Examination ofWitnesses (Question Numbers
60-79)
MR DAVID
BEHAN, MR
JOHN BOLTON,
MS ALEXANDRA
NORRISH AND
MR JEFF
JEROME
29 OCTOBER 2009
Q60 Dr Taylor: Going back to Alexandra,
when you were talking about what was universal, you said there
were five areas for everyone. One of those you mentioned was prevention,
which is keeping people at home. Did you say the others? Did I
miss the others?
Ms Norrish: I did say them.
Q61 Dr Taylor: Could you list them
so I could write them down?
Ms Norrish: I could, yes. May
I borrow the picture again so I do not miss one out? There is
prevention.
Q62 Dr Taylor: It is that diagram?
Ms Norrish: It is this diagram,
yes. It is the hexagon. It is prevention, assessment, joined-up
service, information advice, personalisation and fair funding.
Q63 Dr Taylor: Would you agree with
one of our advisers, who suggested a move from the focus on eligibility
as a boundary for local authority responsibility? Do you think
there is a move away from eligibility as being a boundary for
what local authorities are responsible for?
Ms Norrish: I think that what
we are moving away from is a service in which local authorities
have no responsibility for some people in their area in practice.
In theory and in the law, local authorities are required to provide
an assessment to anyone who wants one, are expected to provide
information and advice, but we know in practice that frequently
that does not happen. We have spoken to many, many people who
have said they have tried to approach their local authority for
information or for help and in some cases they have had no response
at all, in some cases they have been signposted on to Age Concern
or one of the organisations in the voluntary sector. I think what
a move to a universal system does is it breaks down that barrier;
it moves away from a system which only some people, the poorest
essentially, are sure that they are going to get any help from
the state into a service where everyone in the country who has
a care need is entitled to at least advice support from the state.
Q64 Dr Taylor: So elderly people
who are financially reasonably well off but are utterly alone
in the world could benefit from some help?
Ms Norrish: They would benefit
from the support around information and advice, they would benefit
from the reforms to assessment to make the process easier to manage,
so, yes.
Q65 Sandra Gidley: I want to come
back to this notion that everybody wants to stay at home and that
is what people tell us. We hear this mantra constantly. We also
hear about personalisation, people are supposed have free choice,
but actually there was a paper produced—it is probably four
or five years ago now—by the Social Care Institute for Excellence
which surveyed people of the generation yet to access care and
a proportion of them said, "Actually, no, I do not want to
stay at home if I cannot have my normal life. I would quite like
to go into a home." Why are you disregarding that 20%, where
is choice in all of this for the individual and are we convinced
that staying at home is the best?
Ms Norrish: Generally, the evidence
we have about people going into residential care is that for those
people who enter it too early, it actually reduces their outcomes.
In particular, it reduces mobility, it reduces people's independence,
it reduces their flexibility. Somebody who has been living at
home and has been having to think about going to the shops or
organising their life to some degree is suddenly put into a much
more potentially passive situation. The evidence that we have
got is not particularly strong around this, but the evidence that
we have got suggests that actually people tend to go downhill
more quickly if they are put into residential care. There does
come a point at which actually someone is so physically disabled
or in such a high level of need that residential care is the best
way of providing the care that they need. I think the other point
that you are making is one about isolation and is about residential
care being a better solution than someone just being stuck in
their sitting room not being able to get out and see people from
day to day, and I think you are absolutely right, but I do not
think it is a binary answer. I do not think it is either people
living at home or people being in a residential care home. There
are other ways you can help someone to be supported in the community
actually to get that sense of emotional support back without having
to put them into a residential care home when actually the fundamental
problem is not that they need 24-hour support but it is just than
they are lonely.
Q66 Dr Stoate: I would like to press
on a bit more with my funding questions. Alexandra, the Green
Paper does not tell us how much the various funding options would
raise. Are you in a position to tell us what those figures might
be?
Ms Norrish: The costings of this
are all in the impact assessment. There is a table in the impact
assessment which lays out the cost of care to both the state and
to individuals. So, yes, the costings are all in there.
Q67 Dr Stoate: That is the cost of
care. Do we know how much money is going to be raised by the various
funding options?
Ms Norrish: Essentially what this
captures is how much the state puts in and how much individuals
would have to put to in meet the cost. The level that the state
puts in, of course, is subject to decisions made in future spending
rounds—so that is why, in a sense, we cannot absolutely
say this is how much money will come from the state, this is how
much will come from the individual—but, if you like, this
is the overall total and this is how at the moment we have got
it split.
Q68 Dr Stoate: Have you done any
work on what might be an acceptable level of tax burden and proportion
of GDP that might be spent on this?
Ms Norrish: We have got a number
of different scenarios in the modelling. As we go forward, if
we were to keep the proportion of funding that comes from the
state and the proportion of funding that comes from the individual
stable at the level that it is at the moment, funding from the
state needs to increase by 3.2% per year, and that figure is in
the impact assessment, but, clearly, that is just, if you like,
a mapping of one potential way of measuring the proportions.
Q69 Dr Stoate: The Green Paper does
not set out in much detail what implications this might have for
people of working age. Do we have any figures or any idea about
that?
Ms Norrish: When we were looking
at care for people of working age, we found that the vast majority—I
cannot remember the exact figure but I am sure it is upwards of
90%, I think it might be 96%—are actually getting their
care paid for fully by the state already, they are not making
any contribution towards the cost of their care. So what we have
done is just extrapolate forward, essentially, that people continue
to get their care paid for by the state, and that is paid for
out of general taxation, as it is at the moment.
Q70 Dr Naysmith: Ms Norrish, the
Government has ruled out transferring the budget for Disability
Living Allowance into the social care funding system. They are
going to do it with Attendance Allowance. Many people fear that
they will lose this vital means of paying for extra (i.e. non-care)
costs and get nothing in return, possibly ending up as net losers.
Is there any calculation available as to the likely winners and
losers, what protection can be offered and what arrangements are
envisaged for this possibility?
Ms Norrish: What we said on disability
benefits in the Green Paper was we are looking only at benefits
for people who are over retirement age. So we are not looking
at Disability Living Allowance for people under 65. You are right
on that. What we did when we started to model this was we looked
at the various sources of funding that are available to people
during their retirement years, and we looked to see whether any
of them overlapped or were inconsistent with each other and we
found that the two which overlapped most closely were social care
funding and Attendance Allowance which were often aiming to achieve
very similar outcomes but some people are getting both and some
people are getting neither and are falling between the cracks.
One of the proposals in the Green Paper is that you would take
the two funding pots and you would combine them into one so there
would be one assessment process rather than the two different
assessment processes you have at the moment. On the one hand that
makes it a simpler system to administer. The consequence of it
is for the first time you apply a means test to Attendance Allowance.
The reason we did that was when we did a lot of work with DWP
during the drafting of the Green Paper we looked at the data they
had on Attendance Allowance and we found that while the vast majority
of people who get AA need it, they are on low incomes and they
have high levels of need and it is a really important part of
their support and without it they could not function, there is
a significant minority of people who are on much, much higher
incomes who do not actually need the support that AA gives them.
During the course of the consultation we talked to people around
the country about this and I have had people coming up to me telling
me stories about people they know who get their AA and put it
in the bank and are keeping it "to pass on to their grandchildren".
There was one person I heard about who every year goes on a four-week
Saga cruise and uses her AA to extend it to a six-week cruise.
This is where we have to take a view on whether the best use is
being made of public funding. The judgment that we took around
that was that you could transfer that funding from the people
who are on higher levels of incomes to people who are on lower
incomes and who potentially have higher levels of need and so
that is the proposal in the Green Paper. However, we do know that
AA is a very popular benefit because it is flexible and it is
transparent. It is flexible so you can spend it on whatever you
want, you do not have to spend it on your care and you can get
it in cash if you want to. It is transparent in that you know
exactly how much funding you are going to get. What we are looking
at is how you bring the advantages of that into the new system.
In terms of flexibility what we have said is that we are not just
talking about putting this money in the existing social care system.
In the National Care Service the Green Paper says everyone who
wants a personal budget will be able to get a personal budget
and a personal budget can be taken in part or in whole in cash,
so people would be able to use that funding flexibly. The idea
of a personal budget is that you can use it to decide your own
priorities, so if what matters to you is spending your money on
transport or whatever else it may be then you have got that flexibility
as with AA.
Q71 Dr Naysmith: That is all very
helpful. The point of the question is will there be some losers
in this system, people who currently may get money for this flexibility,
this personalisation? Who will lose out?
Ms Norrish: There will not be
any losers amongst people who are currently receiving AA. One
of the things that the Green Paper says is that everyone who is
currently receiving AA would receive an equivalent level of support
through the new system so nobody is going to lose out who is currently
getting their benefits. In the future of course if you reprioritise
then, yes, some people would be nominal losers.
Q72 Dr Naysmith: Some people have
suggested that it is age discrimination to treat Attendance Allowance
differently from Disability Living Allowance. Is there any validity
in that accusation?
Ms Norrish: Age discrimination
applies if you do not have a basis, a reason why you are treating
people of different ages differently. The reason that we are looking
at people receiving these two different benefits differently is
people who are receiving DLA under 65 are almost exclusively on
very low incomes. People who get DLA frequently will be unable
to work and will not have had the opportunity to build up assets
and will not have those savings and so they are in a very different
financial position from people who are over 65 who potentially
have worked all of their lives, who have savings, who have assets
and in the last couple of years of their life develop a care need
and so claim AA, so that is the basis.
Q73 Dr Naysmith: You think legally
there is no strength to that argument?
Ms Norrish: We have talked to
lawyers about this and they have advised us it would be alright.
Q74 Dr Naysmith: You were talking
about consultations that have taken place but there seems to be
quite widespread public ignorance about what social care is, how
it is currently organised and funded and the options for the future.
How can you overcome this ignorance? Lots of pressure groups have
been speaking to MPs and so on but outside there seems to be a
lot of lack of understanding about what is going on and what is
being proposed.
Ms Norrish: I think social care
is a system where there is much less public knowledge than there
is for example of the NHS. It is not a recognisable brand and
it is something, as David was saying, that comparatively few people
at any one time are using although the vast majority of us will
need it or have contact with someone who does at some point during
our lives. In terms of how you build on that, how you increase
the public awareness, we have been running what we call the Big
Care Debate since the Green Paper.
Q75 Dr Naysmith: I was going to ask
you about that. Not much seems to be happening with the Big Care
Debate.
Ms Norrish: The Big Care Debate
was launched on 13 July. Since then we have had upwards of 15,000
responses. We have run 36 events going round each of the regions.
We have had 43 public roadshows and those have each been designed
to be in city centres where there is a majority of people going
past. We have had a so-called footfall of more than two million
people so that is two million people who could have walked past
and seen the material. We have had 78,000 hits on our website.
We have had a whole range of media coverage. You may have seen
the work that we did with the Guardian. We did a whole
supplement on the National Care Service. We have done work with
the media in all of the regions where we have had the events.
We have had local radio, we have had local television there, we
have had local journalists.
Q76 Dr Naysmith: Do you think you
have done enough or are you doing enough? Have you a big enough
budget for this?
Ms Norrish: You can always do
more and all of my comms team advise me that when you are running
something of this size and this scale it does not happen overnight.
It is not going to happen overnight. It is something that we need
to sustain and so that is very much what we are doing. I think
we have got off to a really flying start.
Dr Naysmith: Thank you.
Q77 Dr Taylor: I hate to say it but
I must walk around with my eyes closed and be completely deaf!
I had not looked at the Green Paper until we were about to start
this inquiry and I had no idea that the consultation finished
on 13 November. That is maybe a huge criticism of me but I really
had not learned anything about it at all. What I really want to
know is can you give us any idea of what is coming out of this,
particularly on consultation question number three which is the
funding options? Is there a consensus coming towards answering
that?
Ms Norrish: We have not finished
the consultation obviously.
Q78 Dr Taylor: No, I realise that
but we are trying to get a feeling.
Ms Norrish: And I do not want
to pre-empt anything that could come out of that. We have heard
widely differing views argued with passion on both sides throughout
the consultation, so I really do not want to pre-empt anything
that comes out at this stage.
Q79 Dr Taylor: What is your plan—to
publish all the responses or summarise them with those in favour
of each of the three options?
Ms Norrish: What we have done
is we have asked Ipsos MORI to work with the Central Office of
Information who are running a lot of events for us and, as we
did with the Green Paper, to produce an independent report. We
have asked MORI to go through every single one of the responses
that we have received and count them so that we have got both
the qualitative and quantitative analysis of where people are
coming from because we have got a lot of different strands of
public response coming into this. At one extreme we have postcards
which literally have a tick-box saying which funding option do
you think we should have. At the other end of the extreme we have
the contributions that will be coming in from our stakeholders
of which many will be tens of pages long. We have the detailed
comments we have had from our website and the various streams
that are coming in from the write-ups of engagement events. All
of those will be pulled together and analysed. What Ipsos MORI
will then do is the report that they publish will have a section
on each of the different strands and will pull together the results.
We will not be publishing in full every single one of the responses
we have had because, as I say, there have been 15,000 of them
so far. I defy anyone to find that a riveting bedside read.
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