Social Care - Health Committee Contents

Memorandum by the Anchor Trust (SC 56)



  0.1  Anchor Trust welcomes the opportunity to submit evidence to the Health Select Committee Inquiry into Social Care.

  0.2  Our submission includes the views of staff representatives as well as feedback from our customers, the older people to whom we provide services.


  0.3  Anchor Trust is a not-for-profit organisation with more than 40 years' experience of helping older people. We are England's largest not-for-profit provider of sheltered housing for rent as well as England's largest not-for-profit care home provider.

  0.4  We provide great places to buy or rent as well as care and support services, including:

    — Almost 700 retirement housing schemes.

    — Property management services for leaseholders at 230 estates.

    — 96 care homes, including two specialist dementia homes.

    — Care to 3,000 customers in their own homes.

    — Almost 1,000 integrated care and housing properties.

    — Home improvements for more than 40,000 customers a year.

  0.5  We are increasingly integrating the range of services we provide into people's homes and have developed Anchor At Home, which provides home care with additional support to enable people to stay in their homes, such as gardening, shopping and handyman services.


  0.6  We welcome the positive moves by all the major political parties to address the question of future funding of long-term residential and domiciliary care for older people. The select committee inquiry is further welcome evidence of a growing recognition of the challenges presented by our ageing population and a desire to respond to these issues.

  0.7  However, we have significant concerns that solutions proposed thus far by both the Government and Opposition parties are not of the scale necessary to meet the needs of older people, the fastest-growing segment of our population. This is particularly true given the increased strain being placed on public finances as a result of the economic downturn.

  0.8  As the number of people aged 85 and over grows faster than any other age group in the UK, it is time that these issues were debated honestly and openly.

  0.9  Consideration of future funding of long-term residential and domiciliary care should start with a commitment to services which prevent the need for more expensive and intensive high-impact services. This saves public money and improves quality of life.

  0.10  We support efforts to increasingly put older people in control of their care and support as part of the personalisation agenda. But the personalisation debate should be about how to ensure we provide care which is tailored to the individual. Increasingly, the word "personalisation" has simply focused on enabling older people to manage the financial aspects of their care.

  0.11  Providing choice is laudable. But personal budgets for older people raise significant risks. Not least of these are concerns about how vulnerable adults can be safeguarded in such an environment and that total funding for social care services can be more easily eroded under such a regime It is also not clear that all older people will want or be able to manage budgets directly.

  0.12  The social care workforce needs to be recognised for the skills they already have. Further training and development will continue to be needed as longevity and associated care needs increase. Such continuous development means staff will be better able to provide services which are tailored to individuals' specific needs. We believe the Government should create recognised career pathways for social care professionals.


  1.1  The starting point when considering future funding of long-term residential and domiciliary care should be a commitment to services which prevent the need for more expensive and intensive high-impact services.

  1.2  The assurances in the social care funding Green Paper were therefore welcome. However, we have real concerns that hard-pressed local authorities may not be able to deliver on this commitment when having to make difficult funding decisions. We would welcome a ringfencing of such funding streams.

  1.3  The risk that local authorities may feel unable to focus resources on preventative services was highlighted by the Communities and Local Government Select Committee's report on Supporting People, published on 3 November 2009. The committee warns that "vulnerable people must not lose out as local authorities and their partners grapple with tightening budgets and the challenges of delivering services in a multi-agency environment."

  1.4  To develop preventative services would mean a shifting of resources to keep people well. Fair access to care is in place but Local Authorities interpret the rules in their own way within their locality. The system and criteria need to be tightened up so that the same principles are applied across the country, resulting in preventative services being valued for what they can achieve given early intervention.

  1.5  We welcome the Green Paper's proposals for a needs assessment which is the same across England. This is a major step forward and would mean older people can take the results of that assessment wherever they go, enabling them to live the life they choose, where they choose.

  1.6  The only way portable assessments will happen in practice is for a resource allocation system to be put in place for all client groups based on need and not diagnosis.

  1.7  The present variations between local authority practices are inefficient and do not appear to add value at a local level. A national framework should be developed to calculate local funding allocations and ensure they are in proportion to the local cost of care, which can vary significantly across the country.

  1.8  Such consistency of approach will reduce the workload for local authorities, slashing bureaucracy and unnecessary public sector administrative costs.

  1.9  However, a fully national funding regime would not take into account local market factors such as staff remuneration and travel costs etc. Furthermore, funding at a national level would mean a total overhaul of local government finance. We prefer a part local/part national approach, which offers consistency and portability. Realistically, this would create a central role for the local authority, which is best-placed to understand the local cost of care.

  1.10  Too often, decisions on care at a local authority level are made on the basis of price. The price paid should reflect the need for social care to have a higher status and become increasingly professionalised. We would recommend the use of a national "fair price for care" model, such as that developed by the Joseph Rowntree Foundation to ensure a consistent and fair approach across the country.

  1.11  We support the proposal made by the English Community Care Association for vouchers to be provided, based on assessments, with which individuals could shop around to find the right combination of services for themselves. We believe such vouchers should only be redeemable through a registered care provider, in order to ensure services are regulated appropriately.

  1.12  We believe that the housing elements of long term care (ie the cost of board and lodging) should be covered for those on low incomes. Housing benefit should be payable for those who do not have the means to pay for the housing element of care home services.

  1.13  The concept of a National Care Service is something to be welcomed. We would have liked to have seen a NCS funded in the same way as the NHS; with both care and health needs being met and free at the point of delivery. This would negate the situation of having to decide when to provide free health care to those being deemed as sick and those deemed merely as frail or disabled having to contribute to their care.

  1.14  However, a fully tax-funded solution has been discounted in the Government's Green Paper consultation as placing too heavy a burden on the working population. We believe that, of the three options for funding put forward in the paper, the comprehensive option has many merits but is unlikely to be popular as the compulsory nature of the contributions makes it appear too similar to taxation.

  1.15  Our preference therefore is for a partnership approach.

  1.16  The NCS should have a crucial role in educating people about the cost of care, their likely entitlement to State support and the options for self-funding. Insurance and equity release options will be key mechanisms for self-funding and the NCS and wider government should promote these options.

  1.17  A suggested way forward is that a care duty could be made of people's estates and the level of payment would reflect their wealth. There is already a mechanism for collection on people's estates over a certain threshold sum and this could be further utilised to collect payments towards a National Care Service.


  2.1  The personalisation agenda is one we support; both in terms of shaping services around the needs of individual customers and giving them control over choosing and paying for those services. We already provide personalised services in our homes and domiciliary care. But the personalisation debate should be about how to ensure we provide care which is tailored to the individual. Increasingly, the word "personalisation" has simply focused on enabling older people to manage the financial aspects of their care.

  2.2  The drive to put social care funds into the hands of older people themselves, rather than pay for services via local authority commissioners, means all care providers will have to transform their business models. Anchor is changing from a commissioner-led organisation to one which is increasingly focused on meeting the needs of thousands of individual customers.

  2.3  As a large, national organisation we are able to respond quickly to the changing market and re-engineer the business. But moving to personal budgets too rapidly means smaller organisations will struggle to survive.

  2.4  Commissioners will also need to change very significantly.

  2.5  We propose a transition phase to enable providers and commissioners to adjust to the new environment.

  2.6  We have concerns that vulnerable groups, such as those with dementia, may not be able to manage their own budgets. There are also concerns that regulation of all providers will be impossible if individuals can spend government subsidy however they wish.

  2.7  We do not believe personal budgets will slash the expensive bureaucracy currently associated with administering funding. We also have concerns that personal budgets could undermine the integrated nature of extra-care provision, if it were to separate funding for the housing and care elements.

  2.8  Any government pursuing the personalisation agenda must do so in a way which protects vulnerable people.

  2.9  This could include exemptions for certain groups as well as vetting to ensure third parties, such as friends or relatives, are well positioned to make decisions on the individual's behalf.


  3.1  Our "person-centred" approach to care aims to reduce the need for medication by shaping services to customers around their specific needs, interests and way of life.

  3.2  Just 12% of residents in Anchor care homes are receiving antipsychotic drugs compared with a sector average of 20% across the UK. The lower use of drugs in Anchor homes is due to a range of relevant, unique and engaging non-pharmaceutical approaches.

  3.3  A cure for dementia is some years away and the focus until a cure is found should be on high-quality care, which recognises the needs and aspirations of individuals.

  3.4  Care workers need increasingly specialist skills to respond to customers' increasingly complex needs. For example, at Anchor we now have 500 dignity champions, who have received specialist advanced training in dementia care.

  3.5  The people who provide this specialist care should be recognised as professionals and rewarded appropriately.

  3.6  Politicians can do much to tackle unemployment by promoting social care as a career of choice. We welcome the subsidy for social care providers who provide employment and training to out-of-work young people. Links with welfare to work providers should also be encouraged and supported with appropriate funding.

  3.7  There has to be recognition that there is a cost associated with good quality care. This is particularly the case given the advent of individual budgets and the move away from large volume council-wide contracts.

  3.8  Public subsidy should focus on outcomes and enable providers to pay social care professionals substantially more than the minimum wage.

December 2009

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