Why we need a publicly owned care service

30 July 2019

Dr Gillian Dalley

The ‘problem of social care’ is currently perceived to be a problem of funding. As such, the funding question dominates policy-thinking and public debate. The central concern of this article, however, is broader. It focuses on the essential nature of social care, particularly its structure, quality and sectoral location – in addition to funding.

Key points about current social care:

  • Social care is almost entirely provided by the private sector, for profit.
  • Private provision means the whim of the market determines distribution, type and quality. This results in patchy distribution, flourishing in some wealthy areas, shortages in others, with widespread evidence of unmet needs, poor quality of care and lamentable employment conditions.
  • Unlike care and treatment in the NHS, social care is not free at the point of use. Individuals requiring social care (as noted, almost all privately provided), are means tested. Those with assets over £23,250 are disqualified from receiving it free.

This submission argues the case for bringing social care into the public sector to remedy these failings.

The case for taking social care into public control:

1.      Vision:

Social care must be a service which is available to all citizens, based on individual needs, in settings of their choice. The ethos of public service – of fairness and high standards (for both service users and the workforce which provides the service) – should be at its heart.  To achieve this, and as an essential public service, it has to be located within the public sector, just like the NHS. The notion of profit is alien to this vision and should be ruled out entirely.

2.      Structure:

  • The vision can only be put into effect with major structural change.
  • Currently most social care (around 90%) is in the hands of private providers (residential care homes – provided by private companies or a very small number of charities; domiciliary (home) care – provided by private agencies).
  • Private providers range from small, single (often family) owner businesses to large companies often owned by hedge funds. Many have recently gone out of business, causing major problems for clients and local councils who have a legal duty to ensure those with eligible needs receive the care for which they qualify.
  • Councils themselves, for the most part, are no longer service providers.
  • Care services for individuals needing care are either a) commissioned and paid for by local councils or b) selected and paid for by individuals who don’t pass the means test (self-funders).
  • The distribution of provision is highly variable geographically with huge financial implications for councils: in some council areas over 50% of clients are self-funding, with councils financially responsible for the remaining proportion; in others, fewer than 10% are self-funding, with councils financially responsible for up to 90% of those with care needs in their areas.  Thus there is a ‘post code lottery’ in access and cost for both individuals and councils.
  • In the future, the aim instead should be to achieve public sector provision consisting of a mix of residential and nursing care homes, home care, village living with a mix of facilities, access to which becomes available as individuals’ care needs increase – and other innovative schemes which may come along.  Provision should be developed as needed, shaped by forward planning based on a continuous analysis of demographic trends.
  • As long as councils retain statutory responsibility for social care, central government must guarantee adequate funding, thus ending the way in which it can currently squeeze local government at whim to the extent where councils can no longer fulfil their legal obligations to their residents. ‘A contract of care’ between government and people is required.
  • Alternatively, radical change might foresee a funding system not unlike that for the NHS with a transfer from local to national funding.
     

3.      Responsibility for planning:  

Too often the development of social care is left to ‘happenstance’ and calculations about business opportunities as framed by businesses in the private sector. Private developers whose main goal is profit go where the money is – areas where wealthy self-funders are located, rather than poorer, council-supported clients – and not according to need.

Conversely, in other less wealthy areas, private companies are closing down care homes and home-care services haphazardly without consultation or thought to the welfare of clients, claiming their businesses are unsustainable. It is impossible under central government-imposed austerity for local councils to cope with growing levels of unmet need and demand.

4.      Planning in the future:

A central requirement for any public service is that it meets public needs effectively, efficiently and economically, taking account of change in the short- and long-term. This requires planning, monitoring and regular review by the statutory services, locally and nationally. Planning must be undertaken for:

  • workforce development, matching staffing to needs
  • assessing and forecasting care needs over time
  • designing and commissioning provision of appropriate accommodation (care homes, community buildings, resource hubs) according to changing demographic trends.

 Such planning currently does not exist.

5.      The need for quality improvement in the social care sector:

  • Recent evidence has shown how appalling standards of care in the sector can be, along with widespread shortage of services, non-existent in some areas. 
  • Across the sector little training is available, with unqualified staff taking on huge responsibilities for which they are not trained. Few quality standards are laid down for the training required – either in care or management - leading to a downward spiral in quality. A comprehensive training programme must be developed.
  • No serious investment in training from private providers is evident. Comparison with the NHS in relation to these issues is laughable.
  • Regulation, in the hands of Care Quality Commission (CQC), is inadequate. CQC standards are not sufficiently explicit, being grouped under global categories such as ‘safety’ which are so broad as to be meaningless, and reports by inspectors are full of stock phrases and organisational jargon, which serve to demonstrate a lack of insight and responsiveness to the particular circumstances of individuals and their needs.
  • At worst, inspections are infrequent and superficial.

6.    Funding – current and future:

With the elimination of private provision, social care can – and must – be properly planned, costed, funded and provided – and all these functions aligned for maximum quality and efficiency. Issues include:

  • Who pays? Currently individuals with assets above £23,250 have to pay for their social care. Otherwise it is state-funded via councils.
  • Options are: a) fully funded from the public purse (either direct from the Treasury via national insurance/general taxation; or wholly via local councils;) or b) partially publicly funded, with citizens subjected to various levels of means-testing and/or capping.

Several reports have been published over the past 25 years, all accepting the notion of partial funding. Most reports accepted this with various suggestions of introducing caps upon the total amount any individual should be required to pay. The Dilnot report suggested the most ‘generous’(to the individual) level of the cap (£35k).  

Only the Royal Commission report in 1999 suggested, in the case of residential care, the idea of splitting off the costs of accommodation and other ‘hotel’ services (meals, laundry etc) from the costs of the care itself with the former being means tested and the latter fully funded.  This already happens in Scotland. This could be considered by government as an alternative to the full-funding of all aspects of the service.

7.    NHS and Social Care - an integrated service? 

Bringing social care into the public sector will be a major step in the journey towards possible integration of the two services. Ultimately however the source of funding needs to be better aligned. As long as social care is funded through councils, the division between the two will remain insurmountable. In times of pressure or crisis each service will always close ranks to protect its own interests (financial, professional, management). This is a fundamental, evidenced and incontestable feature of organisations and will always be antithetical to achieving the long and widely held ambition of integration.

This article is adapted from a submission to the Labour Party’s consultation on the future of health and social care. The submission was written by  Dr Gillian Dalley – a Labour Party member in Islington North. The full submission can be found here.

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Comments

Malcolm Hunter replied on

This is something that I wrote a few months ago, as a contribution towards Labour's local election manifesto writing process in Leicester, having recently retired as a mental health social work team manager. (This rather upset some of my former managers, but unlike on some occasions in the past they were no longer able to threaten me with disciplinary action for being publicly critical).

https://docs.google.com/document/d/19bFw8n4cTPYArdRbMUFk8Pj3hIObshCpixpNygGT4u0/edit

Annie Haslam replied on

Thank you, to Malcolm Hunter. Your suggestions are immensely practical and offer solutions to a problem that not only exists now, but that will become of graver & graver concern as the months & years pass. Knowing that almost all “ordinary” people will, at some point in our later years, require the “benefits” of such social care, is terrifying. I’m 64 and am well aware that my, already somewhat delicate, physical health will need support & practical physical help, if I’m lucky enough to continue living into old age, with the infirmities & need for practical physical assistance that come with the ageing of ones body & loss of physical strength. Having had COPD & arthritis for many years, I have a pretty good idea of what my needs could be, and I’m truly worried (fearful, to be honest)about what the future for me & all those with similar needs, will hold. The sooner the problem is dealt with the better, for those currently in the social care system & everyone that one day will be!

If social care change is implemented as outlined in your suggestions, old age would hold fewer fears & care at the end of life would be funded far more adequately & equitably, as is right, in a socially caring & compassionate society, which is surely what we aim for?

Annie

Rob Doughty replied on

My daughter worked in several Residential Care Homes as a Care Assistant, and her experiences, together with those of our whole family when my mother was in a Care Home, convinced me that Adult Social Care, whether Domiciliary or Residential, should be provided under the umbrella of the (properly and adequately funded) NHS. This would remove the lottery of care quality and create a pattern of joined-up thinking and care plans.

David Warren replied on

As a former carer I have been calling for this for some years. The current system fails everybody and needs to change.

Chris Sterry replied on

I agree that Social Care, in its current form, is a lottery and that funding is but one area of concern.

I also agree, to some extent, that Social Care should be free at the point of delivery.

Consistency over delivery is also a major area of concern, in terms of quality, quantity, but also choice.

When Social Care was, to a large extent, delivered by Local Auhorities some form of quality and quantity was available, but not choice.

I say some form of quality and quantity because just being delivered by Local Authorities does not guarrantee these, as it is with health care, for there are good hospitals and GP surgeries and some not so good.

Mid Staffs being one point in question, but there are others.

Regulation of quality is down to the CQC, but there have been major failures Winterborne and Woolaton Hall and others, but these were in the private sector, possibly under a NHS banner, but perhaps not. So far as I see it the CQC are more concerned about bureaucracy, the written reports, than they are will the actual delivery.

But for choice, there was none, you had who the Local Authority sent, whether they be good or not so good, whether they fitted in with persons in need of care and maybe their family, i.e. a possible clash of personalities.

Within the article it is assumed that there will be no private provision and that this is none within the Health services.

You may say, that is down to the prvitisation which is now allowed for, but private health as always been available for those who wish for it and are able to pay for it. For this was one of the concessions that was allowed for when the NHS qwas formed in 1948.

You may not be aware but before the NHS was formed it was all private and you had to pay for it. The Government of the day commissioned the Beveridge Report http://www.nationalarchives.gov.uk/cabinetpapers/alevelstudies/1940-origins-welfare-state.htm and in 1944 a Ministry of National Insurance was set up in Newcastle, and in June 1945 the Conservative government passed the Family Allowances Act, see also

https://www.nuffieldtrust.org.uk/health-and-social-care-explained/nhs-reform-timeline?gclid=CjwKCAjw4ZTqBRBZEiwAHHxpfodJ05WVtAQy1OFQCPkxyZxjaz1A55Sl0w-iYZA3DFOw300xs8qEaRoCZRUQAvD_BwE and also https://www.historic-uk.com/HistoryUK/HistoryofBritain/Birth-of-the-NHS/ and also https://api.parliament.uk/historic-hansard/commons/1948/feb/09/national-health-service

So there was some opposition from Doctors and Dentist and their professional body, the BMA, around provision of private practice, surgery purchase and others.

Re the private practice doctors and dentists were allowed to to work for the NHS, but also keep a private practice, if they so wished. The GP practices were not held by the NHS as hospitals were, so there were owners of the practice, the Partners and other doctors and health professionals who were employed by the practice.

So the NHS was created and it worked well in most instances, but the free at point of delivery did not last long , as in 1950 the first prescription charge was introduced, 1 shilling, as it was quickly seen that the basis of funding was not sufficient, in a way similar as of today, but the prescriptions are now much more and more direct payments for health have been introduced.

Some medication can now no longer be on prescription.

Funding for health is still a problems and now the article suggests Social Care be brought in on the same basis.

How long then,for Social Care, should it become free at the point of delivery, follow the same route, some free, but others not.

My sugggestion is that the individuals contribution to Social Care be done aways with, but still keep private Social Care.

I, for my adult daughter, am an Individual Employer, where I am in receipt of a direct payment from our Local council, should it be fully health funded, it would be a Personal Health Budget.

My daughter had an Assessment of Needs and am amount for the total cost was calculated to pay for the care, which I administer and I use this to purchse care from whom I wish, here is the choice, I choose the Care Support Provider and we consult on who they provide to deliver the care, in addition I also employ some PAs, Personal Care Assistants, who I interviewed and decided to employ, they are fully answerable to myself and my daughter, whereas, from the Care Provider their staff are primary answerable to their afncy. I am one of the lucky ones as the Provder listens to myself on who they send.

This works reasonably well, except there is a vast shortage of persons willing to work within the Care Profession and of those that do, not all provide good quality care and there are also some Care providers who also are not prepared to ,listen to the person in need of care and on occasions their family members.

But this is no change from when the carers came directly from the Local Authorities, for what Local Authority, really listens to the public and this article suggest we go back in time for this to occur again.

Yes, the current Social Care system is far from perfect, but at least there is some element of choice, but not enough.

What is needed is an organisation thats sole purpose is to produce quality care standards which are consistemt throughout the Care Profession, a possible area for paid carers to register with, look at pay scales and care fees, standardise training and others and be managed by a management consisting of care providers, people in need of care, family carers (family members), paid carers and representatives of the Local Authority, CCG, CQC, maybe Healthwatch and possibly others.

This is an organisation which I am currently looking to organise.

But the funding of Social Care needs to be looked at as a matter of urgency and in my view this is way more important than Brexit, which is of course also important.

Social Care has been off the offical Agenda for far too long.

Anthony E Deaves replied on

It needs joined up thinking between hospital and coming . My late mother was cared for by my wife for over ten years .those people without that luxury should care halfway places and should come out of the same pot of money with all paying for it from taxes if all us pay a little taxes.

Judy Scott replied on

An additional point is that when Older People are discharged from hospital or have a significant illness at home they need a period of recovery and rehabilitation which takes talented trained staff who work intensively for a short period to help make as much improvement as possible before areduced longer term care plan is established - the private sector have no incentive to work in this way since they are there to provide care at a profit not intensive rehabilitation which ultimately reduces the care costs. we need more social workers in charge of home care systems and longer term work with care homes after discharge from hospitals to stop more older people being condemned to a life of needless dependence when they could have been helped to greater independence

Mike Stephenson replied on

I agree with the case put forward above by Dr Dallyf it is so obvious and desirable that we should have a public care owned and run service. Those who finance private profit organisations in this work do not see how wrong it is to take their share profits on the adversity of older and ill people. I am solidly behind the way forward outlined in this email.

Vin West replied on

I have been lobbying Welsh Government for many years to make social support free at the point of need and funded by progressive taxation or national insurance so that means testing can end and everyone can receive support of their choice where, when and from whom they decide. I have sat on all of the Ministerial Advisory Groups on “Paying for Care” since 2000 and each time we have unanimously advised Welsh Government that health and social support should both be approached the same way.

The Gerry Holtham report to Welsh Gov takes us partly in this direction but it is time to take some bold decisions to established a civilised social support system fit for the 21st century.

Anonymous replied on

We had to find a place for my mother with dementia. The quality of provision was astounding from places that I would not inflict on my worst enemy to some super facilities. Finally selected a suitable place. Fortunately my mother had money left to here so the £6500 per month is doable. So far cost around £95,000. Her house has now been sold to maintain her for another few years. What happened after that I have no idea.

I wonder when the country will wake up to the fact that we ALL need to pay a great deal more for our NHS and end of life care?

Clive Cartmel replied on

We had to find a place for my mother with dementia. The quality of provision was astounding from places that I would not inflict on my worst enemy to some super facilities. Finally selected a suitable place. Fortunately my mother had money left to here so the £6500 per month was doable. So far cost over £100,000. Her house has now been sold to maintain her for another few years. What happens after that I have no idea.

I wonder when the country will wake up to the fact that we ALL need to pay a great deal more for our NHS and end of life care?

Jennifer Hall replied on

I have 8.5 hours of care a week which is just enough to hoist me in and out of bed daily and shower me and wash my hair once a week. I make my own meals and worry about what I am going to do when I need more help as I inevitably will. If my care provision breaks down because of carer illness or failure of carer cover I can end up sleeping in my wheelchair. I do not use the council's inadequate services because the agencies that they refer me to have been badly managed. Carers on the whole have been badly trained and, in some cases, they have been uncaring and frankly dangerous. In some weeks it was possible to get 4 different carers all of who needed to be talked through the transfer regime. Because I have more than the qualifying savings I receive no financial help from the council. The only help that I was offered by the council was with the administration of my care account. This relied on information from the care agency to the council which was not always right. After a couple of years I decided not to use the council and I entered into a private arrangement. The advantage of this is that I can deal directly with my carer, pay her a decent wage and have the peace of mind of receiving a service over which I have some control. For this I pay £8,000 a year. I pay a further £1,250 for cleaning a year. I have been receiving care for over 10 years so have spent approximately £92,500. If I deduct my mid-rate DLA I have paid about £40,000 from State Pension and my savings. When I asked why the council had stopped running its own carer service I was told that the council oouldn't afford it. Well neither can I.

Jennifer Hall replied on

I have 8.5 hours of care a week which is just enough to hoist me in and out of bed daily and shower me and wash my hair once a week. I make my own meals and worry about what I am going to do when I need more help as I inevitably will. If my care provision breaks down because of carer illness or failure of carer cover I can end up sleeping in my wheelchair. I do not use the council's inadequate services because the agencies that they refer me to have been badly managed. Carers on the whole have been badly trained and, in some cases, they have been uncaring and frankly dangerous. In some weeks it was possible to get 4 different carers all of who needed to be talked through the transfer regime. Because I have more than the qualifying savings I receive no financial help from the council. The only help that I was offered by the council was with the administration of my care account. This relied on information from the care agency to the council which was not always right. After a couple of years I decided not to use the council and I entered into a private arrangement. The advantage of this is that I can deal directly with my carer, pay her a decent wage and have the peace of mind of receiving a service over which I have some control. For this I pay £8,000 a year. I pay a further £1,250 for cleaning a year. I have been receiving care for over 10 years so have spent approximately £92,500. If I deduct my mid-rate DLA I have paid about £40,000 from State Pension and my savings. When I asked why the council had stopped running its own carer service I was told that the council oouldn't afford it. Well neither can I.

T J Reddington replied on

I agree the system is wasteful and results in sometimes very poor care but .. What would you propose should happen to personal budgets? - particularly where specialist care is required - We have a personal budget to provide my adult son's care - his staff are specifically trained to meet his needs while we offer good conditions of employment at less than any private provider's standard rate.

Lou Simpson replied on

Having been a unpaid Carer for family members for the last 20 odd years, I believe it is time that the NHS and Social Care became inter-grated both financially and as deliverers of care and support. This would negate the ongoing fight as to who pays for what and would get rid of the pernicious Continuing Health Care system that is presently in place for those that are classified as needing nursing care.

I have experienced and provided for the care of elderly relations where one could afford care and the other could not. Both were a nightmare in trying to obtain sufficient and good quality experienced care, both at home and in a care home. There have been good paid Carers who have been lowly paid and used by their Management and Bosses. There have been horrendous Carers with no training and little experience of dealing with the complex needs that our loved ones presented.

The fact that it is a low paid, no career progression or very little job, means there are times when the wrong people are employed with little monitoring by the councils or above.

We have been our Disabled Son’s Carers for most of his life and again it is the continual fight to get appropriate and experienced good services for enough hours per week to cover all areas of life. No young person should have to go through this appalling system of reviews just to prove that care is still needed when it is a condition that is unlikely to improve especially if the good care needed is not delivered. No person should find the goal posts move so that they end up with less hours but rarely more if their condition is stable even if areas of life are not being met i.e. socialising within peer groups in a safe and holistic environment.

The present system is not fit for purpose. As Gillian Dalley states both the NHS and Social Services should be paid for under a fair and sustainable taxation system. Looking at how the Scandinavian Country’s fund their excellent services would be a start, yes we would pay more tax but you wouldn’t have to sell your estate, (which we have already paid tax on) to fund one’s care. It would put a stop to the post code lottery as to who receives services or not.

I’m now 70 and seriously doubt anything will change in my life time, but I hope for my children, grandchildren’s sake it changes before they have a need for these services, any more than they already have.

Lou Simpson replied on

Having been a unpaid Carer for family members for the last 20 odd years, I believe it is time that the NHS and Social Care became inter-grated both financially and as deliverers of care and support. This would negate the ongoing fight as to who pays for what and would get rid of the pernicious Continuing Health Care system that is presently in place for those that are classified as needing nursing care.

I have experienced and provided for the care of elderly relations where one could afford care and the other could not. Both were a nightmare in trying to obtain sufficient and good quality experienced care, both at home and in a care home. There have been good paid Carers who have been lowly paid and used by their Management and Bosses. There have been horrendous Carers with no training and little experience of dealing with the complex needs that our loved ones presented.

The fact that it is a low paid, no career progression or very little, job, means there are times when the wrong people are employed with little monitoring by the councils or above.

We have been our Disabled Son’s Carers for most of his life and again it is the continual fight to get appropriate and experienced good services for enough hours per week to cover all areas of life. No young person should have to go through this appalling system of reviews just to prove that care is still needed when it is a condition that is unlikely to improve especially if the good care needed is not delivered. No person should find the goal posts move so that they end up with less hours but rarely more if their condition is stable even if areas of life are not being met i.e. socialising within peer groups in a safe and holistic environment. Whilst the intention of reviews is to adjust for changed needs it certainly does not feel like ia holistic approach that covers all areas of life.

The present system is not fit for purpose. As Gillian Dalley states, both the NHS and Social Services should be paid for under a fair and sustainable taxation system. Looking at how the Scandinavian Country’s fund their excellent services would be a start, yes we would pay more tax but you wouldn’t have to sell your estate, (which we have already paid tax on) to fund one’s care. It would put a stop to the post code lottery as to who receives services or not.

I’m now 70 and seriously doubt anything will change in my life time, but I hope for my children, grandchildren’s sake it changes before they have a need for these services, any more than they already have.

Chris Beney replied on

We are overdue an independent review, perhaps a Royal Commission (though these seem out of favour nowadays). I own up to not knowing who is responsible for what: Borough/District; County; NHS; Central Government. but there is clearly a fault line between NHS and Local Government and that needs addressing now. Starting to do that might point to solutions to the other issues. For funding, at least in the short term, a lifetime care contribution cap rather than the present annual income based one might be fairer.

Rhona replied on

Mankind has progressed very little over millennia in terms of meeting the needs of everyone in society. The setting up of a care system that works for everybody in their hour of need would be one small step in the development of compassion for humanity.

Odette Swann replied on

We also need a major change in attitude and priority in the country regarding funding (funny how, with care funding in such a crisis, the country could find such a vast amount of money to spend on the Olympic Games), and also in attitudes to employment funding - the jobs of care workers and nurses, along with other key workers, are in fact more vital to society than many of the vast number of better paid office desk jobs in the country today, and pay scales should reflect that, if people are to be attracted into care work.

Tony Jowitt replied on

Life is about caring for others and giving love

Chris Sterry replied on

I agree that Social Care, in its current form, is a lottery and that funding is but one area of concern.

I also agree, to some extent, that Social Care should be free at the point of delivery.

Consistency over delivery is also a major area of concern, in terms of quality, quantity, but also choice.

When Social Care was, to a large extent, delivered by Local Auhorities some form of quality and quantity was available, but not choice.

I say some form of quality and quantity because just being delivered by Local Authorities does not guarrantee these, as it is with health care, for there are good hospitals and GP surgeries and some not so good.

Mid Staffs being one point in question, but there are others.

Regulation of quality is down to the CQC, but there have been major failures, Winterborne and Woolaton Hall and others, but these were in the private sector, possibly under a NHS banner, but perhaps not. So far as I see it the CQC are more concerned about bureaucracy, the written reports, than they are with the actual delivery.

But for choice, there was none, you had who the Local Authority sent, whether they be good or not so good, whether they fitted in with persons in need of care and maybe their family, i.e. a possible clash of personalities.

Within the article it is assumed that there will be no private provision and that there is none within the Health services.

You may say, that is down to the privitisation which is now allowed for, but private health as always been available for those who wish for it and are able to pay for it. For this was one of the concessions that was allowed for when the NHS was formed in 1948.

You may not be aware but before the NHS was formed it was all private and you had to pay for it. The Government of the day commissioned the Beveridge Report http://www.nationalarchives.gov.uk/cabinetpapers/alevelstudies/1940-origins-welfare-state.htm and in 1944 a Ministry of National Insurance was set up in Newcastle, and in June 1945 the Conservative government passed the Family Allowances Act, see also

https://www.nuffieldtrust.org.uk/health-and-social-care-explained/nhs-reform-timeline?gclid=CjwKCAjw4ZTqBRBZEiwAHHxpfodJ05WVtAQy1OFQCPkxyZxjaz1A55Sl0w-iYZA3DFOw300xs8qEaRoCZRUQAvD_BwE and also https://www.historic-uk.com/HistoryUK/HistoryofBritain/Birth-of-the-NHS/ and also https://api.parliament.uk/historic-hansard/commons/1948/feb/09/national-health-service

So there was some opposition from Doctors and Dentist and their professional body, the BMA, around provision of private practice, surgery purchase and others.

Re the private practice doctors and dentists were allowed to work for the NHS, but also keep a private practice, if they so wished. The GP practices were not held by the NHS as hospitals were, so there were owners of the practice, the Partners, with the other doctors and health professionals who were then employed by the practice.

So the NHS was created and it worked well in most instances, but the free at point of delivery did not last long , as in 1950 the first prescription charge was introduced, 1 shilling, as it was quickly seen that the basis of funding was not sufficient, in a way similar as of today, but the prescriptions are now much more, with more direct payments for health been introduced.

Some medication can now no longer be on prescription.

Funding for health is still a problems and now the article suggests Social Care be brought in on the same basis.

How long then,for Social Care, should it become free at the point of delivery, follow the same route, some free, but others not.

My sugggestion is that the individuals contribution to Social Care be done aways with, but still keep private Social Care.

I, for my adult daughter, am an Individual Employer, where I am in receipt of a direct payment from our Local council, but should it be fully health funded, it would be a Personal Health Budget.

My daughter had an Assessment of Needs and am amount for the total cost was calculated to pay for the care, which I administer and I use this to purchse care from whom I wish, here is the choice, I choose the Care Support Provider and we consult on who they provide to deliver the care, in addition I also employ some PAs, Personal Care Assistants, who I interviewed and decided to employ, they are fully answerable to myself and my daughter, whereas, from the Care Provider their staff are primary answerable to their agency. I am one of the lucky ones as the Provder listens to myself on who they send.

This works reasonably well, except there is a vast shortage of persons willing to work within the Care Profession and of those that do, not all provide good quality care and there are also some Care providers who also are not prepared tolisten to the person in need of care and on occasions their family members.

But this is no change from when the carers came directly from the Local Authorities, for what Local Authority, really listens to the public and this article suggest we go back in time for this to occur again.

Yes, the current Social Care system is far from perfect, but at least there is some element of choice, but not enough.

What is needed is an organisation thats sole purpose is to produce quality care standards which are consistent throughout the Care Profession, a possible area for paid carers to register with, look at pay scales and care fees, standardise training and others and be managed by a management consisting of care providers, people in need of care, family carers (family members), paid carers and representatives of the Local Authority, CCG, CQC, maybe Healthwatch and possibly others.

This is an organisation which I am currently looking to organise.

But the funding of Social Care needs to be looked at as a matter of urgency and in my view this is way more important than Brexit, which is of course also important.

Social Care has been off the offical Agenda for far too long.

Judith rowan replied on

My experience re the 'care' sector is largely negative. Agencies are in it for the money, clients' wishes are disregarded, staff are often too young, inexperienced and have too great responsibility . Agencies have little or no thought for the safety of either client or agency staff. Often two people should be assigned to a task, i.e. lifting/turning a client, and only one is sent to do the task alone. This is dangerous for both client and worker. Good staff are overworked, and pressured to do far more hours than originally agreed. The emphasis is on money for the company, service to the client is last on the list. The 15' minute call is neither use nor ornament. It is time human rights were respected and and endorsed in practice. We all need connection and human interaction.

Peter Reineck replied on

Government outsources public services for several reasons, of which one is plausible deniability for failures, and another is to ensure delivery on targets: targets re set, and contracts are written, accordingly. It will be interesting to see how Government resolves this dilemma in the Public ownership model.

Alison Tomlin replied on

I agree with the previous three comments. My mother lived in a village 6 miles from the nearest sizeable town; her care workers sometimes had no time allocated to get from one client to another five miles away. She had both fantastic and dangerous care workers, and I was glad I had the time and money, and affection/closeness, to stay with her when the care worker was particularly dangerous and unkind. My mother had no dementia; the care worker’s job must be much harder if the client can’t say what’s needed, and I doubt that our society offers enough training and support for them.

I have a care worker from an agency set up as a charity by a woman who saw that local agencies could not meet the needs of clients from particular groups. For example whenever possible the agency finds a care worker who can speak the client's mother tongue and understands particular needs, e.g. religious practices and care at the time of death. I'm atheist, white, English, and really appreciate the cultural exchange I have with my brilliant Somali care worker. She'd find it hard to get a job with other agencies - little formal education, probably would have difficulty getting through the various qualification levels. Some people need care workers who can, for example, keep a record of anything giving cause for concern; I don't, and the agency discussed with me what I needed before allocating a worker. This agency has recently lost its local authority contract, and will keep going only if enough of its clients can arrange direct payments. I am confident that the successful bidders are much larger companies with central offices and professional workers raising contracts; haven't checked but bet they're not charities.

I didn't at first know how good my agency was: I chose them because they paid slightly more than the minimum wage, unlike the others I tried. Care workers are paid peanuts for astonishingly responsible work; that's partly because private agencies extract money from the system, and partly because local authorities' budgets are largely controlled by central government.

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