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Social Care Green Paper and the inner workings of a think-tank

July 14, 2009

The Government will publish a Social Care Green Paper today.   We have long been calling for radical reform of the social care system and have lobbied the Government heavily in the lead up to the Green Paper.    With only 10 months at most before the next election this Green Paper will not be turned into legislation in the near future, but what it can do is help move the debate forward.   Later on today the LGiU will publish an initial response to the Green Paper.  I know that some organisations will have written their response already, which frankly makes for boring copy that is unlikely to get much notice.  At the LGiU we prepare for these kind of major publications by thinking through some key tests.     This is our internal paper, it is rough and ready, but may interest others in local government ahead of the publication:

Social care and support green paper pre publication note

The current system is dysfunctional, is perceived to be unfair, inefficient, lacks incentives, makes those ineligible invisible….and underfunded – the Green Paper has to confront its failings and provide robust options for radical reform.

What are the tests the Green Paper needs to pass?

• sustainability – has to be a lasting settlement ‘a dependable contract across generations’, a sustainable political settlement
• fair – between individual and taxpayer, between generations, between people – support shouldn’t depend on where you live – the system now is the ultimate postcode lottery – your council is funded well and you get support, you move to next door underfunded council, and you lose it – not about local discretion
• flexible – centred around the individual, responds to individual’s circumstances,
• understandable and transparent – the opposite of what it is now
• a system that works – focus funding to avoid crisis, not funding for crisis, builds on contribution of users and carers – understands what people want and need and how they can be positively involved in meeting needs
• a system that is accountable, democratic and devolved
• person-centred – with infrastructure that supports personalisation and services based on the values of independent living

Funding

• we have stressed that responsibility for ‘paying’ for the system should be a partnership between individuals, families, the government and the community but it is also about rebuilding social networks and developing community capacity, promoting, recognising and rewarding the contribution from carers, families, neighbours, communities and older people themselves
• need to use existing resources better, shift from acute to prevention, bring resources together across public sector, make better use of private assets
• We have said over and over again that social care has been the cinderella service compared to health. Constraints in public spending may define context but can’t determine solutions – social care has been massively underfunded – the Green Paper has to find ways of getting more money into the system. Look at the difference in funding over last 10 years between health and social care. In health there has been major redistribution of resources and a shift from acute to community services. This requires political courage. The Green Paper should address how we can measure, value and incentivise prevention?

Universality

• LGiU have proposed an element of universal provision – particularly stressing rights to advice, information and advocacy – has to be an entitlement that is enforceable or it’s meaningless
• We call for a national debate on a universal outcomes framework covering all services in a locality – this should cover everyone, not just those receiving care support
• a system focused on prevention should entitle everyone to support for independent living – may be temporary grants, low level care?

National and local debate

Does the green paper get the balance right between national direction and local discretion?

The main issue here will most likely be around eligibility for support and allocating resources. We think people should be entitled to a consistent system of assessment (for home and residential care) wherever they live, and that if their needs meet defined criteria, they should get support. Then it is up to councils to decide with them what form that support should take – how resources are allocated at the local level will be decided by the council through each council’s interpretation of a national allocation system, tailored to meet local needs and markets.

If all service users are to have a personal budget, it has to be transferable between councils.

We think this is what the green paper will say, If this is what the government wants they have to underpin it with a funding system that allows it to happen.

Democratic accountability and local authorities in the lead

Does the green paper offer options that enhance accountability – what is it saying about commissioning locally – our report ‘Never too late for living’ made the case for local government led commissioning and transfer of funding:

• transfer NHS funding into LAAs where councils can demonstrate it saves money by preventing hospital admissions, residential care etc
• identify what money is spent locally on supporting people in later life and use Sustainable Communities Act to divert funding (and now total place ideas)
• staged process of integration, from pooled budgets to piloting local authority led merged commissioning

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