe that all social care workers should be registered by a body such as the current General Social Care Council. This should enable greater protection for vulnerable adults and for the workers themselves. Registration can also be part of the process for improving standards of care and personal development amongst the workforce. We are concerned that transferring services from large organisations to small ones may achieve economies at the expense of the workforce. Even with more training and development there will always be incentives to reduce the terms and conditions of the staff in a commercial environment where many tasks can be performed by untrained people. A failure to ensure proper provision of pensions, reasonable job security, and a safe working environment, for jobs which are largely filled by women, many recently arrived in this country, will in the long run deliver a heavy burden on the state. It will also do little to improve the status of social care work or attract new recruits in areas where there are plenty of alternative employers.
12. There is more to social care than meeting our bodily needs. People may require support with relationships and with the emotional aspect of their lives, especially if they need to come to terms with rapid changes in their needs for support. This sort of work was formerly provided by social workers, but has been eclipsed by other demands on staffing. A variety of voluntary organisations provide emotional support, counselling and therapy of various kinds, but the provision is patchy.
The Socialist Health Association was founded in 1930, is affiliated to the Labour Party, and campaigns to promote health and well-being and the eradication of inequalities through the application of socialist principles to society and government.