Social Care - Health Committee Contents


Examination ofWitnesses (Question Numbers 80-99)

MR DAVID BEHAN, MR JOHN BOLTON, MS ALEXANDRA NORRISH AND MR JEFF JEROME

29 OCTOBER 2009

  Q80  Dr Taylor: When do we expect Ipsos MORI to give us this sort of report or to give you the report?

  Ms Norrish: We need obviously to give them the time to do the analysis. We do not have a publication date set yet but I imagine it will be in the New Year.

  Q81  Dr Taylor: You have mentioned the theoretical footfall at the roadshows. At your 36 events what sorts of numbers of people did you actually get coming to those?

  Ms Norrish: We have had anything between 80 and 100 at the majority of them. We deliberately set them so we had a Thursday afternoon, a Thursday evening, a Friday and a Saturday morning event in each region so that we could reach as wide a range of different people as possible, so, in particular, carers and working people who could not make normal working hours events were able to come to the Thursday nights and Saturday mornings. Thursday nights were often smaller but often very, very good discussions whereas the other events tended to be larger.

  Q82  Dr Taylor: I am still completely puzzled why I have missed out on these entirely. So out of these 36 how many would have been in the West Midlands?

  Ms Norrish: Four.

  Dr Taylor: I still feel terribly guilty about this. I would love to know if other people have attended these or knew of them.

  Sandra Gidley: No.

  Q83  Dr Taylor: Everybody is shaking their heads so we who should be aware of these sorts of things were not.

  Mr Behan: My understanding is that all MPs were written to. I will check that immediately I go back to the office. If Richard is worried he has missed out we can advertise the events on 3 and 4 November in Brighton and London respectively and if MPs feel they have missed out they have the opportunity to come and attend one of our final events. What you will see, just to expand the answer to Richard, is that a lot of the events are interactive, they are discursive and we ask people for instance to give their comments freely using different media. We then ask people whether they work in social care or they are a carer or they are a person who uses services to identify that by virtue of a coloured spot, and Ipsos MORI will then try and segment the views we are getting based on whether people are using services, caring or working in those services and so the richness of the data. That is why it will take them some time because it will not just be a quantitative assessment "we had this many in", but there is some attempt to get into the richness of the information.

  Dr Taylor: I would love to know if I did receive something.

  Chairman: Can I just say, Richard, I knew about the further consultation and the other Rotherham MPs and I have sat down with the Rotherham Pensioners Action Group and discussed it in detail and they submitted evidence in and they sent it to me as well.

  Q84  Dr Naysmith: Have you had one in Bristol?

  Mr Behan: Yes we have.

  Q85  Dr Naysmith: Have you had one in the South West?

  Mr Behan: We have had four in the South West. There have been four in every region.

  Q86  Sandra Gidley: Some of the regions are very big though but I think we need to move on. Alexandra Norrish, can you briefly explain to us the choice that the Green Paper poses between a fully national model and a part local/part national model?

  Ms Norrish: When we designed the funding options around the Green Paper and when we were having the discussions with people last year, one of the big issues that people told us about was the postcode lottery that meant that people in different areas received different levels of funding, and so the Green Paper contains two options around ways in which you could design the funding system to move towards the National Care Service and really the question is how national is the National Care Service? The fully national option involves central government setting the level of funding that people with a particular level of need and who need a particular outcome would receive. It is closer to the Attendance Allowance model in that it would be something like a national tariff whereby that individual would know that they were going to receive £200, or whatever it might be, and then if they move to a different part of the country they would continue to receive that same amount of money. This ties into the portability proposals in the Green Paper so essentially your care is standardised wherever you are. You could flex that. There would be a formula that would mean if you were in a more expensive area you would get slightly more, et cetera. That is the fully national option and the implication of it is that it would have an impact on council tax. If you are essentially telling local authorities how much they have to spend on each individual in their area then it is no longer fair to expect them to be contributing to that cost through raising their own council tax, so you would have to reduce the level of council tax and raise more funding at national level. The part national/part local system is closer to what we have in the current system and it retains more local flexibility and retains the ability of local areas to raise council tax towards their own priorities if they choose to. So what would happen would be that the individual would still have their assessment which would be carried out in the same way wherever they were in the country. They would know they had a right to have their needs met but then the local authority would be responsible for identifying exactly how much money that particular individual was going to get in that local area in order to meet their needs. The advantage of that is that it gives you the local flexibility. We have had some people, particularly people working in local authorities, telling us that in their areas the costs of care vary literally street-by-street or village-by-village and so the part local/part national option enables the system to be more responsive to that whereas the disadvantage of it of course is that it retains the fact that people would be getting different levels of funding depending on where they lived which they may still perceive as a postcode lottery.

  Q87  Sandra Gidley: Even if you have a part national/local model there is still going to be the right to a national assessment and you mentioned the portability. I am not quite sure how that is going to work in practice if you have got these local variations. Is there going to be a points system for allocating resources?

  Ms Norrish: One of the things we will look at in the run-up to the system is exactly how you would design that new eligibility system. There are many different ways that you can run a system of that sort. For example, Attendance Allowance has consistent national self-assessment right across the country. Looking around the world there are examples. Japan does have a points-based system for example and I think France is based almost entirely on self-assessment, so there is a whole range of different approaches that you could take.

  Chairman: Mr Jerome, welcome to our first evidence session! I am sorry you have been sat there in complete silence for one and a half hours now. Stephen?

  Q88  Stephen Hesford: Good morning. I do not know whether these questions are personal or what but these are the questions. Can you in effect explain yourself, what is your relationship to the DH? To whom are you accountable? Is it the Secretary of State? Is it some kind of consortium of quangos? What is the position?

  Mr Jerome: It is the latter. My role is one created on the back of the Putting People First concordat which hopefully the Committee knows about in terms of the agreement between central and local government and other key partners to actually try and move forward on a "partnership co-production", is the term but I am trying not to use that one because it is not a very user-friendly term, in the spirit of working across the partnership to move the Putting People First agenda forward. The thinking was that if we can create a role that works particularly from a sector-led basis (a sector being local government in this particular case) but accountable, if you like, to a partnership between local and central government that the sector will be able to encourage itself on the delivery side to move forward. I am predominantly working on the local government side to a partnership of the Local Government Association and the Association of Directors of Social Services and to the Department of Health but I am not accountable to the Department of Health; I am accountable to a consortium of those three organisations and I link to the Putting People First programme board which is chaired by John Bolton.

  Q89  Stephen Hesford: So are you ultimately accountable then to the Secretary of State for DCLG? Is that how it might work?

  Mr Jerome: No, I am not accountable to any Secretary of State. I am accountable to the organisations that could be accountable to two Secretaries of State in fact.

  Q90  Stephen Hesford: Targets have been set in this area. What powers are there to oblige local authorities, as commissioners and providers, to meet them?

  Mr Jerome: If you are talking about the targets being the ones that we have set out particularly in the Milestones document that we recently sent to local authorities, what we are trying to do is to say there is a concordat, we support this direction of travel absolutely and totally on the local government and Association of Directors side, and we think it will now be helpful in terms of creating some pace in terms of progress to set out some markers that we think local authorities need to work alongside.

  Q91  Stephen Hesford: But in simple terms what are those milestones and targets?

  Mr Jerome: They are milestones as opposed to targets. It is the definition of a target. They are not part of the performance regulatory regime, if that is what you mean, but we are expecting that people will try and meet those.

  Q92  Stephen Hesford: What are they?

  Mr Jerome: There are five areas basically. There is one around engagement and partnership. It is partly a leadership approach, how well are councils and their partners, particularly users and carers, engaged in creating this programme to make clear what the programme is, to be involved in decisions about the programme, et cetera. We have got another on investments in prevention and intervention services so that there is some evidence around the way in which local authorities are investing in preventative services and targeted intervention. We have another that is relating to the operating model, if you like, the system that creates personal budgets for people. I usually explain that as everybody getting the public sector offer, public sector money, knows the pound sign associated with that. That is the personal budget. We have put down a marker on that one particularly that we want local authorities to hit 30% of those people who receive council services having a personal budget or a pound sign by 2011. The other one is around information and advice, and you have heard a bit about that already, so that there are clear programmes and clarity about access to information and advice and actual evidence that there is good access to information and advice by March 2011. Then finally there is one about commissioning, particularly with the NHS and other partners, around the sorts of areas including the efficiencies that arise from that over the next 18 months of the programme.

  Q93  Stephen Hesford: And consumer resistance to any of your milestones; which is presenting a problem, if any?

  Mr Jerome: I do not think there is any resistance. There is clearly concern in some quarters about certain aspects of that. I think the two I would probably pick out are some people would probably be concerned about their ability to meet personal budgets targets by 2011 and the other area is probably in relation to the NHS, how easy it will be to get the NHS to work alongside local government in that timescale and getting that matched together. Those are the things that come back to me most from local authorities.

  Q94  Stephen Hesford: Finally, are you familiar with the Adult Social Care Reform Grant?

  Mr Jerome: Yes.

  Q95  Stephen Hesford: Is that a factor? Is that helping?

  Mr Jerome: Is that helping? Yes. That has gone to local authorities and to regions and there are regional programmes both through the Regional Efficiency Partnerships but particularly in this case through the Joint Improvement Partnerships that are chaired generally by directors of adult social services. They have all got programmes in relation to Putting People First and there is also money in local authorities. What we know from our survey last year is that local authorities are using that productively both internally and externally with providers to move this programme forward.

  Q96  Chairman: Could you just confirm, is the Secretary of State ultimately responsible for what the Government call the Social Care Transformation?

  Mr Jerome: Well, it is a policy objective.

  Mr Behan: I am not sure whether you want me to come in, Chairman.

  Q97  Chairman: I was asking Jeffrey. I just wanted a yes or a no to that question.

  Mr Jerome: Yes it is and David can give the answer.

  Q98  Dr Taylor: Can I go back to some of the definitions of terms used by the Government some of which we have used and heard about already. What do you understand by "personalisation"?

  Mr Jerome: You have heard it already but effectively it is setting out care and support services around individual needs rather than always doing it on a collective basis. That is probably the simplest way to put it.

  Q99  Dr Taylor: "Self-directed support"?

  Mr Jerome: Similarly it is a concept where ideally individual users or their carers will be in charge of the arrangements that are put around people, bearing in mind not everybody has full capacity so there are things that you may need to put in place to assist that.



 
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