Examination of Witnesses (Question Numbers
593-599)
MR ANDREW
HARROP, MR
STEPHEN BURKE
AND MR
ANDREW CHIDGEY
26 NOVEMBER 2009
Q593 Chairman: Good morning, could I
welcome you to what is our fifth evidence session on our inquiry
into social care? I wonder if I could ask you for the record if
you could give us your name, and the current position that you
hold.
Mr Chidgey: I am
Andrew Chidgey, Head of Policy and Public Affairs at the Alzheimer's
Society.
Mr Harrop: Andrew Harrop, Acting
Charity Director for Age Concern and Help the Aged.
Mr Burke: Stephen Burke, Chief
Executive of Counsel and Care.
Q594 Chairman: Again welcome. I have
a couple of general questions just to all of you, and we will
get down to some specifics with individuals as we go through this
session. I wonder if I could ask you, what do you see as the greatest
shortcomings in the current social care provision that can be
addressed by national reform?
Mr Harrop: It is obviously a very
complicated picture at the moment, and I think the first problem
with the system is complexity. It is impossible for a service
user or their family to understand the entitlements and navigate
the system. We also think that the coverage of support is far
too limited, both in terms of eligibility criteria, which means
you really have to be very disabled today before you get state
funded care; and of course because the system is means tested,
which not only means that some people have to pay quite significant
charges, which they may find difficult to pay for, but it also
turns away a lot of people who need help. Either people do not
come and ask for it, or some local authorities just say, "You
are over our thresholds, go and find your own support". Then
the final big issue I would like to highlight is the issue of
the amount of money spent per service user—of people who
are in the system—which translates to the amount or quality
of care that people can get. In the case of people living in their
own home, care packages for older people are really very, very
small compared to the levels of needs they have; and in care homes,
we have a system where most local authorities across the country
underpay care homes compared to the true cost of providing care.
Mr Burke: I would share that view.
The system is extremely complex. People see it as being unfair,
in the postcode lottery that Andrew talks about, in terms of what
you get depends on where you live, and how much you pay also depends
on where you live, but I think the issue of underfunding is critical,
because obviously that underpins the postcode lottery, but also,
for instance, it has a big impact on the growing number of self-funders,
people who in effect are cross-subsidising their residential care
home place, for example, for underfunding of local authorities,
other people are being asked to make third party top-up payments
and so on, so underfunding and a huge level of unmet needs, people
who really do need a service who simply are not getting it at
the moment.
Mr Chidgey: I think we have a
lot of people who, with a little bit of help, well organised,
could live much more fulfilled independent lives, whether they
be living in their own homes on their own, or with family, or
in a care home. I think what we have at the moment is very high
policy aspiration, that describes fantastic outcomes that we want
to achieve for people in terms of fulfilled lives, in connected
communities, with all sorts of peer support networks, but we do
not have the delivery. So that is the problem, the gap between
the aspiration and the ability to deliver it. Of course it is
partly about the lack of funding in the system to do it, but I
think there are a whole range of things that this inquiry has
already been covering in its sessions.
Q595 Chairman: I think we will take
issues around the level of funding, the particular way social
care is funded, means tested, and local variation, and effectively
the potential rationing by the means of eligibility criteria,
those are the areas of concern. Can I just ask you: how much unmet
need is there currently, and for which group is it most acute?
Mr Burke: Sir Derek Wanless in
his review for the King's Fund certainly estimated that, but also
the Commission for Social Care Inspection perhaps more recently
talked about at least over 300,000 people with unmet needs, and
that figure probably is an underestimate. There are a number of
other surveys as well, but they tend to focus on particular local
authorities, rather than the national picture, so I am very interested
to see what the Commission for Quality Care are going to come
up with in their forthcoming annual report.
Mr Harrop: Yes, that is right.
I think the Wanless report remains the gold standard in terms
of analysing levels of need and how the system is working. The
report Stephen just referred to from the former CSCI was very
helpful in looking particularly at self-funders—people who
are too well off to receive help from the current system. They
talked a lot about the unmet needs there, and to what extent family
carers were able to meet them, and it concluded that many were
not getting help from either family or the care system. I would
emphasise what I said a few moments ago about eligibility criteria
as well. People, who under any ordinary understanding of sickness
and disability need help, are being told, "You are not ill
enough to get help from statutory services".
Mr Chidgey: I think it depends
on your level of ambition, does it not, really? Wanless described
in his report a number of different models that we could aspire
to, thinking about the funding, and he said that in the most advanced
form, which I think is what maps to what the policy aspiration
is in Our health, our care, our say, or Putting People First,
he said that in 2007, there was at least a £3 billion funding
gap, so that is in terms of money, but in terms of which are the
groups of people where there is greatest unmet need, I think that
if you look at people living in their own homes who are living
alone, I think there is significant unmet need. I think if you
look at people who are living in their own homes with a family
carer, I think a great and increasing burden is being placed on
families, because they are there, they are willing and they will
do it quite often even though it may have significant adverse
impact on their own health and well-being; and then in relation
to care in care homes, at the moment, despite some positive work
from regulation and improvement in some sectors of the care market,
I think we still, as we know, see significant underperformance
in helping people to live far better lives than they currently
do.
Q596 Chairman: Would you agree that
probably the biggest sector is people living alone at home?
Mr Harrop: They are all important,
are they not? People living at home are the most vulnerable and
isolated, and it is extraordinary that there are tens of thousands
of people with disabilities who do not get help from anyone, but
I do not want to ignore the other two sectors.
Q597 Chairman: I accept that, we
were just trying to focus on where we think the unmet need is.
You will have seen the evidence we have been taking in the last
few weeks, and measuring it is difficult in itself.
Mr Burke: It is also the reliance
on family carers, where people are being expected to pick up the
care responsibility and not getting any help from their local
authority, as well as isolated older people.
Chairman: We will probably look at one
or two of those areas as we go through the session.
Q598 Sandra Gidley: How prevalent
is poor quality social care, and are you able to give us any examples?
Mr Burke: I think there are a
number of particular areas which we would point to which are certainly
raised time and time again through our advice service; first of
all, in terms of people who are using home care services, it is
the way care is commissioned and provided, so when people are
being given a 15 minute slot with a home carer, it is simply not
enough to meet even their most basic of needs, let alone develop
a relationship with that carer, which a lot of people say they
want; and also not just 15 minutes, but it is the timing of that
care, so being expected to go to bed at 6.00 in the evening or
get up at 10.00 in the morning. Linked to that, I think, is the
issue about continuity of carers as well, and I think that is
particularly important for people with dementia, in terms of familiarity
with their carer; also the level of training that is available,
particularly for carers of people with dementia as well. The other
big area that we get a lot of concern about is in residential
care, where simply again not enough notice is taken of residents'
wishes, in terms of their choice of activity, timing of when they
eat, and so on, let alone respect of their own culture and food
and things like that. So I think personalisation has a long way
to go in terms of improving the quality of care for people living
in their own home and in residential care.
Q599 Sandra Gidley: Are you saying
personalisation may be more difficult in a care home setting?
Mr Burke: I think it is not nearly
as advanced in residential care as it is for people living in
their own homes.
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