The current system is not sustainable. If we were starting a care system from scratch, knowing now what we do about our ageing population and increasing care demands, we would never produce a system that is based more on cost than people's needs. There is a funding shortfall, with councils cutting care services as demand rises faster than available funds. All those involved in care are saying that the current system is not fit for purpose. We have participated involved in several groups urging the Government that this issue is urgent and reform cannot wait any longer. The more time spent on consultations, reviews and debates, the worse the situation becomes and the greater the impact on older people and their families.
The Treasury is wrong to believe that not implementing Dilnot-style reforms would save money
In reality, by not sorting out social care, we will probably spend even more money, but it will be in an unplanned way via the NHS instead of planned spending on care. Therefore, the Treasury does not have an option of 'saving' money on care. It is just a question of whether more spending comes in the least efficient and more expensive manner via the NHS, or the most efficient way via integrating health and care to look at the person as a whole.
Not reforming care will mean the NHS running out of resources
If care is not reformed, to help people understand what their responsibilities are and how to prepare for care needs, the demands on the NHS will rise and the spending overshoot could damage the UK's credit rating!
Political timing is such that the system is likely to reach breaking point before 2015
Therefore failure to introduce proper reform could become a defining electoral issue.
We need a system which prepares people for care
We do not have a system where people are preparing for care as part of their retirement plans. A partnership model, where individuals pay for some care and start to prepare for care needs once it is clear what they will get from the state. Dilnot would protect the lower middle classes. The message we get from older people is that they don't mind paying for some of their care but they don't want to lose everything. Means tested pensioner benefits is not the answer. Dilnot makes sense as a framework as it is specifically helping the lower -middle income groups who would have otherwise see their life savings wiped out by care costs. By having a higher means-test threshold, the less well off will not lose their entire house value.
Social care needs to be focused on outcomes - not on hours spent
A fundamental redesign of the care system is needed that is based on outcomes rather than the number of hours spent on care. Outcomes such as the wellbeing of the patient, whether they resulted in a hospital stay and the duration of their stay, recovery times and their ability to maintain an independent lifestyle would be good ways of measuring the effectiveness of social care.
Local Authority funding needs to be approached differently
Demand for care is increasing and yet the amount being spent on care appears to be falling. There is money in the care system that could be directed towards social care but we need to approach funding differently. Currently, funding for social care is held in Local Authority budgets and is not ring-fenced for care so may end up being spent elsewhere as councils manage their budgets. We need to approach care funding differently - health funding is considered at a national level and care should be no different.
We should consider removing the artificial distinction between 'health' and 'care'
The present system treats people who are 'not well' dramatically differently depending on how they are classified. If they have a 'health' need, they are assessed and receive the care they need, irrespective of cost in most cases. But if they are judged as having a 'care' need, they often receive no assessment and no money or the available money is rationed so that many needs are unmet. This is clearly unfair.
Integration of health and care services is key
Keeping 'health' and 'care' separate gets in the way of good care and is having a significant impact on many older people's quality of life. We've seen people receiving more expensive NHS care when social care could have met their needs. Every £1 spent on social care saves £4 in hospital care, integration, where we no longer look at 'health' and 'care' in silos, will ultimately help the save the NHS from the inevitable strain of the care demands of our ageing population. We appreciate this is a huge task and will take time but we need to get the ball rolling with this integration - perhaps starting with GPs.
We need to track how many people need care
It is currently very difficult to quantify how many people need care as there is nothing tracking the number of people who apply for the assessment for council care and are turned down or those who are told not to bother with the assessment. These people obviously have a care need and by monitoring this we could gain a better picture of care needs in the UK and we can signpost people more effectively - giving them information on things they can do themselves, where they could go for additional help and how the care system works so they can think through their next steps.
We need to change the narrative
Care is not just about old people - it is about families and loved ones. The current system focuses health spending on people's needs, but focuses care spending on 'tasks' and 'visits' or 'hours' and 'minutes' of care. if we were designing a new system to look after frail older people with long term conditions it would not look like this system at all.
New initiatives for carers are pointless without funding reform
Of course we'd like to see more focus on rights for carers to ensure they earn a well-deserved break, however there is no point promising these things until we address budget and funding issue. If the budgets for care are still held amongst Local Authority budgets then the money for these initiatives won't necessarily help those that need it.
Extracts of Saga's Director General giving evidence at the Health Select Committee can be read in full here.