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	TX: 07.05.07 1200-1300 - Social Care PRESENTER: PETER WHITE
	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 成人论坛 CANNOT VOUCH FOR ITS COMPLETE ACCURACY. WHITE Hello and welcome to You and Yours from the Freemasons Hall in Manchester. We're here to discuss the future of social care. All morning a distinguished group of professionals has been debating how to find solutions to a time bomb which some people think is even bigger than that of pensions. And something which is guaranteed to affect every one of us at some time in our lives. VOX POPS I'm seeing disaster ahead. I don't know who's going to look after us. Who is going to do the work? Where is the money coming from? How is society going to cope? Absolutely terrified. One of the bones of contention with carers is that although we save the Treasury billions of pounds a year and some people have worked all their lives and paid full stamps we still have to pay for our day care centre and anything else that we require. I get six hours a day funded from the local authority which more or less meets my basic needs, such as getting up in the morning, getting dressed and of course by implication that means that you can only go to the toilet at lunchtime or teatime. WHITE Just a few introductory views and experiences there, many more to come. Traditionally in fairy tales long life is conferred upon you as a blessing for good behaviour. But what they often forgot to warn you about was that it'll cost you. As more of us live longer without benefit of blessings we're beginning to realise that longevity is expensive. And before you think - nothing to do with me then, I'm young and in bouncing good health and my parents and relatives are as fit as fiddles, the chances are that whatever method the UK chooses to fund social care most of us will end up paying something towards it or becoming a carer ourselves. Here on You and Yours we're starting the national debate that organisations like the health think tank - the King's Fund - have been calling for: How do we care and how do we pay for that care? How do we maintain people's independence and provide the help and support that allows them to retain dignity in their daily lives? Well the King's Fund, the Joseph Rowntree Foundation and 13 other organisations have formed a partnership called Caring Choices. They're holding events all over the country and this one in Manchester is the very first of them. Niall Dickson is the King's Fund's chief executive. Neil, why do we need this debate now? DICKSON Peter this is a huge area and a neglected area of national life. A lot of the time it's below the political radar, yet in England alone we're talking about a £10 billion business. If we do nothing - nothing at all - over the next 25 years, simply maintain the current inadequate system, that will go up to £25 billion. We're going to see more and more people with dementia, we're likely to see a two-thirds increase in the number of people living over 85. That's a huge opportunity - it means we're all living longer - but it also means that we're frailer for longer and that of course means that we've got to organise our care rather better. There's a lot of recognition at the moment that the current system is not working, it's complex, it's seen to be very unfair. A lot of older people talk about being betrayed by a system that they thought would support them. If you looked at local authorities around England at the moment two-thirds of them are only providing help to those who are really at the critical end, the really serious end, that means many thousands of people are being denied the help that they thought they should have. So I think it is time to have a debate, it's time to have a debate to raise awareness among politicians, among the general public, among elderly people themselves and those who are just about to be elderly. And we've got to have a debate about how we pay for all this. What sort of care we want and how we pay for it and how we get the balance right between the roles of the state, the individual and the family. WHITE Niall Dickson thank you very much. So that's why it matters but how exactly does social care currently operate? Well You and Yours disability reporter Carolyn Atkinson has been navigating the system, complex as it is, and she begins by defining what social care is. ATKINSON Social care is about helping people to get up and out of bed, have a bath or shower, get dressed, prepare meals, go out and basically have a life. It's not about looking after people who need medical treatment in hospitals - that comes from the NHS budget. Provision of social care differs in different nations of the United Kingdom. At the moment 1.5 million adults in England receive some form of social care, one and a quarter million of those are over 65, the rest are younger and disabled. So where does the money come from to fund all of this care? Unlike the NHS, which is paid for by central government and is free at the point of use, social care is funded by local authorities and is usually means tested. The money comes from a mix of council tax and central government funding. Now the money local authorities receive has to pay for a range of services, everything from dustmen to street lighting, so that's why the social care they offer varies so much depending on where you live and the priorities that your local council chooses to make. Latest figures show overall social care spending in the UK adds up to around £13 billion, that compares with £26 billion on defence, £59 billion on education and 72 billion on the NHS. So who gets what when it comes to spending that social care cash? Well each council assesses someone's level of need as either low, moderate, substantial or critical. While each council comes up with its own precise eligibility criteria there are national guidelines when it comes to banding people. If someone's life is in danger or they're unable to do anything for themselves they're deemed critical. At the other end of the spectrum: someone categorised as low need will be unable to carry out one or two personal care or domestic tasks. However, two people both categorised, for example, as substantial need but who live in different parts of the country, will not necessarily get the same level of support. And the goalposts are moving. To date 100 of the 150 local councils in England are only funding people assessed with substantial or critical needs. Only one council helps people with low need. If you do get funded care to live at home it can either be given by a carer from an agency or you get the cash, known as a direct payment, and you organise your own care package. Thousands of others are funded in part or full to live in residential homes. This whole system of paid for care is propped up by a massive informal workforce of six million unpaid carers - friends and families who look after their loved ones. WHITE Carolyn Atkinson. But of course when we're talking about social care we're talking about real people with real needs. We're about to hear two people who receive care: one a young disabled working man but first an elderly woman born in 1906, the year in which the Liberal government, which first introduced some semblance of social insurance, came to power. THACKER My name is Rose Thacker. I'm 101 years old. I'm one of 11,000 of us centenarians and it's projected that in 30 years time there'll be 40,000. I wonder if that's true, I hope it isn't because not only do we need looking after when we get old but many, many people that I know already, instead of enjoying a peaceful old age and dying, are in their 60s and over looking after old parents, which is a terrible burden. SMITH Hello there, my name's Mike Smith, I'm 40 years old and I'm director of policy for a major accountancy firm. I'm disabled, I have a relatively rare neurological condition which means I use a wheelchair full time. I'm one of the 10 million disabled people in the UK and there are a quarter of a million of us who are under 65 and receiving social care packages. Organising my current care package was a real trial - it took me two years of negotiations with the local authority. The battle was incredibly intense and really quite debilitating - I ended up feeling pretty down at the end of the whole thing and I'm pretty much used to fighting for things just in my job or in my day-to-day life. I know local councillors who said afterwards that they couldn't quite belief that if it took me that long, how long would it take for other people who were less able to fight for their own rights. THACKER This is how the system works if you're having care at home. You have a well trained social worker in charge of a person but the person who does a bath does it once a fortnight or once a week and is someone from an agency. You're old, you get incontinent, you need a bath - they only come on Wednesday or every other Wednesday. It just doesn't work. I mean I've known people with care packages, they've died, they've been dead two or three days before anybody's found out. One of them was hanging out of the window trying to call for help. SMITH I get six hours a day funded from the local authority. Six hours a day gives you the really basic access to simple provisions like personal tasks, such as getting up in the morning, getting dressed, doing my shopping and various further activities to help me live independently. They wouldn't provide overnight assistance because they say they're working to social care needs strategy. So I had to go for the independent living fund for that. I then have to go to top up funding for my access to work scheme, which overall gives me a mixed allowance which more or less meets my basic needs but if I want anything extra, like going away on holiday or anything like that, I need to pay for all that myself out of my own income and therefore I end up paying another £3-500 a month to pay for the additional services I need to have a real life. Real life - things that most people take for granted, like engaging with my friends, going shopping, going to the cinema, basic things that other than simply getting out of bed or getting one meal a day. THACKER When I was on the Association of Hospital Management Committees I heard Lloyd Bevan many times say: I'm going to take the financial anxiety out of illness. Well we could learn so much from those days. WHITE The stories of Rose and Mike, direct from the coal face. Very much setting out the problems, we're very much seeking the solutions today. Here with me in Manchester is a distinguished panel of guests who discuss the future of social care. And in the audience are people who work in or use social care services, including listeners of You and Yours, ready to put questions to the panel. Let's meet the panel: Sir Derek Wanless is a senior associate of the King's Fund and Sir Derek has written the definitive report on this subject and advised government on policy; Anne Williams is president of the Association of Directors of Adult Social Services, they're the people who deliver social care and she's still very much hands on in Salford; Mervyn Kohler is from Help the Aged which represents the biggest user group of social care and Liz Carr is a broadcaster and comedienne, she's a wheelchair user, a campaigner on disability issues and a user of care services. [CLAPPING] Sir Derek, what I want to know is what's the best and the worst thing about the current social care system that we've got at the moment? WANLESS The best thing I think is the fact that the resources that we do put into social care are concentrated on the right people. But the worst thing that goes exactly along with that is that there's a huge amount of unmet need. There are maybe 300,000 people, we estimated in our report, who won't be getting care in 20 years time, if we keep the system as it is, who should be getting care. WHITE Liz, you use the system, what's the best and the worst thing from your experience? CARR I think the best is that somebody like myself, a disabled person, a wheelchair user, who requires full time assistance can get that, that I'm not in residential care, that I'm actually here on the platform as a participation today. And the fact that we're talking about things like independent living, direct payments, there are very positive models of social care out there that actually show me things can work. In terms of the negative it's the fact that so few know about these and the fact that we don't have the funding to support these and that's what scares me is the fact that so many people are not receiving what they need and are having to pay for what they need as well. WHITE Anne Williams, what's the bit of your job you're least satisfied with - with the delivery of? WILLIAMS It's having to concentrate the limited funds we've got on people only with the most substantial and critical needs, not able to deliver lots of the services that make a real difference to enabling people to live independently in their own homes. WHITE So you mean the people who need a bit of help ... WILLIAMS Yeah, a bit of cleaning, a bit of gardening, some handy person services, chiropody - we've had to withdraw from lots of those things. WHITE Mervyn, what are you hearing about from your members? KOHLER Well I think Peter the best thing is that we've got the rhetoric right. We want to provide people with flexible personally tailored packages, we want them to be in control of their lives - to have independence, to have choice. This is great but conversely the worst thing is that we're in a state of collective delusion about actually living up to that rhetoric, collective dementia perhaps one might even say in this context. WHITE You say we're deluded, do you mean that there are people who think we're getting it right? KOHLER I think you can read quite a number of ministerial speeches and believe that that is where things are. WHITE Okay, thank you very much indeed. We'll hear more from the panel throughout the programme. But first, a crucial part of the system, one without which it just couldn't operate, are the carers, many of whom look after relatives or friends for free or who are paid carers, either paid directly or who work for agencies. Let's hear from some of them. VOX POPS Hello my name's Laura Christian. There is about 1.5 million paid carers and I'm one of them. Sometimes this job can be quite difficult, as much as it's also very rewarding. One of the big issues, of course, is it doesn't pay very well, average wage is around about 5.50 an hour, not much beyond minimum wage. It is very, very task orientated. Each client is allocated a certain amount of time for their care, from an assessment usually, a sort of medical and physical assessment. The highest they're going to get is around about an hour, it's usually half an hour. You'll have about six people perhaps in a morning and if you stay longer with one of them then it goes late for the other one, which is unfair on them, so you really do have to get things done within a certain timeframe. Which unfortunately takes away quite a lot of the more holistic stuff really, I suppose, is the word but that's the only way we can do it until it becomes a much more desirable job really and there's more people wanting to do it. My name is George Russell, I'm one of six million people who are carers who have someone in their family. I care for my wife Enid who has Alzheimer's Disease. I am 73 years of age. My wife attends a day care centre three days a week and she's away maybe four hours per day. I have someone that comes in twice a week to bath her and attend to her personal caring situation which I pay for and I also pay for the day care centre as well. The communication between Edith and I now is very, very limited, she does not understand what I mean when I speak to her. Most of the time she's virtually in a world of her own. It is a very lonely life caring for someone with Alzheimer's but we make the best of it, Enid is very happy and smiles a lot. It is a horrible disease and they call it the long goodbye and it certainly is a long goodbye. WHITE So the perspective from the carers. High time now to hand the baton on to the audience. The first question is from a You and Yours listener Ann Drinkwater. Ann, would you like to put your question to us? DRINKWATER Why can't the provision of social care be standardised across the United Kingdom? WHITE So you're referring to the famous postcode lottery which appears in social care as in so many other things. Okay Anne Williams, you provide something in Salford, should it be the same in Cornwall, in Newcastle, in East Anglia? WILLIAMS Ideally yes but there are some difficulties. Local authorities get different allocations of money and make different priority decisions and raise different levels of income from charging. Therefore in terms of care at home, especially, there remains a huge variety of ... WHITE So would you - would you lobby for that degree of uniformity and would the local authorities - because of course you're only part of the local authority - would they back you on this? WILLIAMS As a director every year we have to lobby for the money for social care against the roads, education, street lighting - all those kind of things - and different decisions are made in different localities. WHITE Sir Derek Wanless you referred to this in your report. WANLESS A lot of this isn't just about where the money comes from, it's about have we got the resources, the skilled people, the right premises, the right technologies to actually provide this. And one of the problems that we identified in the report is that this has been very much a hand to mouth job over the last few years, it's been about not what do we want to do with social care, it's been how much will this year's budget stretch to and that's both nationally and even more intensely locally produced different levels of support for people. And I think in the long run that's unacceptable. WHITE Let me go to Liz Carr, I mean I imagine disabled people talk to each other, they compare notes about what's happening in different parts of the country, I wonder how it impinges on your kind of disability. CARR The advantage of it, if there can be, and this sounds bizarre, is that it does allow you to see pockets of good practice where they can do things differently. So I know that there are the odd authority that doesn't charge for example, you know, I know there's about only two left in the whole country now. So it shows me well if they can do that, why can't they do it? It is about political will, it's not always about funding. WHITE And Mervyn Kohler, your comment on this? KOHLER About once every month or so Peter I get a phone call from a woman in Staffordshire who's been chattering with friends on the telephone and is saying: Listen, why when two people seem to have the similar sorts of needs do they get eight hours of service in one local authority and 15 minutes in another? It is this sense of unfairness which is absolutely bedevilling the way in which everybody looks at our social services provision at the moment. WHITE Can I just go back, just finally, to Ann - Ann Drinkwater - to ask what was driving you to ask this question, does it come from your own personal experience? DRINKWATER A little but I live in a beautiful part of Derbyshire and I want to live there and garden till I'm very old and I don't want to feel that I'm going to have to sell my home and decamp to Scotland, I think might be the best, maybe all the elderly ought to go up to Scotland and live there. WHITE Ann I'm glad you mentioned Scotland, you could have been dead on cue, because perhaps one of the clearest examples of what perhaps looks like a very extreme case of postcode lottery is Scotland where personal care is being offered free for sometime. Now in our audience we have Julia Unwin, who is chief executive of the Joseph Rowntree Foundation, very much associated with this alliance. Julia, first of all, just explain how that system works. UNWIN Well in Scotland in 2002 they introduced an entitlement to free personal care for anyone who's assessed of being in need. And we've been looking at it to see what the impact is, because as Ann says we could learn from it. What we've found is it has created a real sense of entitlement and that in turn has given the people who receive it a sense of certainty. What that's done is allowed for more choice and control for older people and their carers. There were lots of fears about what would happen - we were afraid that free personal care would reduce the level of informal care provided and that has absolutely not happened, in fact informal care has flourished. The difference in cost between the rest of the UK and Scotland has been less than popularly assumed although there has been a difference. WHITE But doesn't social care expand to fill an almost infinite need? UNWIN Well our evidence so far is that it hasn't done that in Scotland at the moment. But what it also hasn't done is done anything about the supply, so you have people assessed as needing care with the money to buy it but not necessarily the right people in the right places to provide it. I'd be interested in what the panel think - is this the route we should go down in the rest of the UK? WHITE Anne Williams, should you go down this route in Salford? WILLIAMS Well it's interesting because as you can tell I'm a Scot and my mother is 85, living at home and we've discussed this a lot. I think, knowing a little bit about it, personal care is not everything, there's tight definitions remain in Scotland as to which part of care is actually free. And there are worries among older people about will taxation be able to continue to fund this. And a growing worry that waiting lists are being used to actually control the expenditure. WHITE Derek Wanless, you've looked at Scotland as well in your research, what's your reaction? WANLESS We looked free personal care alongside a whole series of other methods of financing social care. We actually chose a different model where people contribute something towards it. But the crucial thing that's similar to free personal care is that we thought the best model was an entitlement model, it was a model where people had an entitlement and that entitlement they paid something towards. And the reason that's important is that we'll all then have an interest in the system, we'll all then want the system to develop and be strong. The point about getting demand and supply together and avoiding waiting lists we thought was a really important one, so we also argued that there should be some pacing of this because we need more services for domiciliary care at home, more services for carers and we need better care homes for people with cognitive impairment - dementias. And if we get all those things in place then a funding system based on entitlement we thought was the best solution for the future for all of us. WHITE Right. There's a general acceptance in what almost everyone has said that the current system isn't working, isn't sustainable, and that money is very much an issue - how much should the state pay for example and how much should individuals contribute and in what way? So at this point we'd like to perhaps throw the debate very much open to you in our live audience, what comments or questions do you have about who pays and that division between what the state pays and what the individual pays. Let's take our first question or comment. PAYNE John Payne. I work for the Extra Care Charitable Trust. There's a big chestnut really waiting in the wings, which is that will people have to use their housing equity to pay for their care? And nobody really wants to talk about it because it's difficult to grapple with. We as a trust have done some very, very interesting research which would suggest that actually people are beginning to recognise that they're going to have to use housing equity to pay for the care going forward. Not least because they want to guarantee the quality of that care. So they need guarantees and they need quality but if you put that right they would be willing to consider a bargain for getting to ensure that they use housing equity to get the care that they deserve. WHITE And to make it absolutely clear this is taking the value out of your house - staying in it for as long as you can but then taking the value out of it to pay for your care? PAYNE It has to be done in the right way because people really want to pay at the end not at the beginning of their need for support. WANLESS It's an interesting idea but of course not everyone has a house to sell and therefore there immediately are problems, there are potential problems. It's also an area where people are worried about the products they've seen in the past and that's partly because financial institutions find it hard to price the risk, they don't know how long people will be alive. And what people don't want is for this to in any sense be able to backfire on them and they're left with not just their house gone but debts as well. The more people are using their houses as their pension as well then of course all of these things are I think going to be rather tricky. Part of the solution, but by no means the whole solution, is how I would describe that. WHITE Right. Mervyn Kohler, how much is this in the back of people's minds that this is going to have to be ... KOHLER I totally share Derek's concern that only 70% or so of our older population actually own their own home to start with, so that marginalises 30%. And of those who are home owners the people who live in a house in Barnsley have got an asset which is worth shed loads more than a home in Bromley or something like that. So you get a new form of postcode lottery if you're just looking at taking equity into consideration. I'm very much in favour of more older people looking at their housing equity from the point of view of trying to spend it on something which improves their lives but I don't think we want to mainstream it as a way of formally paying for care yet. WHITE Okay, more comments from the audience? BLOOMER Peter, my name's Hilary Bloomer and I was a carer for my husband until he died last year. I was in receipt of direct payments because the social services department where I lived said they couldn't provide any care for him after 7 o'clock at night. So he was settling down at 7 and then not surprising ready for breakfast at half past three or four in the morning, which I wasn't. So I went down direct payments route, it puts you in control of the care that you're buying but having said I got the money from social services to do that of course they said to me you won't be able to recruit anybody in this part of the world because you can earn more stacking shelves - supermarkets pay more. And we don't value people who do this kind of caring enough. I was in a position where I was willing to top up the sum that social care gave to me so that I could recruit people that I thought were appropriately trained and of the right quality to support my husband. And I advertised offering a minimum wage of £10 an hour and guess what I had 36 applicants and they were brilliant, I mean of the 36 I could probably have employed about two dozen of them but I whittled it down and got a team together who were brilliant. So rates of pay I think are a really critical issue. WHITE So it does bring it back to are we prepared to spend more as a community. BLOOMER Peter I agree utterly but I think what I'm saying is it's combination of national, local and contributions where people can afford those contributions. WHITE I want to put a question because this comes really to the heart of the matter of how we pay for this. A You and Yours listener, Keiron Houghton, e-mailed us to ask: As a 30 something I'm actually wondering both with regard to my own parents' care, plus myself, what should I be doing to prepare for my own care provision now? So Derek Wanless, what should people thinking about this now, what should they actually do? WANLESS As I'm registered with the Financial Services Authority I'd better declare that this is not financial advice because you need to know a lot about each individual's circumstances. For young people the best advice is pension advice. You're right a lot of people will need care but there are a lot of other things people need in older age and preparing to have savings and pensions generally for whatever is thrown at people I think is the first - the first thing. As far as older people are concerned, it depends very much if we're talking about the system as it is at present or the system I would like to see that we recommended in the report because the system in the report, which produced an entitlement which had people paying something towards but not much towards compared with people who presently are means tested for their care it's a very different sort of position in terms of what it would be. So I think the advice for older people is probably to find their voice and make sure there is an entitlement system put in place. WHITE I'd like to ask you in the audience what you really think about how much you'd be prepared to pay, let's actually define it in terms of what proportion as of what you pay and what the state would pay and perhaps what levels of tax you'd be prepared to pay. AUDIENCE MEMBER I'd go for the Swedish model. I know I'm old now but I'm still paying tax, that's something that we tend to forget is that pensioners, especially as we can go on working until - as long as we wish, we are taxpayers and therefore I would be prepared and seeing as I'm in the 60-65 age bracket and a woman and I would be paying more under Gordon Brown's recent legislation, I think that's the way to do it because then we can guarantee the future of other people - the 30 year old - I've been worried about the 30 year old is sent the e-mail Peter because we've got to give her a better future. WHITE So can you see that in terms of numbers, what do we think they pay in Sweden, Derek Wanless perhaps you can tell us? WANLESS I know yes, the Swedes pay about 53% of their GDP in tax compared with our 39-40, very big difference. And in fact the report I did for the King's Fund says that's not necessary, I mean we're not talking about that sort of level of spend in total to deliver the entitlement system I talked about. WHITE Okay and anymore comments? AUDIENCE MEMBERS I wouldn't mind paying the extra tax, whatever cost, actually, as long as Mr Brown will release the £2 billion that he's saving on pensions with his means testing. I'm prepared to take responsibility, I'm prepared to pay more tax as well because I want to have quality of life towards my own age, I don't want to be in fear of dying alone - feeling neglected - and I'm prepared to pay for that. I do think though we need to be thinking - changing our mindset, so we've got to embrace all these problems and we have got to try and be supportive - it's got to be a two-way process - it is about an issue for us all and we've all got to have a sort of understanding that we have to give up certain things as well I think if we're prepared to really tackle this - do we need the latest gadget or should be thinking about our old age? It's as simple as that really, it's about getting out of our denial about old age. [CLAPPING] WILD Mike Wild, I'm the Director of Manchester Alliance for Community Care but I'm actually in my mid-30s and a member of the generation who has student loans to pay, is struggling to get on the housing ladder and doesn't particularly trust pension schemes. So I'm curious to know why we should be relying on equity and those kinds of solutions. My generation isn't probably going to have that much equity. So I fully support the tax proposal. WHITE Right. The Joseph Rowntree Foundation has been looking at the things that perhaps we could do now, that they would like to see now, we have their Chief Executive with us, Julia, what are the key things the foundation thinks we should do? UNWIN Well there's a package of things that we think together could make a difference in the short term but could also provide building blocks for improving things in the long term. We think people should be able to release some of the equity in their homes because 70% of the population do own their own homes and they should be able to release that and stay in their homes, paying for some of the care they need to be there. We think we should double the amount of money that people in residential care are allowed to keep, it's a disgrace that people have less than £20 a week pocket money, that's not dignity for anybody. And we believe that we should increase or double the capital threshold for care home support because we think that would make it much easier for people to cope. WHITE Sir Derek Wanless that's a manifesto, how many things - how many of those things would you sign up to and are they practical? WANLESS They're certainly practical, yes, because they're relatively simple changes in the present system. They'd also provide some very useful information to help us design the long term system, the sort of partnership model that we produced in the King's Fund report. So I think working together what the Joseph Rowntree Foundation have done is produce some very sensible short term immediate potential actions and all very consistent with finding the right long term solution. WHITE Has anybody got this right? Have any other countries - can we not look to what they're doing somewhere else and say this is the model for the future? WANLESS Each of the reports I've written I've done that in the hope that the answer would be there somewhere and I could just describe the perfect system in health and in social care. Every country I've visited, first of all, didn't think it's own healthcare system was very good and also didn't think that they'd got social care and healthcare quite right. WHITE Mervyn Kohler. KOHLER No one thing comes forward as a shining knight in armour but it is perfectly clear that in the countries which have better social care systems they are prepared to invest more money in them and that is, I think, the key message we've got across. You've been saying this afternoon several times over variations on the question of who's going to pay, well the short answer is we will and we'll either pay for it as individuals or we'll be paying for it collectively or somewhere in between. But what we won't be able to do is get away from the fact that care, as Sir Derek's magisterial report clearly showed, is going to cost us a heck of a lot more in the future. WHITE Let's just finally go to the audience. This is all about people and what will happen to us, what will happen to our parents, what will happen to our children - anymore solutions, however bold, however left field they are, that you'd like to suggest? REDMOND Imelda Redmond from Carers' UK. We represent the family carers - the six million that are in the UK - and really take their voice to the heart of policy making. Now when we talked earlier about only two-thirds of people who are at the sort of top end of need are getting help it doesn't mean that their needs go away and so it's families that are picking up all that other care that people are needing. And what I think we need to do now - I mean in the long term I would absolutely agree with Mervyn - we've just got to have the debate about how much of our GDP do we spend on social care. But in the short term one of the things I think that happens is that the social care system that we currently have assesses people, says I'm afraid you're not eligible and then they fall off the radar. And what we need to do in the meantime is put something in place that picks those people up, that helps them find appropriate care, that helps carers navigate their way through that complicated system. WHITE And what would that something be? REDMOND That something would be - I think having sort of a brokerage service and some people can pay for it and we've heard people in this audience saying I'll pay for it but they don't know where to even begin. So I think we need to move away from a sort of client based one-to-one social work model and more into a brokerage model. SHEEHY My name's Eddie Sheehy from Salford and I think the most important thing is if we get our values right because we're talking about people and we're talking about dignity and respect and if we haven't got the values right that underpin all that the economics sort of wash across the top. We are the fourth or fifth richest country in the world and we have to do this ... WHITE But I'm going to push you on this Eddie, are you saying we need to go to kind of Scandinavian type tax levels, is that what you're saying? I know you're talking about values but values have to be paid for. SHEEHY Well we've spent a lot of money on health but we haven't spent a lot of money on social care and I think that imbalance needs to be redressed. [CLAPPING] CLAY Deborah Clay from Help the Aged. Following on from the last person really and thinking about one way for the future is building what's been termed as care in communities and learning lessons from America, for example, and examples of that are where perhaps older people support each other with reciprocal arrangements, time bonds - where people - perhaps somebody will do gardening for somebody and somebody else will do something for them - those sorts of things. Telephone trees where people will phone others to check they're okay and they'll phone others. But building the values within a community to look after each other and to see if that can't be supported in some way. WHITE We've heard a lot about values and attitudes, as I go back to the panel for the final comments, perhaps just one thing arising from some of your comments which is are we taking enough responsibility for our care, we all know we're going to get old, we all know we're going to need care at some time or another, is this a matter of growing up a bit? Liz Carr. CARR Well you know I am a believer in free social care, you know like I am a believer in free medical care, so that's the kind of position that I'm coming from, as idealistic as it might be. I find it amazing that in this day and age we can think that that's idealistic when to me it just makes sense - if we value people, we value ourselves as a society, that's the road that we should be going down. Alternatively I'm thinking we should maybe look for reality TV as a way of paying for it to be honest. [CLAPPING] Because it seems that we seem to care more about that than we do about disabled and older people in our society. I'm thinking of something like how do we solve a problem like social care might make some money with people calling in. WHITE Anne Williams. WILLIAMS I think the thing that's most needed is what we're having today and will continue this year, is a really mature public debate, influenced by older people and people who use services as to what will be expected and need to pay as individuals and what the state's prepared to pay in terms of taxation. And I think it's likely to be a combination. KOHLER I'd like to underscore Peter a point which was raised right at the beginning of the programme by Ann Drinkwater about the variable services across the country as a whole. And I wish that we could actually get a grip on the way in which we assess people's care needs, how well we're actually delivering the needs that people reflect and how well and how badly we are not delivering. I mean at least this way we'd get our heads around a map of what social care ought to look like and we could work out how much it's going to cost, we could actually commission things more intelligently, we could provide the services that people say they want. Let's please have some clarity about needs assessment. [CLAPPING] WHITE And finally Sir Derek Wanless, you've written these two big reports, you talked to the government, we understand, if you were to go from this room today and go and talk to them what would you say? WANLESS I'd say what I've been saying since I did the King's Fund report and it very much links in with what Rose said - 101 years old and very wise. This is an entirely predictable problem, it's a long term problem but we can see how many people there'll be and what sort of needs they've got. And we have got to have a structure in place where we can deliver that service and we'll only deliver that service if we sort out the funding issue. But it's the putting in place the delivery which is going to be vital for this. WHITE What do you think the timescale on this is? WANLESS We, in our report, had a 20 years timescale, that's obviously not the timescale for sorting out the problem, it's more urgent than that, but that's the timescale. There was a famous French army leader who was in North Africa and he looked out from his castle at his troops and it was swelteringly hot, he could see that his men were wilting, so he turned to his aide and said - The men need shade, there should be an avenue of trees, we should make one. And the aide, who obviously had a lot of trouble with his boss, said - But sir they would take 20 years to grow. Well then - said the wise leader - there's no time to waste we'd better start today. [CLAPPING] And that's the spirit that we need. WHITE That is it from Manchester. Our very warm thanks to all of you - audience and panel. Lots of provocative and compelling ideas there. You've now set a tough agenda for those who make policy to consider. [CLAPPING] Well that event took place just a few days ago. Now back in the You and Yours studio I've been joined from his office by Ivan Lewis, the minister with responsibility for care services, to address as many of the topics raised in Manchester as we can. Ivan Lewis, first of all, do you accept the premise of the King's Fund meeting in Manchester that social care is potentially as big a problem as the pensions crisis, that it's crucial? LEWIS It's absolutely crucial. If you look at the realities of demography - people living longer and longer but also developing conditions that we've never known before like dementia and Alzheimer's. If you look at the fact that disabled people now have and rightly want full and longer lives and if you add to that rising public expectations in terms of what they expect from social care services it's absolutely right that in the pre-budget report and then in the budget the Treasury and the government have acknowledged that social care is one of the great public policy and political challenges facing our society and facing the government. We now need a new consensus for a new settlement. We need to redefine the relationship between the state, the family and the citizen. And we need a long term settlement that's fair and sustainable. WHITE What became absolutely clear in Manchester is that there is a huge amount of unmet need. People are divided up by their local authorities into levels of need - critical, high, moderate and low - and in two-thirds of English counties only those with critical or high need get anything at all. And the postcode lottery, which that leads to, is hurting people and we've had someone in the audience saying I might have to move from Derbyshire to Scotland just to get reasonable care. Had a lady of 101 who knows people who were found dead in their accommodation. It sounds emotive but it's happening. LEWIS Well first of all we were accused early on in our period of government of wanting to direct, command and control, public services from offices in Westminster and Whitehall. We've now changed that where we have far greater level of devolution, allowing local authorities to respond to the needs of their local populations and local communities. They're better placed to make those judgements than civil servants and ministers sat in offices in Westminster and Whitehall ... WHITE But you still need lower levels - you still need minimum standards of care that need to be met. LEWIS You do and we've laid down minimum standards of care. We've also said that frankly it's not that there isn't enough money in the system, a lot of the money's tied up in the wrong place, in other words we spend far too much at the acute end of the National Health Service - in hospitals - and not enough money on early intervention and prevention through community based health services and social care. WHITE Okay, can we look at some of the specific things. First of all, help in the short term - if you go into a care home at the moment with very little money you're only allowed £19.60 a week as personal spending money, the rest pays for your care. The Joseph Rowntree Foundation has costed it around £250 million a year to allow people that, to give people nearly £40 a week. I mean isn't that the kind of thing that could be done quickly? LEWIS Well in the context of a debate about the amount of money that's available to spend on social care, on healthcare, etc., as part of the comprehensive spending review, as part of the debate about a new consensus for a new settlement, those were exactly the kind of issues that we've got to tackle head on and we've got to resolve ... WHITE Is it attractive to you, that? LEWIS Well if you're asking me to make a judgement and picking off kind of individual options and choices that have to be made I'm not prepared or able to do that. We have to look at the overall envelope of resources, how much of a priority is the taxpayer in society prepared to make social care and what's the appropriate balance between the state's responsibility, the family's responsibility and the individual's. WHITE But you wouldn't want to live on £19.60 a week, wouldn't buy much would it? LEWIS Of course on the surface that doesn't sound acceptable. WHITE It's a small amount isn't it. LEWIS But I have to say this entirely depends, doesn't it, on the means and the income of the individual we're referring to, not every individual - you're not saying, are you, that every individual in residential or nursing care is in that position, that they only get £19 a week to spend, because it wouldn't be true would it? WHITE No we're not saying that, we're saying those people who have no savings and if they're poor and all the rest of their money is taken for care, that's the amount they're left with. LEWIS But isn't that an argument, you see, this is where we get into the substance of some of these choices, that's an argument for means testing where more support is focused on those with the least means. Having said that there's the question of those older people who have saved throughout their lives, perhaps have a small amount of savings, a small capital, who feel very aggrieved at the injustice of the system. WHITE Indeed, which is why I wanted to ask you about ... LEWIS So we then have to get that balance right. WHITE So what about the idea of doubling the threshold of saving you're allowed to have before which you're charged for care - from 21,000 to 42,000 - you say you don't - you can't pick these off but those are the kind of things our audience in Manchester is asking? LEWIS Absolutely and they should be asking those kind of things because those are exactly the kind of choices that government is going to have to make when it looks at the available resources and the development of a new settlement that's fair and sustainable. The government is not sitting here - this is really important - and saying there isn't a problem, we're in denial, everything's fine. WHITE I've asked you about relatively short term solutions for people now, can I ask you about longer term solutions, what Derek Wanless, for example, calls an entitlement or a partnership model, i.e. a deal between the government and the individual, you pay x say, you get y and that guarantees you a minimum amount of care - is that the kind of solution which is attractive to the government? LEWIS That's certainly one option but you present the Wanless proposals as being all easy choices, what you don't mention is that Derek Wanless also proposes significant changes to disability benefits, for example, as a part of the solution to this problem. Now I'll tell you what that isn't an easy choice and that would be an incredibly hard choice in terms of the way that disability benefits have been traditionally - been allocated. WHITE The idea that the benefit should be used to pay for care. LEWIS Yeah, so please let's not have this presentation as it's all easy solutions that Wanless and others are asking us to make. WHITE Can I ask you about the tax suggestions that the King's Fund have come up with in order to fund this whole idea of co-payments basically - of partnership between government and people? Increasing the amount of tax people pay, specifically to go towards social care, so that if you want say a 70 and 30 split between government and the individual that would cost roughly a pound per working person a week. Now you know 90/10 - these are rough figures obviously - £3 per person a week. Is that something the government would want to persuade people that perhaps they need to think about? LEWIS Well as Gordon would say - we're always happy to receive budget representations from wherever they come from. But of course as part of this debate, as I say, there is finite resources, some of it will come through general taxation, some of it will come from individuals and the rest - and from family contributions. The question is what is the appropriate and fair balance. WHITE So we've come up with suggestions here, you're saying it's difficult to pick them off one by one, I'd be interested to know what you're fighting for, so what are you actually saying is a good idea - some form of equity release, the idea you mentioned of benefits being used for - to pay for care, some kind of insurance scheme? LEWIS What I'm doing is listening to the arguments that have been made from Rowntree, from Derek, from others - the King's Fund - I'll be participating in these debates, some of them, and basically talking directly to older people, disabled people, their representative organisations, I do that on a weekly basis anyway because contrary to belief ministers do spend quite a bit of time on the front line, I'll be interested to talk to the professionals who work directly with older people and disabled people. And then having done that, having ensured that we do get social care much - which I think I have achieved - higher up the political and policy agenda we then have to engage with people in the debate about what the real choices are and not all of those choices are easy and popular. WHITE If there isn't any money in the comprehensive spending review it'll be really tough, there are rumours that there won't be any money - any more money for social care, it'll make your fight very hard if you're still in post won't it? LEWIS All I can say is there is an honest frank recognition within the Treasury that social care is now one of the great political and public policy challenges facing this country. But equally I don't want to mislead people, none of the think tanks and charities are suggesting that government should be expected to solve this problem in one year, two year or three. We need a short term settlement which is reasonable in the context of a tough spending round but we also equally need a clear route map to a new consensus that will enable us to offer a world class social care system to those that are publicly funded. And my very strong view is the state, by the way, also has responsibilities to those who will continue to be self-funding. And one of the things that concerns me at the moment is the fact that self-funders are often left on their own by the system and I don't think that that's right and I think that's one of the issues that we have to address. WHITE Ivan Lewis, thank you very much indeed. LEWIS Nice to speak to you. WHITE And you can be sure that here on You and Yours we'll be continuing to lead the debate on the future of social care. Back to the Transcripts homepage Back to the You and Yours homepage The 成人论坛 is not responsible for external websites

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