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An article published in SPAG's Newsletter for May 2005
The Labour Government's latest ideas about the provision of care services were set out, shortly before the election, in a Green Paper, "Independence, Well-being and Choice". Readers were invited to comment by the end of July and SPAG will be responding to that invitation.
The Green Paper, published in March by the Department of Health, presents a vision of how social care for adults in England might develop between now and 2020. It is one of the most imaginative documents to emerge from a government department for many years.
It also represents a dramatic change of direction: "In the last decade, social services and the NHS have increasingly concentrated resources on people with the highest levels of need. Consequently there has been less investment in promoting the health, independence and well-being of the general adult population. ... Changing the focus to a preventive model of care by targeting people with low-level needs today, could prevent them from becoming part of the group of people with 'greatest needs' in the future."
That is precisely what we have been saying for years, as the council closed down its day centres and withdrew home care services from those not judged to be at serious risk to their health or safety. It's a pity that the new and very welcome emphasis on prevention didn't come a few years earlier, when it might have prevented some of the damaging cuts in local services.
What the Green Paper offers, however, is not a return to the past but a new vision for the future. The emphasis is on access to the whole range of social, leisure and learning activities enjoyed by the community as a whole and the freedom to decide what kinds of services are needed by the individual and how they should be provided. Some of the ideas on which the Green Paper invites comments, are:
Individual budgets
People assessed as in need of social care would have the choice of receiving cash or services, or a mixture of the two. The budget would be held by the council but the individual would decide how it should be used.
Direct payments
The present system, under which people can be paid to employ their own helpers, should be greatly expanded. For anyone who, at present, cannot receive direct payments because they are unable to manage their own affairs, an agent would be appointed to manage the payments on their behalf.
Housing
As well as extra care housing, which enables people to live in their own homes with a high level of support, other suggested living arrangements are (1) 'Homeshare', where accommodation is offered to an approved home-sharer in exchange for a package of support which can include companionship, security and help with daily tasks; and (2) 'Adult placement', where people in the local community offer a temporary home to an elderly or disabled person.
Telecare
This is the latest in social care technology. A scheme already up and running in Liverpool is described as follows: "The home is fitted with a small number of sensors that monitor movements and activities and are able to detect such things as the person not getting up in the morning, abnormal usage of the fridge or cooker, or whether the person has not moved for a long time. People can be reminded to take their tablets, and if the automatic monitoring system detects that there might be a problem, a telephone call can be made to the person to check or to alert a carer."
The government, the Green Paper says, is (or was before the election) "committed to transforming care services through the introduction of telecare", making £80 million available to local authorities in 2006-08 for investment in telecare which, evidence from West Lothian and Northamptonshire has shown, "can have a significant impact on reducing the need for residential care, unlocking resources to be directed elsewhere in the system."
Some people will certainly dislike the idea of being spied on, day and night, by electronic sensors - but if it enables people with dementia to stay in their own homes, as the Green Paper claims, perhaps it is a price worth paying.
"Right to request"
The proposal is that anyone would have a right to request, in advance, not to be moved to a residential or nursing home. If such a move was suggested at any time, the reasons for it, including considerations of cost, would have to be fully explained, so that the person concerned could make an informed choice.
A good idea, one might think - but the suggestion that this information should be provided only in response to a formal request is a sad comment on the way people's basic rights can be ignored at present.
What next?
None of the ideas in the Green Paper is set in stone. Many of the proposed developments will take years to put fully into practice, even if the money is available - and the statement on page 40 that "implementing the vision will need to be managed within the existing funding envelope" implies that any additional money will have to be fought for. But, as we all know, when politicians want something badly enough, they can always find enough of our money to pay for it.
The Green Paper asks for responses to the many questions raised by it (many more questions than we have indicated above) by 28 July. It is unlikely that this deadline will be affected by the outcome of the general election, so we need to start thinking about and discussing questions like these without delay:
• How far do we want to go along the path of giving people money rather than services and leaving them to make their own arrangements?
• What kinds of supported housing do people really want, and will there still be a place for residential care homes?
• To what extent can telecare replace regular contact with relatives, neighbours and care workers?
Getting the answers right now could make a big difference to the way social care develops in the years ahead.