Memorandum by the Anchor Trust (SC 56)
SOCIAL CARE
INTRODUCTION
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.
BACKGROUND—ANCHOR
TRUST
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.
EXECUTIVE SUMMARY:
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.
FUNDING OF
LONG-TERM
RESIDENTIAL AND
DOMICILIARY CARE
FOR OLDER
PEOPLE
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.
PERSONALISATION OF
SOCIAL CARE
SERVICES
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.
MORE EFFECTIVE,
CONSISTENT AND
USER-FRIENDLY
SOCIAL CARE
SERVICES.
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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