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.

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.

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

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.

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?

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.

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.

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.

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.

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.

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.