I can announce that grant funding for social care will be increased by an additional £1 billion by the fourth year of the Spending Review.
And a further £1 billion for social care will be provided through the NHS to support joint working with councils – so that elderly people do not continue to fall through the crack between two systems.
That’s a total of £2 billion additional funding for social care to protect the most vulnerable.
Mr Speaker, we will also reform our social housing system.
For it is currently failing to address the needs of the country.
Over ten years, more than half a million social rented properties were lost.
Waiting lists have shot up.
Families have been unable to move.
And while a generation ago only one in ten families in social housing had no-one working, this had risen to one in three by 2008-09.
We will ensure that, in future, social housing is more flexible.
The terms for existing social tenants and their rent levels will remain unchanged, new tenants will be offered intermediate rents at around 80% of the market rent.
Alongside £4.4 billion of capital resources, this will enable us to build up to 150,000 new affordable homes over the next four years.
We will continue to improve the existing housing stock through the Decent Homes programme.
And we will reform the planning system so we put local people in charge, reduce burdens on builders and encourage more homes to be built, with a New Homes Bonus scheme.
Within an overall resource budget for the Department for Communities and Local Government that is being reduced to £1.1 billion over the period, priority will be given to protecting the Disabled Facilities Grants.
This will go alongside a £6 billion commitment over four years to the Supporting People programme, which provides help with housing costs for thousands of the most vulnerable people in our communities.
The full speech is here.
Most people say they are "frightened" by the prospect of going to a care home. This emerged in a recent opinion poll:
The ICM poll found:
· 40% of Britons fear being lonely in their old age
· Two thirds of the adult population are "frightened" by the prospect of having to move into a care home;
· More than 90% said they knew they could not survive on the state pension and would need to rely on savings
Although most people said they care well for older members of their own family, the poll found 55% do not believe older people in Britain are generally treated with respect.
I suspect this poll is reflects some pretty unpleasant truths:
1. People fear being in a care home which, by definition, is away from their home surroundings, takes away their independence and removes them from friends and/or family.
2. At the same time, most people decline to save their own parents from living in precisely the same kind of place that they themselves would fear to go.
3. In many cases this is simply selfishness but it is selfishness that is made to appear OK to the outside world because the welfare state has made it 'normal' for people to put their aged parents into homes. So it is now 'normal' to send old people where they fear to go.
4. The welfare state has, in effect, made it a kind of 'human right' to be looked after in your old age by people who do not know you and to take you away from all you know and love.
5. A way for caring for the old age that originally was probably a last resort has been changed into a first resort.
6. Middle aged people are relieved of the duty of looking after their parents. But then, of course, they find themselves old and find themselves in the same unpleasant position they put their parents in.
Of course it is true that some old people appear genuinely to wish not "to be a burden". But they are making a sacrifice in saying so. Becoming old surely does not mean one loses the desire to be with family or friends and familiar things.
I know of several people who died not long after being admitted to care homes. I wonder if anyone has done some research into whether life expectancy is reduced among those who enter care homes (comparing them, of course, with others of similar health and age). I suspect this is the case. I accept, too, that some people are quite happy in care homes and make friends. However I have been to some of what are said to be the best. They are, by their nature, pretty depressing places. People spend hours alone in their rooms, often slumped watching TV. Mealtimes can mean a group of very old people seated around a table in silence. Some places organise entertainments. Many good people do their best. But these are not genuinely happy places.
Care homes reveal our society being hypocritical and selfish. Vain, too. The poll showed that people like to think that they themselves are doing well by their parents. It is just 'others' who are letting their parents down.
The story in the Guardian is here.
Tom Utley, commmenting on Sir Derek Wanless' report in the Telegraph today, bravely puts forward a point of view on care for the elderly which is not often publicly expressed:
One of Sir Derek's ideas is that most means-testing should be abolished, so that many fewer pensioners will be forced to sell their homes in order to pay for their care. I understand the appeal of what he says, because means-testing punishes the thrifty and rewards the profligate.
But I am now going to make myself extremely unpopular by saying that I don't really see why pensioners shouldn't be expected to sell their homes in order to pay for their care in old age.
Many will argue that they have financed the NHS and the social services by paying their taxes throughout their working lives - and so why shouldn't they reap in their old age what they sowed during their youth?
The trouble is, of course, that most of today's pensioners did not sow nearly enough during their working lives to cover the costs of looking after them in their dotage. If only the NHS were a proper insurance-based service, as it was originally intended to be, then they would have a point. But it isn't - which is why we are in this mess.
There is, as we all know, a very much better way of looking after the elderly than simply shovelling money in the direction of strangers, in the hope that they will look after them.
I am thinking of the most effective social security system ever devised by man or nature. It is a system that still operates in most primitive societies, but one which is on the verge of collapse in modern Britain.
I mean, of course, the family.
In almost every way, I would much rather live here than in a mud-hut village in Africa.
But I reckon that the very old in the Third World, looked after by their families in communities bustling with life, have a much better time of it than a great many British OAPs, sitting around in care homes stinking of urine, watching afternoon television and counting the days or weeks until that rare visit from their young.
There is more on this in The Welfare State We're In in the chapter on pensions. The section starts on page 299 with Octavia Hill's comments on pensions to a Royal Commission the late 19th century.
There are several ways of dealing with that minority of the elderly who need prolonged special care in old age:
- care at home or in an institution, paid for out of savings, insurance, mortgaging the home (and getting an annuity) or (if going into a care home) selling the home.
- care by the family or paid for by the family.
- care at home or an institution paid for by other taxpayers.
The apparent attraction of the last one is undermined by several factors:
- people come to rely on it but then find that, like most services theoretically provided by the state, it is rationed and not always available to those that need it. (This results in elderly incapable people living dreadful, lonely lives at home. They sometimes effectively starve themselves. It is quite possible for them to break a bone and then be unable to get help, causing them to die in dreadful circumstances.)
- children come to think that their parents are the state's problem, not their own. Their way of thinking about the issue - and thus their behaviour - changes.
- people come to think it is not worth saving and amassing capital because it could all go on the cost of a care home and, if they have no capital, the state will pay for the care anyway. So why bother saving?
- some people are likely to cheat or else legally take measures to avoid paying for their own care. They will hide their assets or give them away so that their children get their money while the state pays for their care. Or, to be more accurate, other people will pay for the care of their parents.
Page 14 of "Social Care Needs and Outcomes - a background paper for the Wanless Social Care Review, July 2005", shows that no country (out of a wide selection) has fewer people over 65 in institutions and no country has fewer people receiving some kind of care in their homes. It would be lovely to imagine that this is because British people over 65 are so healthy. I am afraid that what the statistic really shows is that no country neglects its elderly as badly as Britain does.
There are many thousands of elderly people in Britain who are in their homes, alone and not really able to cope. They are receiving no help from anyone. There is state provision of care for the elderly in Britain. Therefore there is rationing of care. Many people who need it simply do not get it.
The link to this supporting material of the report is, if the technology serves, here. The table is on page 14.
How interesting and encouraging that the Derek Wanless report on care for the elderly has - on the whole - come out against the current high level of means-testing.
It is good to see resistance to the idea that there can be two people - one of whom spends everything through life while the other saves prudently for old age - who then find themselves in next door rooms in the same care home. The first gets care in old age at the expense of other taxpayers while the second pays for the same care out of savings. It is not fair and the fact of it discourages people from saving - which generally is a sensible and empowering thing to do.
No wonder that this is a King's Fund report and not a government one.
Mr Wanless previously wrote a report for Gordon Brown which helped the Chancellor justify a massive increase in spending on the NHS. But Mr Brown has also greatly increased means-testing - precisely what Mr Wanless is now implicitly criticising.
I was telephoned by Radio 2 this morning and asked my views on means-testing. I said I was against it because it discouraged work and saving. Pity, said the researcher. We have already got Niall Dixon of the King's Fund to oppose means-testing. We are looking for someone who is in favour of it. I don't envy her searching for such a person. Mr Brown is the greatest proponent of the idea (having been very much against it prior to being in government). Unfortunately Mr Brown will not be making himself available for debate on the issue.
One of the difficulties of the Wanless plan, from what I have seen of it so far, is that it involves co-payments between individuals and government. Having experienced for myself the bureaucratic nightmare of trying to get state help for the care of an elderly person, I fear that organising such co-payments would be the mother of all bureaucratic hells.
One alternative would be for people to take out insurance with one of a wide range of private companies, mutual societies, trade unions and so on. In an ideal world this would be voluntary. Given the realities of British democracy, it would probably have to be compulsory for any politician to get it through.
BBC News story on the subject here.
The King's Fund report and supporting material here.
Many people remain committed to the NHS, I believe, because they think "if I get seriously ill at any time in my life, I will be looked after and it will be free". In their hearts, they may think the care may not be great, but at least they will get some care and it will be free.
But this is simply not true. Last night on Panorama there were graphic portraits of people who had believed this. But then they had got severe Alzheimer's Disease or had endured disabling strokes or had been knocked down by a car and become totally paralysed. They were treated, for a while, as patients in NHS beds - for free. But then they were shunted out into private nursing homes and told that they would have to sell their homes and pay for their care.
In theory, the government pays for medical care by not for 'social care'. In the Coughlan case, the Appeal Court upheld this distinction and insisted that the government should pay for someone with medical problems. But the programme eloquently argued that, in practice, the NHS ignores the Coughlan judgement and in many cases goes to great lengths to categorise people as being in need of social care, rather than primarily medical care.
In other words, the NHS shuffles off responsibility for paying for people who have become totally dependant on the help of others. It says, "you pay for it, we won't".
The NHS - and the government as a whole - offer the myth that you will be looked after, for free, if you become disabled for the long term. For many people, it is simply not true.
The welfare state has created an insurance policy that does not provide what it claims. It is another welfare state mis-selling scandal. It would be better if the welfare state were honest about it from the start - if it said, "We will not provide. Take out proper insurance because this is not it. Rely on us and you could lose your home."
"We are an accident and emergency service. We don't do long-term care." But such honesty is not a part of the welfare state. Perhaps it is just not a part of democracy as it has developed in Britain in recent years.
One of the more telling clips in the film was a fresh-faced Tony Blair boldly declaring in 1997 that he did not want a Britain in which old people needing care had to sell their homes. Well, that is precisely what, after nine years of his rule, we have got. It was all blather and lies. It was aspirational and wholly misleading. The programme could have made a lot more of that if it had wanted to. It could have repeated that clip after every case of a disabled person whose home had been sold. It would, quite justifiably, have highlighted the chasm between what Mr Blair has said and what has actually happened. It would emphasise the failure of his administration in connection with the elderly.
I feel that the distinction between medical and social care is anyway absurd. If someone cannot look after himself or herself and needs a lot of help, that is the overriding fact. If you were buying an insurance policy against that eventuality of needing care, you would not choose a policy that only paid out if someone arbitrarily decided that your problems were primarily 'medical' not 'social'.
It was refreshing, incidentally, to have a serious BBC programme pointing out a gross deficiency in the welfare state and in the NHS as run by this government. It made a very welcome change from the regular failure of the BBC flagship Today programme to do anything of the sort.
Here are some of the cases highlighted by Panorama. The reporter was Vivian White who did an excellent job.
One of the evening fringe events I went to last night was about care for those who are dying. A Marie Curie nurse spoke impressively and movingly about caring for people dying of cancer. Apparently there are 2,000 of these Marie Curie nurses and it sounds as though they act very well in helping people die in their own home and helping the families to deal with this traumatic experience. The nurse was sensitive and sensible. It sounds like an excellent charity.
An important theme of the evening, coming from the other three speakers rather than the Marie Curie nurse, however, was about how the government should give more money to 'palliative' care for those who are dying. The Conservative spokesman on the subject, for example, said that his party wants the percentage of funding given to hospices to be raised from 35% of their expenditure to 40%. He said the hospices would not want 50% as it would endanger their independence.
I questioned whether raising the level of government was really a good idea.
It seemed to me that there was a series of related, possible drawbacks:
1. The more money that is given by the government to the hospices, the more the government will want to dictate how the money is spent, the nature of the care, the nature (and cost) of the training and how teh care is delivered. The more money given, the more the independence of the hospices could be undermined.
2. In consequence the morale of those within the hospice movement could be undermined. We have already seen how the morale of doctors and nurses in the NHS has been damaged. It would be a pity for the same to happen to those working in the hospice movement.
3. At present, those working in the hospice movement are universally admired and respected. They receive esteem which, I think it is fair to say, is greater than that received by those working in the NHS. They receive it partly because their work requires great qualities of character - patience, outstanding bravery and sensitivity for example. But they also receive admiration because people somehow understand that those working in hospices are working largely as an act of philanthropy. They are not just doing a job. These are charity workers with a powerful philanthropic drive.
The more the state may come to fund and dominate hospices, the more this huge respect could be endangered.
4. The more the government comes to dominate, the worse the service is likely to become. At present I suspect it is terrific. But if the government were in the driving seat, the same might happen to the quality of care as has happened to the quality of medical and social care in the NHS.
5. The more money given by the government, the less that charitable donors are likely to be willing to give. People like to feel, when they are giving money, that they are filling a vitally important human need. They don't like to feel they are just helping the government with its finances. The more the government is involved, the more people will feel the hospices are just part of government spending.
6. At first, the amount of care provided by hospices would probably be sustained or even improved by the deployment of government money. But we have already seen in other areas of the NHS that provision is at first increased only to be decreased later. This has happened in the provision of GP services, for example. Care for the elderly in their own home and provided by government falls well short of what is needed after much was promised. The number of care home places has actually fallen at a time when the number of elderly has increased. The same kind of thing could happen to the hospice movement.
A member of the audience who works professionally in this area of 'palliative care' said that the discussion about financing was about to become obsolete because the government was in the process of deciding, through its agency NICE, that hospice care is something that the NHS should finance. So it would become entirely a matter of government finance. I don't know how much truth there may be to what he suggested. It seemed to be news to the Tory spokesman on the subject.
In any case, I fear that the hospice movement - as an independent, excellent, admired charitable movement - may be under threat.
For the time being, however, I suspect it remains mostly funded by charitable donations and the hospices are, I expect, among the most worthwhile of charities to support.
The following comment on the government inspection of care homes seems worth putting up as a posting, too. I asked the author for a glossary of terms for those who are not familiar with all the organisations he refers to. They are at the end.
The government regulations are amazingly bad, cost a fortune to both care home owners and the public sector, and achieve nothing.
There are several problems.
(1) They are applied quite staggeringly inconsistently. Some hammer people for minor or invented infractions, some just ignore them. This tends to (IME) bias towards those run by the Public Sector. largely because the inspections are done by the former colleagues of the people in the public sector ; back scratching stuff.
It's a bit like Fire Regulations. With LEA schools the line has always been basically getting them up to scratch would cost an absolute fortune, so they are effectively exempted. Private Schools do not have this luxury. This seems to apply in NCSC/CSCI/CHAI as well.
(2) The Inspectors are laughably ignorant about the actual work, literally, I once had to leave the room because I had a fit of the giggles. It is tickbox mentality run riot. Because they have no clue, they focus on minutiae like how big the windows are, because they have no qualifications or experience to evaluate what is actually happening.
The comments in (1) still apply ; the application of tickboxes is variable to say the least. They write what they want.
(3) The standards have to be measured. This forces towards things which are quantifiable. Quality of Care, Happiness of Patients etc is not quantifiable. Forms and Records are. So they require more and more forms and records, which makes less time available for the job of actually caring. Inspection is usually about 70-80% looking at records and forms, and has been done without viewing any practice at all. This is like OFSTED inspecting a school without ever seeing a classroom or child.
(4) They can say and do what they like. The complaints route is all to them and their above levels, and they will ignore the ombudsman, basically. There is a tribunal, but the burden of proof is on the complainant, not on CSCI. A variation on OFSTED is you always get the same inspector, so if you make a complaint the same person will come back effectively wanting revenge. So no-one complains, though I know no-one who thinks any of them are competent.
(5) Like any quango, the main aim is to increase its reach, budget, areas of control. Much effort goes into this. There is a laughable punch up going on where I live between SSD & CSCI, which involves them refusing to invite each other to meetings etc. (for the benefit of the children, doubtless). This is because both want the power and money that comes with "child protection"
(6) Because they don't have to pay for anything, the requirements extend endlessly as a back covering exercise. It is always in their interest to demand more staff, more targets, more forms, more systems. This increases costs, which most users cannot afford and SSDs will not pay. So care home owners sell up and quit, or they focus purely on meeting the targets. You get the impression that as long as the forms are okay they don't care about what is actually happening.
The worst cost increase is staffing. They are demanding minimum levels of staff training, which is fine, except someone has to pay for it at some time. Care Homes are run to some extent on cheap employees to do mundane jobs. Having everyone at NVQ3 (another rule ignored for public care homes and schools) racks up employment costs spectacularly, let alone training costs. At the same time, they want more staff (except for Local Authority provision).
(7) As a carry-on from (1), LAs are dodging the targets by redefining care homes as "rented accommodation with 24-hour support". This way most of the regulations don't apply. So they dodge them (something Private orgs aren't allowed to do), even though the practice is identical. To be fair, there's nothing actually wrong with the homes, they just don't tick the boxes.
(8) It repeatedly reorganises at great expense. Originally it was done by SSD. Then they all went to work for NCSC (late 2002). Two weeks after NCSC started, they were told they would be converted to CSCI and CHAI (early 2004). Now they are going to be OFSTED and CHAI. Imagine the money wasted !
IME : In my experience
LEA : Local Education Authority ; run public sector schools, pretty
badly. It's worse than you can possibly imagine.
SSD : Local Authority Social Services Departments ; roughly
divided into "Children & Families" and "Adult" divisions, though they
are trying to combine this back and add control over education. Yet
another bureaucratic turf war. Also responsible for Child Protection,
but are squabbling with CSCI over this at the moment. Both sides want
DfES : Department for Education and Science. *Also* squabbling for power with NCSC/CSCI/CHAI, over who has control of Residential Mainstream and Special Schooling.
NCSC : National Care Standards Commission, monitoring Residential
Accommodation, Hospitals, Fostering, OAP Care, Residential Schools,
Sheltered Housing and all sorts of other similar stuff. Typical Blairism Monitoring and Targets organisation. Basically a "OFSTED for Care Provision".
Later (announced 2 weeks after opening !) split into :-
CHAI : Commission for Healthcare Improvement
CSCI : Commission for Social Care Improvement
Which does the same thing. Not quite sure where the split is. I think
CHAI does Hospitals, CSCI does the rest but wouldn't swear to it. I
*think* that CSCI are going to be subsumed into OFSTED, this is one of
Gordo's red tape reductions. I'd bet my life savings the same people
will be doing the same jobs .... it's a joke.
Incidentally, as far as I can tell despite all these switches the same
people (literally) do the same jobs in the same way, they just change
the name and bring out masses of new initiatives and reprint all the
OFSTED : Office for Standards in Education. Quango for schools
NVQ : National Vocational Qualification.
Part of a Help the Aged report, quoted on BBC Online.
Older people who die in hospital often endure their final days in dirty and noisy wards, where busy medical and nursing staff can devote little attention to them
How are the elderly treated in different countries and in Britain in particular? There is an interesting selection of letters in The Times today which raises a lot of the big issues in a short space. Does government involvement do more harm than good? How much damage to provision has been done by government regulations? Should people be looking after their aged parents themselves? Is it better for the elderly to be in their own homes, rather than in a care home (the cost is not very much greater)? Here is one of the letters:
MY 98-year-old grandmother has been in residential care since a fall in September left her unable to care for herself. The care home is under-staffed and under-resourced. The food is awful and there is real lack of warmth. She cannot walk and has been given a room two floors up, so is forced to sit all day in a lounge with others or be left in her room alone as there is not the staff to move her. It makes me very sad and angry that her life has come to this.
I looked at several other homes during her initial 12 weeks. I was appalled: many were dirty, smelt awful and the patients were left to sit and stare into space. We have more compassion for animals in this country than our elderly. If I could have had her living with me, then that is what I would have done rather than subject her to this.
My dad is also in a nursing home; at just 56 he had diagnosed a degenerative brain disease. Thankfully his experience has been better and the home is wonderful. The catch is that he is 35 miles away in Milton Keynes, as that was the nearest place that could care for him.