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You and Yours - Transcript 成人论坛 Radio 4 |
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TX: 29.01.08 - Care in the UK: Reviews and Reports PRESENTERS: PETER WHITE AND LIZ BARCLAY |
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Downloaded from www.bbc.co.uk/radio4 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. BARCLAY But before we hear from you on screening there's been more developments in the debate about social care. As we've just heard on the news a report from the Commission for Social Care Inspection, the watchdog, highlights what it calls the sharp divide between people who do and do not qualify for certain kinds of help. As the criteria get tougher we not only heard from people who'd fallen through the safety net, we've also heard about people who once had care and are now losing it. People like Nick Whyley, who lost his sight 10 years ago. He's been able to rely on social services for help with things like cooking, washing and cleaning since then, a need which was heightened after he suffered a stroke. WHYLEY Up until January 2007 I received enough money to buy in 14 hours per week, I then received notification from the department - they said they had reassessed me and they said that two hours were appropriate. And I said well I was blind last month and blind this month. I disagreed very strongly with that and it wrangled backwards and forwards throughout the year until October when they just pulled the plug completely. Because of my stroke I'm much less mobile than I was so I can't get out so much. One of my people I've had to let go completely, so I'm getting less social contact with other people. And everyday is a struggle. BARCLAY Nick Whyley, and you can hear more of Nick's case on tonight's In Touch on Radio 4. WHITE Well social care minister Ivan Lewis has responded to the commission's report by giving it the job of carrying out a root and branch review of who qualifies for care and why. LEWIS We want them to review two things. One is the national bandings that currently apply, in terms of people being defined as having critical and substantive need or medium level need or low level need. And then we want them to look at this major variability in terms of local decision making, both within local authority areas and between local authority areas. WHITE But given that their report has pointed out that there is a lot of injustice and unfairness in this system, if they look at eligibility they're going to want to relax those rules to take more people in, that will require resources, have they the freedom to completely change these eligibility rules on the basis of which many people are now getting turned down? LEWIS Well let's be clear, there will always have to be a national framework to guide local decision making but the current system is leading to unintended consequences. During the course of this month your programme has rightly highlighted a number of issues - self funders are left on their own to navigate the system and make difficult choices about care, that was never the intention of this system; people with so-called low level needs, it might be an elderly person who's lonely or isolated, are being increasingly told sorry we can't help you, so there's a no help here culture which is not simply about resources. WHITE Surely social services, and they've said to this to us, they don't want to turn people down, social workers have told us how embarrassed they are administering their own system, they're almost bound to require changes in eligibility which require greater funding aren't they? LEWIS Well as you know we're committed to a number of other things this year - a new deal for carers the Prime Minister will announce later in the year; a transformation programme to give people personal budgets and we're also going to have a major extensive consultation with the public on how they believe this system ought to be funded. If we want to shift towards prevention and early intervention then you can't, for example, say that people who have low level need the local authority simply says there's nothing we can do, there's a whole range of services that local government provide outside of the formal care system. Supporting people to live independently and have the maximum possible quality of life is not just about the money that is spent or the services that are provided through the adult social care department of a local authority. WHITE But when we talk, for example, to people who were 14 hours care a year ago and have now have all that care taken away, really practical things like laundry and help with cooking in their own homes, that will require those hours to be reinstated won't it and that requires resources? LEWIS But when you say you talk to people who say that, you'll then talk to people in a neighbouring authority with very similar care needs who have not had that care taken away from them and may indeed be receiving more care. There are local authorities who have the same demographic challenges and pressures, the same level of funding both from central government and through local council tax payers who are making wildly different decisions about the level of care that people are entitled to receive. Now part of that, I accept that the government has some responsibility for this in terms of the national banding that was devised a number of years ago which in my view is leading to this culture of no help here, if you've got means or if you've got so-called low level needs then too often people are being turned away. WHITE What timescale will you be giving the commission to report? LEWIS We want them to report to me by the autumn of this year and that will feed in to the major extensive public consultation we're having on the whole future funding of social care in this country and your programme - the 成人论坛 - during the course of the past month, I think has done a really good job in a responsible and balanced way in highlighting why this is now one of the biggest challenges facing many families in our country and this government. WHITE Social care minister, Ivan Lewis, and you can join and put some of your questions if you're one of the guests in our audience for our social care programme on Thursday, more about that in a moment. Now Dame Denise Platt is chair of the Commission for Social Care Inspection and she told me more about what was in today's report. PLATT It's a report in two parts. The first part shows that if people are receiving services arranged by the council or financially supported by their council then for many of them the experience is improving. There's a range and variety of services and people are finding them very helpful. But the second part of our report shows that for those people who fall outside the formal system of care, including those people who are finding and funding their own care, the experience is very different. They are struggling to find the help and assistance they need, often experiencing a very poor quality of life, don't know where to turn for their help and are having a very unsatisfactory experience. So in a way we have two systems running side by side. WHITE And why do you think so many people are falling through the net? PLATT Well we have noticed that councils have tightened their eligibility criteria across the country and we have done a special study to find out what has happened to those people who just failed to meet the criteria, those are people who only a few years ago councils, professionals would have thought eligible for care. WHITE And presumably then also means like the example we heard earlier people who had care and have lost it, had it taken away. PLATT That's exactly right. And those people are very bewildered, they don't see how their circumstances can have changed to have warranted that change to their care. It's clearly not related to the needs they have and the needs they have to participate as a citizen. WHITE I mean isn't it clear that means testing is the key reason for that and that the social services departments themselves say that's because they haven't got enough money and that's a bit difficult to get round, isn't it, without more money? PLATT I think people who need services are confused and want to know what they're entitled to in the system. What they want is a new settlement between individuals, family and state about what they can expect from the care system and what they have to find for themselves and there is no consistency in that at present, as we have found in our study today. Sometimes within the same council as well as between councils people can get a very different response from individual workers. So there are some issues about professional practice here as well as the system in which people operate. WHITE Now the social care minister, Ivan Lewis, has rather tossed the ball to you, I'm assuming that you were half expecting this ball, but aren't you going to have to solve this problem of balancing the care that can be given with the money which is there to give it? PLATT Well I don't think a government minister has ever responded to a report so quickly and we were very pleased that he did respond so quickly because we do think that there is an urgent need to look at how these systems are operating. The work that we're going to do to look at eligibility criteria and how the framework needs to be adapted as we move into a different environment of care, which is more about individual budgets and people's control over those budgets the work that we will do will feed into the government's own review of the longer term funding issue in social care, the green paper which they have announced for later this year. WHITE But are you therefore hoping in the same way that the government seems to be hoping that individual budgets will save money and therefore you can recommend more relaxed criteria because surely that's the only way this problem could be solved isn't it? PLATT Well what we know is that when people have control of the money they do different things with it to support themselves, for example, carers who are looking after very disabled people are often offered additional personal care which they're quite happy to do themselves and what they want is help with shopping, cleaning and somebody to keep the house okay while they do that personal care for their husband, friend or relative. That care isn't on offer at the moment and when people get control over the budget that's what they spend the money on - it supports them better, it gives them more flexibility and actually it does mean councils can be more relaxed. WHITE And do you think that you've got the freedom in the remit that you've been given to actually change this, I mean would you be able to say to the case we heard earlier this should make things better and you might get your help back in a year's time? PLATT We have been asked to make recommendations to government about how the framework for eligibility should look in future and then all the recommendations are up to them to accept or reject. WHITE Dame Denise Platt from the Commission for Social Care Inspection. BARCLAY Well John Dixon is from ADASS - the Association of Directors of Adult Social Services - and he's director of adult services at West Sussex. John Dixon, this report attacks social services for being unfair and inconsistent in decisions, what Ivan Lewis called wildly different decisions in some cases, on who is eligible for care and who isn't, not just between local authorities but within them, how do you react? DIXON Well I think this is an extremely important report and I would agree it addresses one of the major issues of our time which is how we're going to support people who are older, people who are disabled as well as giving them control over their services. And the minister, Ivan Lewis, is passionate about this and directors of adult social services nationally are very enthusiastic to work with him, to construct a fair system which meets personalisation, and also meets the needs of a hundred percent of the population, rather than the relatively fewer part of the population who are entitled to direct state support. And so yes we do want to work with him to address those inconsistencies and are very glad that he's setting up this review. BARCLAY Are you - you're presumably then - you welcome the review but you presumably think it's going to make a big difference to the way you work, how do you see it, what would you like to see happen? DIXON What we would like to see happen, first of all, is arrangements constructed for the new world. We're working with the Department of Health about personalisation, about giving people control over their budgets, about giving people a much greater say and you heard Denise Platt talk about the use the people can make of resources when they have direct control over them. And we want to construct with the minister a system which meets people's needs in this way and gives people control over their services so that the review must be for the future, rather than for the last century. But it needs to be fair, it needs to be transparent and it is very important to accept that there will be differences in different parts of the country, I wouldn't necessarily always say there are inconsistencies, people are - people elect their local councils and their local councils have different priorities, the question is how much - how much should be people entitled to across the country allowing for the fact that of course things will need to be different in one area than another, because that's what local people want. BARCLAY Well what about this whole question of means testing, can we come up with a system that scraps means testing? DIXON No, I don't think so and the Department of Health doesn't think so either. There's been means testing for social care since 1948 and it's a major part of the funding of the whole system and I think people accept that means testing is reasonable. What people want to know is can we have a fair system and can we have a transparent system so that people in one part of the country or other know where they are and how much they might contribute. And that's part of the new system around personalisation that we agreed with the minister that would be working on when we signed an agreement just before Christmas. BARCLAY But isn't the nub of the matter simply that greater funding is required? DIXON Well we would say and I'm sure the minister would say that there is not enough money in the system. The number of older people in particular is growing fast, the expectations that people have is growing. And that's why the Department of Health has also announced a green paper to look at the whole issue of funding and that's going to be doing work over the next year or so. And yes we think that probably will lead to a greater slice of the national cake. But it's also important to get fairness into the system, even with the money that we've got and it's important to use to the best as we can the resources that we have already in the system. BARCLAY John Dixon, thank you. And just a reminder that our care series ends in a live programme, as Peter said, this Thursday with a studio audience in the 成人论坛 Radio Theatre here in Broadcasting House in London. Now if you'd like to be in that audience and have a chance to put your questions to the care minister, Ivan Lewis, there are details available through the You and Yours website, you can also find a link there to the Care in the UK website which has more information and it links to other useful organisations. You also have a chance to have your say through e-mail and our message board, just follow the links to You and Yours through the Radio 4 website, where you can also listen again to some of that care series. 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