The Big Care Debate - Part 3

Recognising the in-kind contribution of carers
This section covers suggestions made regarding the models of funding proposed in chapters 5 and 6 of the Green Paper. However, the relevant official consultation question (three) does not cover this issue. A survey will be available from 25th September here so that you can give your opinions on questions raised in this briefing.

The Green Paper mentions delivering the new National Carers’ Strategy in several places and quotes The Princess Royal Trust for Carers on page 119. But it contains little new proposals for carers, arguing that, “by improving support to people who need care, we will also be supporting carers” (p 20).

The Government says that they do want carers to be able to choose how much care and support they wish to provide (p 58) but advise that it is not “affordable to have a system which completely replaced family care with state-funded care and support” (p119). However, there is a suggestion in the Green Paper that might give value to the support that carers provide.

The Government advises that the costs for couples requiring care and support can be very high, and that since many couples provide care and support for each other, couples could be asked to contribute lower amounts in the Comprehensive model. However, they do advise that such reductions would have to be covered by higher contributions from other people. (p 114)

We agree with the suggestion that the provision of care and support should be recognized and given value by a reduction in contributions. This benefit should be extended to all carers, not just those in couples, which would give just recognition of the huge contribution that carers make to the social care system.

It would obviously be unfair to restrict any benefit to co-habiting carers as there are many carers who do not live with the person they care for yet provide substantial care and support. It would also be unfair for a carer not to receive such a benefit because they are not part of a “couple” but rather care for a friend or relative.

The provision of unpaid care and support should be valued as an in-kind contribution to the system, and reflected by a reduction in the amount to be paid in a Comprehensive model. Even if there was not a Comprehensive model and only a Partnership model in place, it would still be fair to recognize the contribution that carers make by taking this into account when calculating the proportion that the person receiving support has to contribute. Such measures would help the Government achieve its aim of creating a fair system, recognizing the irreplaceable value that carers provide in the social care system.

If care is being provided by an unpaid carer, should there be a reduction in contributions made towards covering the cost of care? This could apply in either the Partnership or Partnership + Comprehensive model.

Improved joined up working to help carers
This section covers Chapter 4 of the Green Paper and is related to the official consultation question 2 looking at how to join up services in a National Care Service, and what choices people should have.

There are not many other proposals in the Green Paper specific to carers but the Government has said it is keen to increase joined-up working and involvement of third sector providers and user-led groups in planning and commissioning, which are aims that we support. There are also proposals for reforming assessments to reduce the number of assessments that one person has to go through which may improve matters.

Many problems experienced by carers are frequently due to the lack of co-ordination between various professionals/organisations, often at the point where care transfers from the NHS to social care. One aspect not considered that might improve joined-up working and help people manage the system are whole-family assessments. Currently, if several family members either give or receive care, they each get a separate assessment. Yet, one person’s assessment can affect another’s entitlements in complex ways and it may be that whole-family assessments, linking in with ‘whole family’ support might make the system easier to use and produce greater joined up working.

Should families be able to receive a whole family assessment if all affected individuals agree?

The Government has suggested that short-term re-ablement programmes where the patient relearns personal care tasks such as washing and dressing could help people maintain greater independence at home, and thus help carers. They advise such programmes could run for six weeks (p 54).

The Government has proposed that an independent organisation could be created to look at which interventions work and what gives best value for resources (p 79) and presumably to encourage joined up working. It would work with the Department of Health to design a social care evidence and research programme to assess the gaps in evidence bases. This information could help commissioners and individuals who purchase care and support. The government does consider giving this remit to Social Care Institute for Excellence which currently identifies and disseminates the knowledge base for good practice in all aspects of social care throughout the United Kingdom.

What barriers do you think there are, or that you have experienced to joined up working?
What services need to be joined-up to make carers’ lives easier?
What would make sure that carers get more choice about the caring they take on and the life they live?

Download a printable version of the briefing: Social Care Green Paper Part 3 (173 KB)