Last week the government launched an ‘engagement exercise’ which will feed into a social care White Paper, followed by a new Act of Parliament. The Act of Parliament will replace all the current social care laws, cobbled together since 1948 and generally considered to be a bit of a mess, with a single – hopefully clear and fair – new law. The Law Commission produced a large number of recommendations on how to do this, earlier this year. The White Paper will also set the direction for social care policy over the coming years and will respond to the recent Dilnot Commission’s recommendations on funding social care. Dilnot said that social care has been under-funded for too long, and he set out some ways to cap the amount that individuals end up paying for their care in later life, in order to create an insurance market so that people could insure themselves against the risks of needing expensive social care, reducing the numbers who are bankrupted by unexpected costs. The government welcomed Dilnot’s proposals and the Law Commission’s.
There are six strands of the engagement exercise and a seventh ‘over-arching’ question about Dilnot and funding. There has been a lot of public consultation about social care in the last few years, so this ‘engagement’ is going to be quite short (running until December 2nd) and hopes to draw together the consultations and recommendations that have gone before. I agreed to co-lead on prevention and early intervention strand.
Who doesn’t think that investing in preventative services makes sense? You could argue that we don’t need any more consultation on this issue, everyone should just get on with it. And yet, whilst in some areas decision makers do just that, in lots of areas, they don’t. Why? And what, if anything, can we do to change that?
We’re at the beginning of this exercise and I’m open minded and very keen to hear things that I find surprising and to have my mind changed on this issue. But my initial thoughts in responding to those questions are that, first of all, lots of people talk about prevention and mean lots of different things. We need a shared sense of what ‘prevention’ means, or the range of things it can mean. We need to be clearer about the evidence base for claims made about the impact of preventative services, and to highlight the research which still needs doing. We need tools to measure those impacts. And we need to use all of that to make a business case which is accepted and acted upon everywhere.
We also need to recognise that this is not all about social care services, or indeed about services of any kind. I believe that we are more resilient and less likely to see our health and well-being deteriorate when we are connected to others, rather than isolated. So how much of the prevention agenda is about what services do and how much about supporting the contributions of families and communities?
It’s possible that none of the changes outlined above would be likely to require changes in the law. But given that the White Paper will also include a new law, it seems sensible to think about the role of the law, and duties placed upon councils and other bodies. The Law Commission suggested that “In our view, the duty to provide adult social care services should exist on two levels: first, the local authority’s wider responsibilities to provide universal services; and second, services provided for individuals following an assessment. In order to divert people, where appropriate, from the second to the first level, there should be a general duty in the statute which would require local authorities to provide information, advice and assistance. The general duty would operate specifically in the context of adult social care, and would be in addition to the wider responsibilities of local authorities to provide universal services.”
I think that is a sensible suggestion. But it doesn’t change a key difference between preventative and crisis services, which is that people can individually claim an entitlement to the latter, but not the former. I think this is one reason why keeping up investment in prevention is hard when finances get tight. So is there a way of giving people individual entitlements to preventative services? Or, in the language of personalisation, “Can we construct a system in which I have the choice to receive a preventative service now, rather than having to wait until I’m eligible for a crisis service?” Doing that would require an assessment and eligibility system which assessed levels of risk, as well as your current state of well being. It might suggest that people were given a personal budget allocation based on their projected needs over the next 6 or 12 months. At present, Direct Payment holders have no incentives to reduce their reliance on state services. As soon as things get better or you find alternative forms of support, your budget is reduced. Could Direct Payment holders be given incentives to make savings, such as getting to ‘bank’ some of them in crisis funds? I should stress that those ideas are mine (and others’) not the government’s! They may not workable or affordable, but I am keen to explore and road test as many ideas – radical and more mainstream – as possible.
You may have thoughts on how sensible or otherwise some of the suggestions in this blog are. Or you may have your own radical ideas for shifting more of our social care spending into preventative and early intervention services, and for community development and support networking approaches to increasing people’s resilience. Please get in touch with them, or respond to the consultation at http://caringforourfuture.dh.gov.uk And if you have an event coming up at which I or members of the reference group could listen to people who use services, family carers or workers, please get in touch.