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TX: 12.05.08 - CARE: The Consultation Begins

PRESENTER: WINIFRED ROBINSON AND PETER WHITE

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ROBINSON
As you'll have heard in the news Gordon Brown has begun a public consultation on the future of social care and here's Peter with an assessment of what this latest development may mean for those who depend on the care system for help with washing and shopping and those who provide care.

WHITE
Yes Winifred, Mr Brown announced this initiative while speaking at the health think tank - The King's Fund - this morning.

BROWN
Today the government is publishing a consultation document setting out the challenges we do face and why we must now look again at the options for reforming our current system of care and support. And this is an issue, I can tell you, that is the heart - at the heart of our ambition for a fairer Britain.

WHITE
And in fact here on You and Yours, as part of Radio 4's care season, we heard from the Prime Minister back in January explaining why he thought that social care was one of the biggest problems his government has to confront.

BROWN
I welcome the fact that so many people are contributing through the work of the programme and the excellent programmes that you do. I also think it's really important we hear the whole range of concerns that people have. From your listeners I think we will hear information that will influence what we do because we've got to take into account not just the situation as it is at the moment but what people think is going to happen in a few years time when there are more elderly people, when people's aspirations are rightly higher, when people have a greater desire to live in their own homes and not in institutional care and therefore we've got to have a system, again, that is more personal and responsive.

WHITE
Mr Brown on that occasion speaking at a carers' meeting in Leeds which was part of a public consultation, another series of national events that will feed into developing a new national carers' strategy. Which serves to illustrate just how complex this problem is. A little timetable coming up. Ten years ago we had the first carers' strategy which tried to secure a better deal for the estimated six million unpaid carers in the UK. We're expecting that to be updated in June. That just dealt with the perspective of those doing the caring though. In 1999 we had a royal commission looking into social care, their big idea was free personal care for everyone, which the government rejected, although Scotland adopted it. Then in 2005 there was the Independence Well Being and Choice Green Paper on social care, another green paper you notice, emerging from which has been the drive to give people greater control over how their care budgets are spent. Then in 2006 Derek Wanless looked at the funding of social care for the King's Fund and concluded that a partnership model was needed in which the state and the individual would share the cost of care. Despite these reviews and numerous other reports from interested charities the minister of care - Ivan Lewis - insisted to us this week that this consultation isn't just a matter of going over old ground again.

LEWIS
This is not about tinkering at the edges or reviewing the existing social care system. This is about the creation of a new care and support system. And what we have to resolve is what kind of a system do they have a right to expect in the future in terms of quality, in terms of a system which is a focus around their personal and individual needs. And also what do people think is fair and affordable in terms of what's the responsibility of the government to fund through taxation, what is it right for us to expect of families and of individuals. And we look forward to having that discussion with the people of this country over the next six months and making sure that the green paper we publish captures how people feel about this system.

WHITE
And there's no precise date yet for that green paper that Ivan Lewis referred to but we are told it will come next year. As for when any conclusions might become law well the Department of Health says it's far too early to speculate. But it is hard to see how any legislation as complex as this could be introduced before the next general election. We're told the consultation will be asking questions like what kind of care should be available, who should deliver it, who should qualify for it and how much say should individuals have. But central to everything of course is money - how's it going to be paid for and where the balance should lie between state and individual contribution. Ivan Lewis wasn't prepared to speculate on the conclusions any green paper might reach but he was sure it wouldn't leave the system the same, nor would it bring about the free personal and nursing care that prevails in Scotland.

LEWIS
I think there are two scenarios which are most unlikely and one is the status quo and the existing system, which I've said very openly lets far too many people down. And secondly, free care for all - it doesn't work, it's not sustainable. And of course people should remember in Scotland that people are still paying for their housing and accommodation costs and their food costs, so Scotland are saying personal care is free but care is not free.

WHITE
What we know so far, I mean as we found in our series in January a majority of people in England do accept that they should have to pay at least some of the costs of social care, should they need it. But, as Ivan Lewis was saying there, Scotland has gone down a different road. Free personal and nursing care was introduced in 2002 after Scotland followed the recommendations in that 1999 royal commission, chaired by Lord Southerland. Well after five years of its operation in Scotland Lord Sutherland has just completed a review of the scheme for the Scottish Executive and he told me what he'd found.

SUTHERLAND
Well the main conclusions are that some more cash would be very helpful in stabilising the policy over the next five years, that there needs to be an understanding across all local authorities of the common standards to which everyone is operating - whether it's in relation to the criteria used for assessing care or the process followed in working out what the needs of the individual are. So these are two areas that have to move ahead, we believe pretty well immediately.

WHITE
It is being said that in some places in Scotland there is still an element of rationing in the way that the system works.

SUTHERLAND
We know that the local authorities want to sort this out because it's a great source of irritation to those in need and those who care for them. And we have made recommendations about sorting that out.

WHITE
Part of your remit was not simply how is it working now but is it sustainable, what did you conclude about that?

SUTHERLAND
Well we have two conclusions. One is that the amount of money being spent on personal and nursing care for older people is around £250 million in a year. The total bill for care for older people is about two and a half billion pounds a year. So it is a tenth of what the total spend is on care of the elderly. So we see it in that context. We also noted that there are several different streams of funding available. One of which was the dedicated stream for personal and nursing care but, for example, attendants allowances, disability allowances, amounts to twice that sum of money. So our second type of recommendation is to say all of these streams should be brought together and we should see the care of older people holistically rather than separating out this one tiny element which is believed to stand outside the health service.

WHITE
Well I've also been speaking to the Labour peer David Lipsey, who worked with you on the 1999 Royal Commission on Social Care. His views are rather different from those in your report.

LIPSEY
It can't be afforded, it spends money on the wrong thing and all the money it spends will go not to worst off people but to people who are rather better off than the average. It's not the principle in the sense that it would be absolutely delightful if we could afford to give free care to absolutely everybody, however, it's a question of making the best use of the money government has - free care is not the best use, more care, better care is.

WHITE
Presumably the Scots are entitled to say this is what we choose to do with that money?

LIPSEY
Well they are absolutely entitled to, though it does seem to me rather eccentric of English taxpayers to give this vast subvention to Scotland at the moment. I'm just sorry that the Scots have decided to spend their money on, what in my view, is a wrong priority and to spend it at a rate of knots which is going to put them into grave financial problems.

WHITE
So are you saying that even if this were possible now it's not sustainable in the future?

LIPSEY
There are more and more older people in more and more need of more and more care, the cost becomes more and more unaffordable. There is a complete political consensus in England, although there are differences as to what should be done, that free care is not the way forward, it is a dead policy south of the border.

WHITE
What about your views about the way in which the review was conducted and indeed by whom it was conducted?

LIPSEY
Well I think the Scots are extremely sensible to have a review, but not really to have one done by the inventor of the policy, anymore than they should have had one done by me to say how awful the policy was. They should have had somebody wholly independent who could come up with a fair and balanced way forward. As it is, not surprisingly, the man who invented the policy says it's a good thing - that doesn't get us anywhere.

WHITE
Lord Sutherland, now how do you react to that - particularly that final point, that you were reviewing your own idea?

SUTHERLAND
The Scots didn't say we've started this shall we continue with it - the Scots Parliament and the Scots Government said we like this policy, are there problems in it - which after five years should be reviewed - and what are these problems and can they be dealt with?

WHITE
Well what about his assertion that you need a money tree to run it? You have said that you do need to throw more money at it, it's 40 million in deficit at the moment isn't it?

SUTHERLAND
Yes, well let's put this in context. I've given you one set of figures where two and a half billion's already spent on older people's care, of which this is one-tenth. If you didn't spend this one-tenth under this head you'd have to spend practically all of it under another head. So that's point one. Let me give you another number. Two years ago the Treasury, much loved by David Lipsey, estimated that public sector pensions would cost £18.7 billion. Within two years they had to increase that by 2.7 billion in actual spend now. So there's a disproportion if you put that against - well it'll cost 40 million to put this policy on a strong foundation for the next five years - there's a disproportion in thinking here.

WHITE
Doesn't he have a point though when he says that maybe it's more appropriate, rather than providing free care to people who can afford it, to provide care to people who may need less care but can afford hardly anything at all?

SUTHERLAND
Well a. the Scots like this policy as a national policy. They are equalitarian and they like the same treatment for everyone. B. in the health service if you have smoked your lungs into a ruin you still get free care, whatever your income is. Why should that be the case that we select out, say, dementia and say you don't get free care for happening to suffer this, if that's the will of the people?

WHITE
Lord Sutherland. And although the green paper is dealing specifically with England, we're told the consultation is very much open to people from Scotland and that their comments, your comments, on how your system is working will be welcomed. If you want to have your say the Department of Health is planning a series of national events and a number of charities will be holding smaller local discussions. You can also submit your thoughts online, details to be found on our website. Or in writing, more information available by calling 0800 044 044. And of course the huge number of e-mails, letters, texts we received during our care month have been passed on and they'll be part of the evidence considered in the writing of the green paper.

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