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THE ATTACHED TRANSCRIPT WAS TYPED FROM A RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT. BECAUSE OF THE RISK OF MISHEARING AND THE DIFFICULTY IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS COMPLETE ACCURACY.

TX: 01.11.11 - Call You and Yours
PRESENTER: JULIAN WORRICKER


Worricker

Hello, good afternoon. Today your chance to shape future policy on adult social care in England. The Commons Health Select Committee is in the middle of an inquiry into this key policy area, following the publication of the Dilnot Report in the summer. It's taken written evidence, now it's considering oral evidence, all with a view to influencing the contents of a government white paper which will be published next spring.


Today the chairman of the Health Select Committee, Stephen Dorrell, is here, if you speak to him today, we've been told by a spokesperson for his committee, that you can directly contribute to his inquiry on the record and have a direct influence on the course of the inquiry. Early oral evidence, we're told, often informs questioning at later sessions. So get in touch with your current experiences of adult social care. How do you find the system now? What sort of care do you or does your loved one need? How are you funding it? As the programme unfolds we'll hopefully build up a picture of care provision in different parts of England but we'd also like to hear from other parts of the UK as experiences there can clearly inform the debate.
03700 100 444 is the phone number, a call will cost you the same as dialling an 01 or an 02 number. You can e-mail via bbc.co.uk/radio4/youandyours or you can text to 84844 and if you do that you'll be charged your standard message rate and we may call you back on that number.
Before we hear from Mr Dorrell I'm going to take a couple of calls just to sort of set the tone for some of the concerns that you're wanting to air over the next hour. Elisabeth Bolton is in London, Elisabeth, good afternoon.
Bolton

Hello.
Worricker

What's your position here?
Bolton

Well my mother had dementia and in 1999 this necessitated her move to a nursing home where she was well cared for until she died four years later. I had to sell her bungalow to fund the fees and if I can make a small point - I was able to sell it but I don't think people in the same position as me now find it that easy to sell houses quickly and I was able to invest and get a rate of interest, which now, of course, you're getting zilch. But one of my gripes is the very low level of assets at which people in England have to pay for all their own care. When my mother was alive I think it was about £17,000, now it's about £23,000. And I compare that with the sort of fees that Tony Blair charges for one of his speeches - would he get out of bed for £23,000? I don't think so. And so politicians who are making the decisions that affect us are living in a totally different world - £23,000 total assets is not a great deal. From what I've read of what Dilnot is proposing I think he says that you wouldn't be stuffed for more than £36,000 altogether. So I think he recognises this particular grievance.


Worricker

Well his recommendation on that was that the means tested threshold above which people are liable for their full care costs should be increased from £23,250, the figure you refer to, to £100,000.


Bolton

Yes and that seems to me a step in the right direction. So that is one thing. Another point which angered me is that you are paying these fees yourself out of net income. In some circumstances, particularly if you're in some freelance professions, you can set your expenses against your income but you can't set the cost of getting your bottom wiped against tax. Before I sold my mother's bungalow her income did not reach that cut off point at which you start to lose the age related higher personal tax allowance. And when I sold the bungalow and invested the proceeds yes it pushed it above that limit. So she lost that allowance. Her effective tax rate soared. And if you're having to spend every halfpenny of your income or even dig into your capital to pay for your care your effective tax rate is about 100% which is very high indeed.


Worricker

Elisabeth thank you very much for kicking us off. I want to take two more calls before I bring in Stephen Dorrell and a brief conversation as well with our reporter Carolyn Atkinson who of course specialises in this area. David Scott in Kent. David, good afternoon.


Scott

Good afternoon.


Worricker

Your experience here.


Scott

Yes my mother's similar situation that she and her late husband sold her house a number of years ago. They'd saved all their life, they'd worked all their lives and now faces - my mother faces care costs of around £36,000 a year and that's rapidly going through her money - she'll go below the £23,000 in just a few months' time, taking her from 100% dependence to 100% dependent on the state. There should be some form of graduation so that she can actually support as she goes this. And we're also left in the situation that we really do not know what the government or local authority will actually support when she gets below the £23,000 so we've had to set up various things now, not knowing what will happen in a few months' time and there seems to be no way of actually getting people to commit until she's below that level.


Worricker

So there's two aspects to this really: There's partly the funding issue but also this business of not knowing enough about future care provision from those who are providing it.


Scott

And also a disposable income, at the moment she has all the normal living costs of running the house and her neighbours - some of her neighbours for instance have always lived on state benefits etc., and they have much higher disposable income, in effect, than my mother has which just doesn't seem to be fair.


Worricker

David, thank you and one more before we talk to Stephen Dorrell. Vicky Raphael in Cambridge. Vicky, good afternoon.


Raphael

Good afternoon.


Worricker

Your point here.


Raphael

I'm a family carer of a young man with learning disabilities, very severe learning disabilities so I've been a lifelong family carer for the last 25 years and I'm now 60. And I find myself in the situation where I totally agree with the Dilnot Report which says that at this point in time we're not looking forward with enough clarity and planning with enough clarity and that actually we're starting from a deficit situation where there isn't enough money in the pot. My son needs total care - 24 hour care - so he needs people with him the whole time, he has very complex epilepsy and needs support in every aspect of his life, so I'm talking about a high level of care. But since April 1st a cap to my budget has meant that I'm now providing more care. As a person who probably should be retiring and now I'm supporting my son for 114 hours minimum a week, day and night. I think this is unsustainable. Now if you put this in the context of many, many other family carers, because I am one of many, and a large number of people with complex needs live at home with their families, so this impacts upon the health and social care of the whole family. So looking forward we've got issues of families who've got older people who are caring for younger people with learning disabilities who themselves are becoming part of the social care scene. It seems to me that the word time bomb is probably a useful descriptor of the situation people are in.


Worricker

And just to clarify your situation because you talked about a cut in your budget, explain where that cut has come from, what's driven that?


Raphael

This is to do with more charges for services up front, this is to do with eligibility criteria which is supposed to not have changed which are being used to sort of manipulate people's situations.


Worricker

And just to clarify that aspect of this because this is quite a confusing area isn't it. There are four different eligibility criteria in terms of need...


Raphael

Yes low, moderate, substantial and critical.


Worricker

Indeed and each local authority will interpret those four in a slightly different way.


Raphael

They will and a problem that impacts on that is the fact that community care law, which is what this is all about, is much more hard to challenge these days because of the changes to legal aid, it's very difficult for vulnerable people to get access to advocacy and legal support to challenge decisions of which I think there will be many challenges.


Worricker

Thank you very much for calling Vicky. 03700 100 444, the phone number. I mentioned that Carolyn Atkinson is in our phone-in room hearing and reading more of your comments throughout the programme but she is our reporter who specialises in this particular area so perhaps Carolyn a brief word from you as to how we got to this point and also the Dilnot Commission, about which we have heard something already, a little explainer on that too.


Atkinson

Yeah, well one of the first things the coalition government did was to appoint an independent commission to look at the funding of adult social care in England. It was headed up by the economist Andrew Dilnot and in July of this year it published the Dilnot Report and that's what is the key thing and that's going to go forward. Now in terms of what social care is - social care is the care that's given to people who can't look after themselves, it's things like getting up, it's getting washed, dressed, making meals, getting out and about. Many people get quite a big shock because they think that social care is free, like NHS healthcare, but it's not. Social care is means tested and a council can assess people in terms of their need - and we've just been hearing there those four levels of need - and then separately in terms of their finances. And it could well be that someone who's assessed as needing care but then they fail the means test and they don't qualify, they're then on their own and they're often known as self-funders but in fact in reality many people - many of those self-funders - don't or can't self-fund and then they go without care altogether.


Worricker

So the Dilnot Commission specifically Carolyn what's it recommending?


Atkinson

Well they are talking about a cap on what an individual should pay. They think that should be somewhere between £25 and £50,000 over a lifetime and they basically have plumped for the figure of £35,000. And they say that is what you should pay over a lifetime and then that it is, the government picks up the bill after that. The commission also thinks that anyone who needs care before they're 18 shouldn't have to pay anything throughout their lives, they've got no way of sort of gathering the money and the finances to do that. And equally people who need care before they're 40 they also think that they should not need to pay anything. So the government would pick up the bill after people who can afford it have paid the first £35,000 and that bill would be about £1.7 billion a year, that's the tricky bit, that's what everyone's chewing over at the moment. The report also recommends having national eligibility criteria instead of varying by councils. And it also wants a system of portability, so if you're living in one part of the country and you want to move to another instead of starting all over from scratch when you need a care package then you can actually just take what you've got and go with it. And finally the other key recommendation is that the means tested threshold, which was mentioned earlier by one of the callers, of £23,000 should increase to £100,000.


Worricker

We can hear that it's a busy phone-in room behind you. This is all about England at this point but what's the situation in Scotland, Wales and Northern Ireland?


Atkinson

Yeah this is about England but basically social care legislation generally applies to England and Wales, Wales is currently very similar to England, personal care there is means tested and Wales just published a 10 year vision for social care earlier this year and it looks at, amongst other things, rather like Dilnot, ending the postcode lottery. In Northern Ireland things are little different, the health and social care services are regionally integrated, which we don't have in England at the moment, but a recent report there warns the current system of free non-means tested home care is pretty impossible to sustain unless funding increases. And Scotland, we hear a lot about free personal care at home, we always get e-mails from people saying it isn't the case and that there is rationing and that is the case. And also what constitutes personal care is different from England, there's widespread criticism of this system at the moment though saying it's unsustainable.


Worricker

Carolyn, thank you. 03700 100 444 the phone number. E-mails via the Radio 4 website. Stephen Dorrell welcome.


Dorrell

Thank you very much.


Worricker

Thank you for coming in. I was reading a quote from you: There are few more important issues in health and social care policy than how we pay for adult social care. So this is one of the most important issues facing the coalition government isn't it?


Dorrell

That's exactly right. It's one of the issues that successive governments over a long period have recognised is key to the delivery of high quality services for adults and in particular elderly people. Successive governments have frankly refused the fence. I don't think it's any longer sustainable to refuse the fence, I'm delighted the coalition set up the Dilnot Commission. We've got a set of recommendations, we now need to work out precisely what we do about this because as your callers are identifying problems which are well known and now need to be solved.


Worricker

What do you most want to hear today?


Dorrell

What I think I'd be interested in hearing is some of the stories that we've already heard around the funding of social care and the issues that that presents. I think the key here is finding ways of getting more integrated care so that you don't, as somebody using these services, go from one part of the system to another. So often we're told that an individual comes into the social care world for the first time, their family comes into it for the first time, they don't know what's available, they don't know how to find care and support that meets their needs. And even when they do find it one bit of the system doesn't talk to another. And so what I think the key to policy is certainly to find ways of funding it on a fairer basis, as we've already discussed, but also to ensure that whether you're meeting the GP, the social service department, the social housing department, that these different parts of the system work in a more integrated and more coherent way - joined up government used to be the slogan, it was much talked about, it's about time we did that too.


Worricker

And as you hear from callers today how much influence will they realistically have on what you're doing at the moment?


Dorrell

Well as you said in your introduction the staff of the committee are listening to this programme. It is in a sense a form of evidence session of the select committee. We haven't got a public session going on this morning, as we normally would have on a Tuesday morning, partly because I'm on this programme and the staff of the committee are listening to the views expressed as part of this inquiry into the future of social care.


Worricker

So are there things, for example, that you've already picked out from the first three callers that you think you really now need to go back and have a closer look at some of the issues they've raised?


Dorrell

Well I think I've touched on the points of funding. I think the point I'd add into that and the contributions we've heard about funding is that yes there does have to be a fairer deal for the individual. There also has to be a clear message - and this is changing people's perceptions - that against the background of this fairer deal families - it ought to be easier for families to plan to meet this obligation and that's part of the key message of Dilnot, that yes there has to be tax - more taxpayer funding in here but it should be a deal between the individual and the taxpayer that those who can afford to plan against this possibility should do so from within their means when they're earning. The other theme I'd pick up from the contributions we've already heard is the important role played by family carers in all adult social care contexts and how we can provide proper support to carers, so that they're not left isolated doing things that they didn't choose to do but they do because they love their loved ones but they often feel that they're undervalued and the system doesn't recognise the essential contribution that they make.


Worricker

We'll hear individual stories as well obviously throughout the next three quarters of an hour or so but also from various organisations who have a particular interest in what's going to emerge from all this. Tony Robinson, actor, historian, ambassador for the Alzheimer's Society, is on the line. Tony, good afternoon.


Robinson

Good afternoon.


Worricker

If you could come to this committee and put forward your wishes what would they be?


Robinson

Well I think I would be very sympathetic with what Stephen was saying. The problem is - and this problem has reared its ugly head time and time again - chairs of health select committee almost always feel the way that Stephen does, as indeed do cabinet ministers who represent health, the issue is not really with them though, it's with the Prime Minister and it's with the Treasury. So I think if I went to the health select committee I'd say well I know you'll agree with me anyway, can we go and see the Prime Minister and the Treasury together and get them on side because I think that is the big political necessity.


Worricker

Stephen Dorrell, that's true isn't it?


Dorrell

Well I think, if I may say so, that the Prime Minister's put himself firmly onside for the proposition that this is an issue that can't be ducked any longer and has to be addressed, that's why Dilnot was set up. But Tony is quite right to say that putting recommendations on the table is not the same thing as actioning those recommendations and I think it is clear that what Dilnot was proposing does involve more money from the Treasury. What the - the deal that has to be offered to the Treasury, as I was seeking to argue, is that there needs to be more public money to support a fairer deal for individuals but the other part of that deal has to be that there's proper arrangements made to allow people to plan to make their contribution to this as well.


Worricker

Tony, do you want to come back on that?


Robinson

Yes I think that's fair enough, I think there are a number of other questions which do need to be addressed alongside that. One of which is how can we get access to care far earlier than is happening at present? Often people are having to wait inordinate amount of time - an inordinate amount of time for things which ought to be part of their basic human rights like attending to their washing and their dressing and going to the toilet. How can we ensure that we get high quality care for people with long term conditions? How can we ensure that the care that's out there is easily understood? And probably, most importantly, how can we reduce the catastrophic costs that are faced by people particularly with dementia and others because there is, as Stephen I hope will agree, something which we call the dementia tax - people with dementia have so many problems springing straight from that dementia, clearly straight from that dementia, which if they had other illnesses might well be addressed by social care provision which they simply don't get when they've got dementia.


Worricker

Tony, can you stay there for a moment because we've got a caller who wants to talk about dementia as well. Annie Rumble is in Carmarthen. Annie, good afternoon.


Rumble

Hello.
Worricker

You've just heard Tony Robinson, thoughts on what he said and how it compares with your situation perhaps?
Rumble

Well I didn't hear much of it because I've had the radio turned off in case you phoned. But the situation with us is that my mother has vascular dementia, she's had several strokes and TIAs, she's 88 years old now, she can do pretty nothing for herself - she can't make a cup of tea or wash or dress herself. So I've given up work - I had a very good job with a bank, enjoyed my work very much - gave up my job to care for her. Currently I get £55 a week carers' allowance, which stops if she goes into hospital for more than two weeks. And attendance allowance of £77 a week, which also stops. And also my national insurance contributions are discounted when mum's in hospital for any period of time. But that's one point, but the main point I wanted to make was that my mother worked from the age of 14, she - I can never recall my mother having a day off sick - she worked and she saved. She paid her tax on her earnings and she paid tax again on her savings, she cared for my father who was a war hero, who sadly died quite young, and then she cared for my step-father who was also a war hero. So this woman had grafted all her life. When she left work, because she had to at 61, she took a job in an old people's home. So this is not somebody who has scrounged off the state - she's worked, she's paid her taxes, she paid twice.


Worricker

Stephen Dorrell, there are quite a lot of correspondence to that effect, that those who save, who've done the right things, are currently penalised by the system.


Dorrell

I agree with that and that's precisely why I think there needs to be this new deal which is what Dilnot is talking about. I would love to be able - of course if we had a money tree it would be wonderful to be able to say well we can solve all the money problems but life's more complicated than that. What's unfair about the system at the moment is that the burden falls disproportionately on those who have been prudent during their lives. And what's needed is a new deal which recognises that but which at the same time makes it easier for people to save and to plan for the care needs that a minority of us, but an important minority of us, are going to need late in life.


Worricker

Tony Robinson, back to you on the first point you raised, when you outlined I think it was three different things that you were keen to see change. You talked about the access to care and the fact that it should happen far earlier, what is blocking that system at the moment, what is getting in the way?


Robinson

It seems to be a whole host of different things. I've not got first-hand experience of it, what I've got is two A4 boxes full of letters from other people who are expressing their enormous frustration, really rather in the way that the previous caller did, at not being able to have the appropriate care because they're not allowed to for some reason or other and even when they are allowed to there is something within the system which is dragging it down, preventing that care from being delivered.


Worricker

And because the system is so complicated you can't necessarily identify what that block is?


Robinson

Absolutely, absolutely yeah. I mean my heart warmed to that previous caller who said so articulately what I believe to be the case which is that the way we treat our infirm elderly now is the biggest blot, I believe, on the landscape of Britain as a caring society that there is. I think that we'll look back on how we treat the elderly now in 150 years' time and won't believe the disregard for the elderly that is built in to our society. And I'm very glad that everybody seems to be speaking with the same voice now, saying it must stop. But my enormous concern is that local authorities, large organisations, the NHS, politicians will all say well yes that's true but we're going to have delay yet again because of the financial situation. I don't believe that is justified, this is cruelty - I use that word not lightly - on such a large scale and I think it has to be addressed right now.


Worricker

Stephen Dorrell.


Dorrell

The key point you made I think Tony and which I wholeheartedly 100% agree with is the need to ensure that the system identifies cases early because that's the way you deliver high quality care, and you intervene in a case when you're still able to help, it's a better outcome from the point of the individual. But the other point that is so often lost in this debate is that it's also ironically the more efficient way of doing it because if you don't - if you miss the opportunity to help someone with a relatively - when their needs are relatively minor what you end up with is somebody with an acute need which is much, much more expensive because they end up in hospital when they don't need to be, 30% of admissions, non-urgent admissions, non-emergency admissions into hospital are avoidable, they end up in hospital when they don't need to be so that's both expensive and bad quality from that individual's point of view. And it's rethinking the way these services are delivered to respond to those needs in a timely and preventative manner, that's how you can deliver some of the quality improvement that I think you're looking for.


Worricker

I just...


Robinson

It's also vitally important for the carers of course, if, as has happened to me and my mother, we weren't aware of what the situation really was till my dad had really got quite advanced dementia, you don't know who you can go to for support, you don't know what you're supposed to do, you don't know what's out there, you don't know anything. At least if there's early identification and early support it gives the carers that space to build a life for themselves and give them the strength to help doing the caring that virtually all of them really want to do.


Worricker

Tony, thank you very much for joining the discussion. There was just a text message a moment ago, Stephen Dorrell, from somebody saying that their situation was complex or too complex to actually address a question or a suggestion in the form of a text, is there an address I can write to the government representative regarding my views - how do people get in touch after today?


Dorrell

The simple way of doing it is to write to Stephen Dorrell at the House of Commons, London SW1 OAA - 1A OAA.


Worricker

1A OAA. I want to squeeze one more call in before we hear about the World at One. Moira Jennings in Surrey. Moira.


Jennings

Hello to you, yes, I'll try to be brief because I think a great many of the callers have expressed my own thoughts and views on it. The only thing I'd - two things I've very rarely heard voiced. One is that - and I understand from an article in the Telegraph recently - less than 1% of those in residential care fund for their care through what's called an immediate care annuity, now this is a very tax efficient method of dealing with it. The monies are paid to the care providers in the residential home and by doing it that way it's tax free whereas if it's paid to the individual it's taxed as taxable income. Generally speaking, and it's obviously the annuity's subject to the medical condition of the individual but generally speaking I speak from experience because I'm a retired independent financial planner and I've set up a great many immediate care annuities for clients and I do actually schedule it to show that compared to their residential care costs how much it's going to cost through 10 or 15 or whatever years the actual immediate care annuity usually will actually have given a return for the money within four to five years and after that the money is still paid but all of the money used to purchase it has been used up.


Worricker

I suppose the point to make about that is inevitably that can apply for some people, those who can afford to save to fund the annuity in the first place, but it clearly can't apply to everybody.


Jennings

No I fully understand that and I also have another perspective on it because my mother developed senile dementia in the late '80s, eventually she had to go into residential care, even though it would have been much cheaper for her to have had a great deal of help at home, particularly as my Down's Syndrome sister was living her. So that obviously added huge pressures to all of us. Eventually money, because she had absolutely no money, she had no money at all, she was paid for and she spent her life in a very good residential home. And then my sister eventually was transferred there as well and she's in fact still there now. She has epilepsy and her situation [indistinct word], she's 65 and this has all been funded by the state. And I agree with that for those people who don't have enough money to do themselves. However, all of - myself and my siblings included - have despite very tough backgrounds come through tremendously well - we own our own properties - now I'm more than happy that a proportion of the value of my property is used to fund my own residential care and I tend to feel that those people who have sufficient funds should do likewise.


Worricker

Which goes back to that point that we were discussing earlier on about those who can planning for what might lie ahead. I'm just going to give out the phone number again - 03700 100 444. E-mails via the Radio 4 website. More from Stephen Dorrell in the next half hour after we've heard about the World at One.


Maggie Humphreys on the phone from Shropshire, Maggie good afternoon.
Humphreys

Hello.
Worricker

What point would you like to make here?
Humphreys

I'd like to say that my mother had to sell her - I had to sell her house, I had power of attorney and the whole of her - the income from the house went on her care home. She was - had dementia, she was like - I loved her dearly, I couldn't have had a nicer mother but she was not my mother anymore, she was incontinent, she couldn't speak. And the whole of the money from the sale of her house went on her care, which lasted five years. And then my brother and I had to top it up with our money and I don't have a pension like other people, except the old age pension, and I realise that there's going to be a terrible problem in the future with people like me and the bulge. I'm 68 now and I think that if I was - I saw Terry Pratchett's programme about Dignitas in Switzerland and how some people go out there, now you'd need to be quite wealthy to do that and I think that something should be set up here.


Worricker

Your reference to the bulge, just to put that in some sort of context, I was looking at some figures on that this morning - over the next 20 years the numbers needing care are predicted to rise from just under six million to seven and a half million.


Humphreys

It's just crazy and especially as there's a recession and there is no money, what is going to happen to these people, it's going to be dreadful. I've told my daughter I'm going to commit suicide but as I said to somebody else on your programme just before, how do I do it? If I jump in front of a train it's not fair on the train driver. Do I take hundreds of tablets? Where do I get those from and somebody might find me and then my kidneys and liver will be damaged.


Worricker

Forgive me Maggie if I don't take the debate too far down that road on this particular programme but I did want to bring Stephen Dorrell in on the wider point that you were making, particularly about this idea that there are people at the moment having to sell property to fund their care. Andrew Dilnot has said: The Commission believes this would mean that no one - the measures he's describing - no one ends up losing more than 30% of their assets in care costs. Are you sympathetic to that?


Dorrell

I am certainly sympathetic to it because the system has been - as has been clear in the whole of this conversation - outside Scotland the system expects those who are able to make a contribution to care costs to do so but it makes no arrangements at all to encourage them to plan to meet that obligation. And what the whole of Dilnot is about and certainly the select committee inquiry is looking at is ways of making it easier for people to plan to meet these obligations which are coming their way. That's partly about financial planning, it's also, as we've been saying, about being able to find your way round the system and to ensure that the care that is available can be accessed in a timely way in order that it can meet the objective, the quality objectives, we would all have of it.


Worricker

There is a role there potentially as well for the insurance industry isn't there?


Dorrell

Absolutely there's a role for the insurance industry and that's why I describe it as a new deal. The Dilnot recommendation is - would cost the taxpayer £1.7 billion but part of the argument for that new expenditure is that if that amount of money is provided by the taxpayer it's then possible with support from the insurance industry to unlock new money into this sector because against the background of growing demand that you describe, where the relevant population is rising, even to meet today's inadequate standards is going to cost very substantially more money. Now some of that, Dilnot proposes, comes from the taxpayer but the deal is that the £1.7 billion comes from the taxpayer and more can come from individuals because there's a proper structure that allows individuals to plan to meet that obligation.


Worricker

Although with the insurance industry I was reading fears expressed by some this morning that insurance companies might end up effectively acting as commissioners and therefore it would be in their best interests to steer people towards the cheapest option which is not necessarily the most appropriate option in terms of a care package I mean.


Dorrell

But that's exactly why there has to be a proper brokerage, signposting, commissioning, whatever word you want to use to ensure that as families encounter the need for care there's a proper system in place to allow them to understand what is available, what can help their loved one in the circumstances in which they find themselves and how to deliver it in a way that meets the particular circumstances of the family. So often this is all characterised as a kind of formula and that's one of the things in the committee we're looking at, is how these national criteria are going to work because the danger is that you end up trying to put an individual in a set of family circumstances into square zs21 on some matrix and that's not, in my view, the way you deliver care that responds in a sensitive way to a particular family's circumstances.


Worricker

I think that leads us nicely to our next caller, this idea of a national eligibility criteria, also this idea of the portability of a care package. Denise Arnold in London, good afternoon.


Arnold

Good afternoon. What happened to me was I have a friend whose mother, 96, lived in county A, the situation in that family set up broke down so she moved to county B, where she was born and bred. That didn't work either, she stayed a week with family who couldn't cope with her needs, so she bought herself into a care home, the only one that had space available, and she was paying £90 a day out of her own money. She had 20 grand in the bank so she thought it would work for a few weeks and thought we could just apply for a place in a home for her. She was in, however, county C by this time. County A wouldn't fund anything because she'd moved; county B wouldn't fund anything because she wasn't there; County C wouldn't fund anything because she wasn't from there. It took us a lot of meetings and a lot of phone calls to get it finally sorted and she spent £13,000 of her own money.


Worricker

How do you reflect on that now?


Arnold

Well I think it's a disgrace. She also was very, very stressed while all these meetings took place because during the meetings instead of looking at her care needs and her needs it was all about funding and she used to have nightmares about - the idea about being on the street and catching a bus and to finding friends who she knew from the old days and whether or not they'd put her up.


Worricker

Stephen Dorrell I mean, I'm not trying to put words in your mouth, but it is surely ludicrous to have a situation where somebody's care needs are different simply for bureaucratic reasons when they move when patently those care needs are exactly as they were five minutes earlier?


Dorrell

I completely agree with that but there is a policy problem, we have to find a way of delivering the outcome that you describe, that you focus not on which box somebody fits in in order to satisfy the - how the payment is going to be made, you focus instead on what the need is and secure it for the individual the need - the care package they need. But how you deliver that is against the background of a local authority delivered service and deliver it in a way that isn't excessively bureaucratic. What makes me nervous about the direction we're going at the moment is the experience in the DWP world of the activities of daily living tests where they become more and more artificial and in different world, wearing a different constituency hat, there are too many examples of people failing this or that test for what seem like totally artificial reasons.


Worricker

But if you had national eligibility criteria would a lot of what we've just heard from Denise go away as a problem?


Dorrell

Well it would be - it would manifest itself - the danger is that it would manifest itself in a different way, that the discussion would then be about how can you possibly in this particular set of circumstances reach the conclusion you have because of some very bureaucratic definition of need. The moment you get into a statutory national formulation of need inevitably it becomes very rules based and there will be perverse outcomes or there's a serious danger of perverse outcomes and that's what we have to guard against.


Worricker

Stephen Lowe is with Age UK, he's social care policy officer, Stephen, good afternoon.


Lowe

Good afternoon.


Worricker

If you can put forward a wish list here what would it contain?


Lowe

Well I suppose I've been asked to not talk about money so much as about the implementation of personalisation in social care which is basically a broad term which describes a range of ways of giving people more choice and control over care and support rather than having to rely on the sort of institution approach to care. And I think the main issue that concerns us about that is - I mean the flagship of personalisation is people getting direct payments to buy their own care and being given cash payments which does actually - a lot of older people use cash payments and get good results from using them but it's basically a way of providing care that's been - it originated with younger disabled adults and it doesn't necessarily suit older people because older people have - start using care in different conditions. Often when an older person starts using care it follows a crisis, for example they're in hospital or they've had a fall and they've got new levels of need, they have to make choices in a hurry, they may be under pressure to leave hospital like tomorrow. They've got very little information about services and it's actually very difficult under those circumstances to actually use a direct payment. And once people set the carer up older people are usually ill, they have deteriorating needs or variable needs so the care needs to be on-going - managed on an on-going basis. So I suppose what our wish list would be really is that personalisation shouldn't just be seen as about direct payments and there should be other ways built into the system of making sure that people can have more control - control over services.


Worricker

Sure, other ways that suit each individual ....Stephen Dorrell, a thought on that.


Dorrell

Well I don't - I absolutely agree with that. I think one slight gloss I'd put on it is that it's a mistake I think to imagine that the points that were being made about elderly people sometimes having difficulty using direct payments effectively, that's not true of all elderly people and some elderly people do prefer to receive a direct payment and where they prefer it it's often the best way of meeting their need. But it's absolutely right to say that personalisation does not - isn't just another way of saying direct payment, personalisation means what it says - it means delivering services which are designed to meet the needs of individuals and they are - they are many, many and very varied. And the system has to be sufficiently flexible to meet that wide variety of needs that occur in different families at different times.


Worricker

Andrea Woolidge in St Albans, I think a point about the criteria Andrea?


Woolidge

Yes it's the criteria and I would want to talk about those direct payments too. They give individuals - I'm talking about an elderly lady - it gives her flexibility, it gives her control, it enables her to use her funds when she needs them not just when the local authority has decided to send somebody in. And what's happened for her is that her payments have been cut at a stroke six months ago, which as I understand it breaks the disability and the equality legislation.


Worricker

Based on what?


Woolidge

Based on - the cut? She was downgraded from substantial need to moderate need on the basis of two people sitting in front of her with a clipboard asking her questions and then downgrading what she described as her needs to be by one level and then discovering that the local authority have decided at moderate they no longer provide funding. So you've got to be substantial or critical to gain funding. In my opinion, as a nurse, she is well into the substantial range and for some things critical. But those goalposts have been moved. And her concerns are along the lines of - we're talking about a highly intelligent, intellectually able woman and she's talking about her distress at feeling she's no longer needed, no longer wanted. The local authority would rather she had an accident than have to pay for her because then she'll be under the NHS, so that would suit them quite well really. But her concern is that cutting frontline care for financial savings is not the right way to make those savings, it is scrap heaping people who have given a huge amount to our society and now deserve to be cared for properly.


Worricker

Andrea, thank you for making that point. Stephen Dorrell, it's now I think three quarters of local authorities who are now only offering to those who are substantial or critical according to their measurements and it is clearly going in only one direction isn't it?


Dorrell

Well it's certainly true that the pressure is growing within social service departments and part of what Andrea was saying I think is - the answer lies in part in what Andrea was saying about the perverse incentive that exists for individuals to be shunted between the health and the social care systems, it's why I put the emphasis I did earlier in this conversation on the importance of integrating these services properly because it's clearly - it's expensive care and bad quality care if there isn't proper - if we don't take advantage of the opportunity to intervene in the case early, to prevent the condition arising that leads to the individual becoming a more dependent patient on the health service. The system at the moment isn't designed to achieve that outcome and it's one of the things that the Prime Minister actually has put particular emphasis on following the NHS Future Forum exercise earlier this year is to deliver more integrated care that treats the health and social care system as one system from the point of view of the people who use it. After all if you're an elderly person relying on your local GP's surgery, the local community health department, the local social housing department, the local social service department for a package of services what you want is a set of services that work together rather than having to go from one department to another with a kind of shopping bag of need.


Worricker

John Fox writes this via e-mail: "Perhaps the government should impose an annual levy on the banks of £1.7 billion ring fenced to pay for the care of the elderly, instead of the taxpayer. The mutterings coming from the Treasury, Stephen Dorrell, after the Dilnot Commission Report was published were described as not that encouraging, what are you hearing?


Dorrell

I think that I read the same reports. I hear of a willingness to engage in a conversation and I think it has to be a conversation that says to the Treasury if you don't - if the government doesn't play the game in the way that Dilnot proposes, that is to say we offer a new deal that encourages people - makes it easier for people to plan for this need the truth is that in the worst possible scenario these people all end up without having had early intervention, without having had proper care, they end up as patients in an overloaded health service and that's the worst way of dealing with it. It also happens to be the most expensive.


Worricker

But everybody is making potent arguments to the Treasury at the moment as to why they should be let off the hook, to some extent, in the broader economic picture, why is this necessarily going to be any different?


Dorrell

Well we just have to look, as I've just said, at the scenario if the care needs of elderly people are not met.


Worricker

So you can make a financial argument for this now along the lines that Dilnot has outlined because if you don't do this now it'll cost more in the future?


Dorrell

Precisely. Look the case for improving care delivered to elderly people is that we should want to deliver proper care to the elderly population and indeed the rest of the adult population that rely on social care. We should want to do it for its own sake. But we shouldn't be blind to the fact that if we don't do it and their conditions become acute then they end up in hospital, the care - their life experience is worse and the cost to the taxpayer is higher - who's the winner?


Worricker

Let me go back to the phone-in room. Carolyn Atkinson, what more do you have?


Atkinson

Well quite - a couple of suggestions from listeners who are calling in their droves, I have to say. Jennifer Sleep, who's 65, says: "It would put my mind at rest if I knew that any caring costs would come out of my estate, i.e. the government would give me the equivalent of a loan to cover the costs and on my death the loan would be repaid. This is a win/win situation for me and my family and it would take the anxiety out of the whole thing." A similar but sort of slightly different solution from Val Downes, who says: "I think that people in this country who've lived and worked all their working lives and paid their taxes and national insurance have more than paid for their social care. Possibly though..." she says, "we should have the same rules as Australia and everyone should have an insurance policy that they pay for to cover this kind of thing." Now the unfairness of self-funders versus local authority funded places is raised by Keith Walker, he says: "In what way will government ensure a level playing field between the local authorities and self-funders in terms of paying for care home places?" He thinks it's very unfair at the moment that people pay different amounts. And one listener who wanted to remain anonymous says: "With the increasing number of older people it's become quite clear society can't support them all but even if it could why should it? Should the taxpayer support the elderly so they can leave their home and savings to their children?" She says: "This is completely wrong and we should stop thinking call social services the whole time."


Worricker

Carolyn, thank you. I just want to squeeze two more calls in. Simon Gillespie's the Chief Executive of the MS Society, Simon, good afternoon.


Gillespie

Good afternoon.


Worricker

What's the thrust of your wish list here?


Gillespie

Well this has been a fascinating discussion so far but for me I think MS is a fluctuating condition so I'd like to hear from Stephen how the government's working on making the system more responsive to people with fluctuating conditions like MS.


Worricker

Stephen Dorrell.


Dorrell

Well I'm sorry if I'm sounding like a stuck record but I think the key thing is not to fall into the trap of over - of making this over-prescriptive and imagining that there is some perfect grid that can be formed into which human beings can slot into pre-arranged squares. That is the opposite of what I understand by personalisation. Personalisation is making certain that there are services available that meet the needs of an individual in the context of that individual's family circumstances. There are two elements in this, going back to the family carers, some people are living on their own, they need one set of - they have one set of needs, others are living with family support and their needs are different.


Worricker

Simon Gillespie is there something you can put forward here that would help?


Gillespie

Well I think the key thing is for us to make sure that the system assesses need quickly enough and things are put in place quickly enough to make sure that somebody who's having an MS relapse for example, which may go on two, three months or so, actually has the support in place for that relapse, not coming into play actually when they're beginning to feel a little bit better and able to do a bit more for themselves. So I think the system's got to be far more responsive. And I certainly endorse Stephen's point about personalisation. Personalisation in terms of people's social circumstances but also in terms of what a particular condition might be doing to them as well.


Worricker

Thank you very much Simon. I've got two minutes of the programme left. Shirley Mirgraff in London, Shirley.


Mirgraff

Yes I'm taking increasing exception to the overriding message that all these problems are created by the fact that there is no money or almost no money to pay for it. If this government, which wasn't elected, would refrain - would drop their Health and Social Care Bill, for which nobody voted, we could save billions at a stroke by halting the reorganisation of the NHS, which it doesn't need - improvements absolutely, we can do that without the reconfiguration. And within that, very quickly, they could save more billions by phasing out in very short order the private finance initiative, which is draining billions out of the National Health Service and we could also save billions by calling a halt to the purchaser provider split which puts up transactional costs by billions and will go on pushing them up by billions even more if this disgraceful and disgusting Health and Social Care Bill gets through...


Worricker

Shirley...


Mirgraff

...the money could be there and it is there.


Worricker

You've made your point, thank you very much. John Ingram in Feltham I'll give you 30 seconds, so I'm sorry to cut you short.


Ingram

Thirty seconds - build residential homes and private or social houses near them and put the children in the homes near their grandparents or whatever and also the fact that housing is a problem so you could do that and they could help their parents as well and that would be cheaper.


Worricker

John, thank you very much and thank you for being so brief. In 15 seconds Stephen Dorrell what happens now?


Dorrell

Well it's been a fascinating discussion, thank you for arranging it. We shall certainly take all these points into consideration, we've got a report to prepare which we hope to publish probably I guess just after Christmas, it's a cross-party committee and our intention is to develop these ideas on a cross party basis and our purpose is to provide real time advice to the government in the policy-making process.


Worricker

Thank you for coming in. Thank you for calling today. Join Winifred tomorrow – four minutes past midday.








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