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Care Services: Older Adults and Disabled People

My Lords, I, too, congratulate the noble Baroness, Lady Fookes, on the eloquent way in which she introduced this important debate. This issue will get more acute as the population ages. As the noble Baroness said, not only will the population age, but more and more long-term disabled people will want to live as independently as possible, which was the subject of the debate on Friday. I will not repeat what I said then, nor will I ask the Minister when the Green Paper will be published, although I was going to. This is a difficult climate in which to try radically to overhaul the social care system, but that should not prevent the Government from doing more than tinkering around the edges. However, there will be many consequences of the downturn, not least for local government. I believe that my noble friend Lady Barker will explore some of those matters further in her debate next week. Today, I shall draw on the Hampshire commission’s report into personalisation and the future of social care, Getting Personal: A Fair Deal for Better Care and Support, which brought together not just local politicians across all parties but experts from all over the country with a social services background to look at the future of adult social care. The commission reported last November. Its recommendations are well worth studying and range from action that can be taken locally to that which needs legislation. An example of the latter is that the commission, in common with many Members of your Lordships’ House, believes that the carer’s allowance should continue to be paid to those aged over 65 in receipt of the state pension. That is not allowed at the moment because of the overlapping benefits rule. The Hampshire commission’s first recommendation is the universal offer, which would have to be made by the Government nationally. It would include access to information, advice and supported self-assessment for all, regardless of their level of need or their financial situation. Those with more intense and urgent care needs would have a right to brokerage to support planning and arranging care, regardless of means. Furthermore, the Government would have a duty to promote and publicise the scheme so that everyone would be aware of their entitlements. That is a sensible proposal and means that no one would be given short shrift just because they had not been assessed as eligible for social care. People who need care—usually older adults—told the commission that they felt "lost and bewildered" when trying to get health and social care. They felt unsupported in trying to access information, even when they were eligible for services, while those who were ineligible often got no information of any kind. A carer’s story reported in the Hampshire commission’s report is typical. She said: ""My mother was in hospital after a stroke. The consultant advised that she would not be able to walk unaided, feed, dress or wash herself again and that we should find a nursing home for her. It was suggested that we should talk to the hospital-based social services team. We did, and on hearing that she would be self-funding, the shutters came down, and the help and information offered was zero"." That attitude simply will not do. Some respondents to the survey were distressed that social services were not interested in giving any advice when they asked for just a little help, such as that which used to be given by a home help, even to elderly people who lived alone and had recently been discharged from hospital. Unless these people cannot wash and feed themselves, no one seems interested in how they are going to manage, yet having someone looking in to see if a person is all right can make all the difference to their lives. It is not always possible for elderly people to ask family members or neighbours to keep an eye on them. Many have no family left and, if they are housebound, they are increasingly out of touch with their neighbours, particularly if they live in urban areas. The second recommendation of the Hampshire commission’s report is another sensible proposal: that urgent social care should be free for up to eight weeks for all those at risk of admission to hospital or who are being discharged from hospital, where there is likely to be joint care with health. The report states: ""The fact that health is free at the point of delivery and social care is means tested is a persistent barrier to joined-up services and can be particularly hard for people to understand at points of crisis"." This finding chimes with that of Age Concern and Help the Aged when they state: ""Most people also hold incorrect assumptions about entitlements to social care, thinking that care and support is free at the point of need, like the NHS"." The Wanless report of 2006 makes this point strongly: ""It often comes as an unwelcome surprise to older people to discover that social care is means-tested and they are expected to rely on their own savings and income until their assets have fallen to the threshold set for state-funded care. It is a common complaint that the existing system penalises those who have saved for their old age"." The commission strongly supported the principle of personalisation of social care, saying that there was now evidence that the poor take-up among older people in Hampshire was beginning to change and that outcomes were improving. It said that the current system through which people obtain social care was, ""opaque, localised and hard for people to understand"." The report demonstrates that self-directed support in Hampshire can be highly successful in making life better for older, frail people and those with complex and high-level needs when they are given the right amount of time to make decisions, the right support and real freedom of choice. There are many more proposals in the Hampshire commission’s report but I will mention just one more, which I think is vital: the importance of training more people in the caring profession. The report makes the point that the current social care workforce is ageing and that there is a need to attract more young people into care work, including those for whom it will be a stage in their career rather than a career-long choice. With the growth of personal budgets in health and social care, a workforce with wider skills than ever will be required to fulfil all the different roles that will be required, including personal assistants and those able to offer advocacy, brokerage and support planning.