Select Committee on Work and Pensions Fourth Report

4  Support for caring

222.  One of the major reasons that carers struggle to remain in work is because of a lack of affordable, reliable and flexible care services. Ms Redmond of Carers UK emphasised that "The majority of people actually pay for their own social care, purchase it themselves. There is no quality advice and information and guidance to help people pick the right care. The care market is under stimulated. There is not enough quality and quantity out there if you want to purchase it. If we really are going to help people who wish to work return to work, we have to get the care system sorted."[214]

223.  Mr Burke of Counsel and Care added that "Without adequate care and support, many carers simply will not be able to work. They say that time and time again. […] I think we ought to do much more research into the cost of inadequate care and the opportunity costs for carers of inadequate care, and the impact not just on their caring but also what they are not able to do and what they are not able to contribute to the wider society, and the cost to society of that as well as the impact on their own health and well-being."[215]

224.  Ms Waters of BT stressed that "We talk a lot about hard to reach people in this country, but I think we have lots of hard to reach services, and there needs to be a very hard look at that because it is a major barrier to people coming into and staying within the workforce."[216] She also said that "Anything would help but we need good quality local services, they need to be reliable, they need to reflect 21st century living, and they need to be consistently available."[217]

Access to information about social care and services for carers

225.  Carers have contact with the social care system principally because of the support or services that the person they care for receives. However, eligible carers are also entitled to services in their own right. Evidence from a recent DWP study confirms the difficulties carers can face in obtaining up-to-date information about social services: "Carers claimed that social services did not volunteer information about available services or other entitlements, and that it was up to carers themselves to search this out for themselves. This could be quite daunting for carers who did not know who to ask, or who lacked confidence in dealing with people in positions of authority."[218]

226.  Nearly half (48%) of people responding to a Counsel and Care survey felt that finding out any information about social care services was confusing. Older people found accessing information about social care difficult, with 45% of people aged 65 or over admitting they were unclear about how to inform themselves about where and how to get help.[219] Carers UK argue that there should be more information and support available - and more transparency about what sort of help is available - including for families who are 'self funders', i.e. who are not eligible for state-funded care.[220]

227.  The Government's 2008 Carers Strategy acknowledges that "At present, unfortunately, fragmented information is disseminated by a number of agencies, often leaving the carer wondering where to begin."[221] We discussed the Government's commitment to roll-out a national helpline and website for carers in Chapter 2. The Minister for Carers, Ivan Lewis, added that a "very important element of this Putting People First reform programme is that the universal information advice is for everybody, irrespective of means."[222]

228.  Quality information and advice is absolutely essential to enable carers to find the right social care support. For the national helpline and website to be successful, it needs to link up with local agencies to ensure carers and those they care for are well informed about local social care services.

Access to social care support

229.  The Department of Health introduced a national set of eligibility criteria, known as Fair Access to Care Services (FACS), in 2003. The aim was to try to ensure a more consistent approach to eligibility and fairer access to care services across the country. The criteria are based on service users' needs and associated risks to independence in order to identify who requires support from adult social care services. In setting local eligibility criteria, councils are required to take account of their resources, local expectations and local costs. There are four eligibility bands: critical, substantial, moderate and low. At present, local councils increasingly provide personal care only to those whose needs are assessed at the 'substantial' and 'critical' levels of risk, a trend that is expected to continue.[223]

230.  Despite FACS, a report by the Commission for Social Care Inspection (CSCI), The State of Social Care in England 2006-07, found little consistency, either within and between councils, as to who was eligible for services. As eligibility thresholds are raised, fewer people receive supported home care. The report found that service users, and their carers, who did not qualify for assistance often struggled and experienced a poor quality of life.[224] A review of the FACS eligibility is being undertaken by CSCI (Commission for Social Care Inspection), which is expected to report to the Minister for Carers in September 2008.

231.  The Minister for Carers, Ivan Lewis said that "we all know the inconsistencies both within local authorities for access to services and between local authorities, which frequently do not make any sense." He also noted the 'cliff edge' of £21,000 of assets for entitlement to services, beyond which individuals receive no help. He added: "Local authorities will tell you that this is all about resources and I think this is complete nonsense."[225]

232.  Variations between local authorities with regard to carers' assessments also cause a lot of distress and confusion for families who need to relocate. The Chair of the Standing Commission on Carers, Philippa Russell said "Multiple assessments are draining and expensive on all concerned. […] It is important because very often carers and the people they support do want or need to move and having to start again in trying to identify and realign all your services is enormously complex. We need to find a way of simplifying the system which is equitable and fair to the provider and commissioner as well as to the carer and the person they support."[226]

233.  Ms Russell argued that "a lot more work needs to be done, not on bureaucratic assessment - there is no point investing in assessment to the point that you cannot then deliver and you have no resources, human or financial, left to deliver services - but we need to be more dynamic and creative. Really we are looking at person-centred planning. If we do develop these more proactive models of assessment, we can make a difference. A very important point here is that if you are a self-funder at present - and the majority of older people using social care and other services are self-funders - you are often largely excluded from the assessment system."[227]

234.  It is helpful to have a national framework such as Fair Access to Care Services to set national standards. However, the current system is not achieving the fairness and consistency required. We welcome the review of eligibility criteria and recommend that the Government considers carefully what support it can offer to those who are not eligible for, or who choose to access support without using, social services.

235.  We call on the Government to develop a system to enable social care assessments to be 'carried over', so that another local authority can make decisions based on (appropriately updated) information previously provided in the social care assessment. This would be less stressful for families, and would also reduce bureaucracy and the waste of resources.

236.  Carer assessments have an important role to play in the Government's strategy for carers as they are designed to assist carers in combining their caring responsibilities with their work, training, education and leisure needs. Practice in the delivery of carer assessments varies widely between local authorities. All carers, including those caring for individuals who do not qualify for local authority social care support, should be able to look to their local authority for support.

Social care funding

237.  The Joseph Rowntree Foundation (JRF) reports that there are several areas where evidence on social care funding points to unmet needs. One concerns quality - for example, cost containment has resulted in poorly trained staff, low pay and high turnover. A second funding shortfall concerns supply - for example, the fall in the number of 'low-level' domiciliary care packages. The third is the affordability of domiciliary packages, with evidence that some people on modest incomes are having in some cases to pay large amounts to get adequate care in their homes.[228]

238.  Currently, most people in England have to pay for home help, including washing, dressing, cleaning and cooking, themselves. At £5.4 billion, privately funded care accounts for 57% of total care expenditure (£14.9 billion), but on current trends this share will grow to 66.5% by 2022; those who need care will be expected to pay more of the cost.[229] State support is means-tested, which is especially disliked by older people who have saved hard for their retirement. The JRF argues that current means-testing arrangements effectively impoverish people before they can get state aid.[230]

239.  In the Comprehensive Spending Review in October 2007, the Government committed to reviewing the way that it pays for long-term care and to producing a Green Paper. It said it was committed to a system "that shares the cost between the individual and the state and that provides both universal and progressive elements."[231] This suggests that Government will not abolish the current means-tested regime.

240.  The Government's announcement followed publication in March 2006 of an important report for the King's Fund by Sir Derek Wanless into the future of social care funding. His report Securing good care for older people called for increases in funding to meet the demand for high quality care in the future. The report found that if the system remains as it is, costs would rise from £10.1bn in 2002 to £24bn by 2026 as a result of demographic change alone, without any improvement to the quality of services.[232]

241.  The Wanless report recommended that the current means-tested funding system should be scrapped and replaced by a 'partnership model'. Everyone in need would be entitled to an agreed level of free care, after which individuals' contributions would be matched by the state up to a defined limit. People on low incomes would be eligible for benefits to fund their contributions.[233]

242.  Currently state funding for social care is growing at a much slower rate than the demographic changes require. This means the Government is heading for a funding gap of an estimated £6bn, unless the system is changed. We look forward to the Government's proposals in the forthcoming Green Paper for funding for a 21st century social care system that is both financially adequate and sustainable.

Provision of social care services

243.  The Commission for Social Care Inspection recently published estimates of the numbers of older people with care needs who do not receive services. Even taking into account the support provided by carers they believe there is a shortfall of 1.4 million hours of care to 450,000 people.[234] Carers UK research, based on a survey of nearly 2000 carers, showed that about a third of carers in England (35%) and Scotland (30%), and well over a quarter of those in Wales (28%) said that they and the person they were supporting were not using any formal services.[235]

244.  This finding could not be attributed to very low levels of care need, as the carers questioned typically had 'heavy' caring responsibilities, (59% cared for 50 or more hours per week, and only 19% for less than 20 hours per week). Among those of working age who were caring for 20 or more hours per week, 33% of those caring for two years or longer, and 48% of those caring for less than two years, were not using any formal services. Nor is the finding explained by saying that these carers do not want to use services, since only a minority (20% in England, 12% in Wales, and 17% in Scotland) said they wanted no services. In fact almost two thirds of carers (60% in England, 62% in Wales, and 58% in Scotland) identified at least one service which they were not currently using but would like to have.[236]

245.  Carers UK research also found that between 40 and 50% of working carers in the study cited indicated that a lack of flexibility and sensitivity in the delivery of services was hampering them in obtaining support. The research had found that more than four in ten (42%) of those new to caring said that the person for whom they cared did not want care services.[237] This could be for a variety of reasons, for example because the care offered was not perceived as suitable or appropriate. This highlights the need for flexible services tailored to the support that a family requires as a whole, and that are responsive to disabled and older people's needs.

246.  Putting People First, published in December 2007, sets out the Government's new cross-departmental approach to the provision of care services. Services will be more personalised, with greater use of Direct Payments and Individual Budgets. Government announced an extra £520 million of ring-fenced funding to reform social care over the next three years through the introduction of Personal Care budgets.[238]

247.  Local authorities can offer Direct Payments to people who are eligible for community care services. Direct Payments have the potential to benefit carers by giving them and the people they care for the flexibility to purchase services that are tailored around both their needs rather than having to fit into a 'one-size-fits-all' programme of services offered by a local authority.

248.  In its Carers Strategy the Government stated: "We recognise, however, that Direct Payments are not the solution for everyone. For that reason, Putting People First has signalled that councils will move in the next three years to a position where everyone in receipt of social care funding will have a transparent, up-front allocation of the funds available for their care and support - a Personal Budget."[239] It added that:

"We have also piloted individual budgets in 13 local authorities in 2006/07. Individual budgets bring together a number of income streams from different agencies to see whether providing greater flexibility delivers benefits to the recipients and enables them to look more holistically at their needs and the needs of their carers.

The evaluation of the pilots is due to be published later in 2008 with a specific evaluation being undertaken around individual budgets and carers."[240]

249.  The Minister for Carers, Ivan Lewis said that "too often individuals find organisations functioning in silos, families and households are treated in silos with children's services, adult services, rather than looking at people in a holistic way. [...] I personally think that personal budgets are arguably one of the most powerful ways to break down those silos, by bringing together different funding streams into one place and giving the people themselves maximum control and power. We now have a reform agenda that is very compelling. […] carers and people who use services - at the end of three, four years, and hopefully beginning over the next year -will start to see and experience a very different response from the system than they have experienced in recent times."[241] I have met very few people in my life who, given a choice, do not want to have maximum control over their own destiny."[242]

250.  We welcome the Government's move towards the provision of more flexible and responsive social care services through Direct Payments and Personalised Budgets. These new developments have the potential to maximise personal choice and to stimulate the social care market for more personalised, flexible service.

Support for balancing caring and employment

251.  Following the Carers (Equal Opportunities) Act 2004 carers now have a right to be informed of their entitlement to a carers' assessment, which must cover their work, training, education, and leisure needs. However, the extent to which local authorities are addressing and meeting carers' needs is open to question. For example, CSCI's report on The State of Social Care in England 2005-06 found that whilst assisting carers to continue or to return to work was regarded as a relatively high priority by councils, only 35 per cent said they were taking proactive steps to support carers in this area.[243] Furthermore, only 4% had linked with employers in their area in their response to the 2004 Act.[244]

252.  The National Family Carers Network states that a number of local authorities are reluctant to implement the Carers (Equal Opportunities) Act: "We have examples of family carers who have been refused assistance with care to cover study or employment on the grounds that the local authority in question is only obliged to consider 'respite' or social care needs. The DCSF has clarified the position with children's services, i.e. it has indicated that childcare to cover employment or training is permissible, subject to assessment of need, but there has been no such message with regard to adult services."[245]

253.  The lack of flexible, appropriate, good quality support services is a major barrier to employment, career progression and regular participation in work for many carers. We are concerned about uneven implementation of the Carers (Equal Opportunities) Act 2004.

Employers' support for caring

254.  The Care Vouchers Campaign proposed a system, similar to the existing scheme of employer supported childcare, to provide a means for employers to help employees with care responsibilities to remain in work.[246] Counsel and Care suggested that care vouchers would have benefits for carers and those they care for, employers and the wider society and economy, helping carers to stay in work and reducing care-related absences from work.[247] Vouchers would be provided to employees either on the basis of salary sacrifice or as an additional payment.

255.  Through the proposed scheme, employers would be able to provide a benefit for employees, namely 'care-vouchers' that could be used to purchase additional care and support services for the people they care for. These would be exempt from both National Insurance and PAYE (up to a limited proportion of an employee's salary). At present, employees are able to claim up to £55 per week exempt from PAYE and National Insurance towards the cost of accredited childcare.

256.  Research by the London School of Economics, commissioned by the Care Vouchers Campaign, has assessed the economic costs and benefits of the proposal. It predicted that a £37m investment from Government, through tax exemptions, would generate an extra £83m for care services. This would have a significant impact as it could pay for an extra 5.5 million hours of home care.[248]

257.  Under the care voucher scheme, employees would be able to choose the most appropriate service for them, and the person they supported, from a range of accredited and pre-approved providers. These services could include:

  • domiciliary care services such as help with getting up, going to bed, dressing, toileting, personal hygiene, some household tasks, shopping, cooking and supervision of medication.
  • telecare and preventative technologies such as gas detectors, flood detectors, motion sensors and bogus caller alarms.
  • residential care, either full time or as a short break.[249]

258.  The Minister for Disabled People, Anne McGuire said she is "not particularly persuaded that they would best meet the needs of carers. For some carers obviously they would be very attractive. I think for other carers there would be a significant benefit to them in managing their care support. Interestingly, I do not think any of the proponents of it yet have costed exactly what it would be. I would suggest that it would be very expensive for the return that carers would get from it."[250] The Minister for Carers, Ivan Lewis added that "my only observation is in a sense if you consider the personal budget model and the potential, there becomes no need for vouchers essentially."[251]

259.  However, benefits received by employees through this scheme would be used for services that are currently not, or not fully, provided for by the state. Extra funding would be entirely additional to that which is currently funded by the state and would not be a substitute for it. Given the current tightening of criteria for accessing local authority funded social care services, the vast majority of carers provide the only means of support to the older or disabled people they care for, and many would benefit from such an arrangement, as the tax exemption would enable them to pay for more care services than they can currently purchase.

260.  The National Family Care Network stressed that many families would prefer to receive Direct Payments of a sufficient level to cover support. However, it argues, Direct Payments are set at local level and there are wide variations in the level awarded. A voucher scheme offers the advantage of agreed national eligibility criteria and the Government can safely assume that the recipient will be repaying all or part of the cost through taxation and/or National insurance.[252] Mr Burke of Counsel and Care stressed that "Whatever happens in the Green Paper debate, I am sure that individuals will still be expected to make a contribution towards the cost of the care, and therefore care vouchers will help them to do that in the future."[253]

261.  Ms Waters of BT stressed that "We know that if we can get money into that area, so if we can prove that there is clear demand and we can organise it sensibly, we can actually stimulate the local market [for care services]. […] One of the most important points about vouchers is it makes access for those people who are not able to get them affordable, and it should stimulate the market because we know that there is not sufficient supply in many cases for carers, particularly where the needs of the person that they are caring for are quite broad, particularly if they are the domiciliary services that just help the carer keep things ticking over and give them peace of mind while they access work."[254]

262.  We believe that Care Vouchers may have the potential to leverage significant additional funds into care services and could be a good way of engaging employers' support for carers. We recommend that the Government undertake a cost benefit analysis of the Care Vouchers Campaign's proposals at the earliest opportunity. We suggest that DWP should take the lead in piloting such a scheme for its own employees who are carers.

Family future planning for care

263.  The Australian Commonwealth Government also operates a number of schemes to assist families that wish to make private financial provision for the current or future accommodation and care of a family member with a severe disability. It offers a Family Relationships Services for Carers (FRSC) which provides family counselling and mediation services for families considering arrangements for the current or future care of a family member with severe disability. It has also developed an information package to help people to plan for the future wellbeing of a person who has high support needs. In addition, since September 2006, parents and immediate family members have been able to place up to $500,000 into a Special Disability Trust for the current or future care and accommodation of a person with severe disability, without being affected by means tests and gifting rules.[255]

264.  We were impressed by the measures that the Australian Government has introduced to assist families planning for the future care and accommodation of a family member with a severe disability. We believe that a scheme along the lines of the Australian Special Disability Trust has the potential to help to leverage additional funds into the market for care services. We call on the Department to carry out a cost benefit analysis of the possibility of introducing such a scheme in the UK. The quality of the advice that is provided to families on how to access such a scheme would be crucial to its success.

214   Q 23 Back

215   Q 24 Back

216   Q 133 Back

217   Q 134 Back

218   H Arksey, et al, Carers' aspirations and decisions around work and retirement, DWP Research Report N0 290, 2005, p97. Back

219   Counsel and Care, Help the Aged and Carers UK, 'Right care Right deal'A Charter for Change: Reforming care and support for older people, their families and carers, January 2008 Back

220   Carers UK, Response from Carers UK to CSCI review of eligibility criteria, May 2008, p8. Back

221   HM Government, Carers at the Heart of 21st-Century Families and Communities: A Caring System on Your Side. A Life of Your Own, 2008, p64. Back

222   Q 157 Back

223   The Commission for Social Care Inspection , The State of Social Care in England 2006-07, 2008.  Back

224   The Commission for Social Care Inspection , The State of Social Care in England 2006-07, 2008.  Back

225   Q 194 Back

226   Q 68 Back

227   Q 66 Back

228   Joseph Rowntree Foundation, Paying for long-term care: Moving forward, April 2006. Back

229   Counsel and Care, A Charter for Change, Reforming care and support for older people, their families and carers, January 2008. Back

230   Joseph Rowntree Foundation, Paying for long-term care: Moving forward, April 2006. Back

231   HM Treasury, 2007 Pre-Budget Report and Comprehensive Spending Review: Meeting the aspirations of the British people, p100. Back

232   Derek Wanless, Securing good care for older people, King's Fund, March 2006. Back

233   Derek Wanless, Securing good care for older people, King's Fund, March 2006. Back

234   The Commission for Social Care Inspection, The state of social care in England 2006-07, 2008.  Back

235   S Yeandle et al, Carers and Services in their Local Context, CES Report Series, Carers UK, 2007. Back

236   S Yeandle et al, Carers and Services in their Local Context, CES Report Series, Carers UK, 2007. Back

237   Stages and Transitions in the Experience of Caring, CES Report Series, Carers UK, 2007 Back

238   HM Government, Putting People First: A shared vision and commitment to the transformation of Adult Social Care, December 2007. Back

239   HM Government, Carers at the Heart of 21st-Century Families and Communities: A Caring System on Your Side. A Life of Your Own, 2008, p62. Back

240   HM Government, Carers at the Heart of 21st-Century Families and Communities: A Caring System on Your Side. A Life of Your Own, 2008, p63. Back

241   Q 194 Back

242   Q 196 Back

243   Commission for Social Care Inspection, The State of Social Care in England 2005-06, 2006, p105. Back

244   Commission for Social Care Inspection, The State of Social Care in England 2005-06, 2006, p90ff. Back

245   Ev 118 Back

246   Ev 97 Back

247   Ev 66 Back

248   T Snell, et all, Tax exemptions on care vouchers for working carers: An economic analysis:, PSSRU at the London School of Economics, July 2007, p4. Back

249   Ev 98 Back

250   Q 217 Back

251   Q217 Back

252   Ev 118 Back

253   Q 39 Back

254   Q 135 Back

255   See visit notes in Annex A Back

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