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Paying for Care Team
Older People and Long Term Care
Welsh Assembly Government
Cathays Park
Cardiff CF10 3NQ
Date: 27th February 2009
Dear Steve
Paying for Care in Wales
Thank you for the opportunity to comment on the consultation ‘Paying for Care in Wales’. We understand the complexities surrounding this topic and are pleased that the Welsh Assembly Government is tackling this issue and addressing dissatisfaction with the current way of working.
Three main principles should underpin the provision of social care in Wales: clarity, simplicity and fairness: clarity over entitlement, simplicity in the system and a fair service. Currently, there is too much disparity in the quality of service between different local authority areas. There needs to be a universal standard for services across local authority boundaries in order to achieve equality of outcome. The method of delivery may vary across boundaries; factors such as the rural or urban nature of the local authority may be relevant. However, the outcomes of provision must be the same for people with similar needs throughout Wales.
The basic fact is that most of us will experience the system, either ourselves or through close family members, and it is imperative anyone in need of care is treated with dignity and respect.
Sharing the responsibility for paying for care
There needs to be a balanced approach to responsibility in the new system. It needs to be made clear what will be paid for by the state and what should be deemed personal choice. Providing information to consumers on what they can expect to be funded by a local authority can help them make a more educated choice on their care options.
Equity Release
As highlighted in paragraph 4.11, issues linked to equity release must be recognised, especially if the asset threshold is to be increased. There has been distrust of equity release schemes in recent years, and the Welsh Assembly Government needs to work with regulators in providing information to older people who require equity release to pay for their care.
Choice
Although the consultation paper acknowledges the right to genuine choice in choosing care, this is not always possible. Some areas, particularly remote rural areas, simply may not have a range of services and service providers available.1 This needs to be acknowledged as a real barrier to the principle of user choice and the implications it may have for the quality of care. Mapping gaps in care provision will give service providers a picture of priority areas for service development, for example through outreach services, providing transport services or flexible community based services. There are a wealth of good practice examples available in the Joseph Rowntree Foundation report of the Older People’s Inquiry into ‘That Bit of Help’.
Additionally, it does not elaborate on people’s rights when in the system. If there are changes in care arrangements or care systems within a setting, those directly affected have a right to be consulted on the personal implications for them.
Disadvantaged Citizens
The consultation paper doesn’t mention particular individuals and groups that may be at a disadvantage, a principle strongly aligned to our own thinking. For example, BME communities are often treated as if they are homogenous, when in reality they comprise of a variety of cultures and faiths as well as differing attitudes of the younger and older generations. The issues discussed in the WAG document Challenging the Myth, such as language considerations when publishing information, could be reconsidered at this point to ensure any potential changes to the system are articulated to all affected.
We would also urge the Welsh Assembly Government to consider the variations between private care home contracts and the impact this has for consumers. Both the OFT2 and the Commission for Social Care Inspection3 highlight the unfairness, lack of transparency and unnecessary complexity that arise with care home contracts. Older people should not be at a disadvantage or be financially vulnerable as a result of a lack of consistent standards in contracts.
Carer rights
As mentioned in the consultation document, further support is needed for carers as the burden, especially as the burden on unpaid carers is likely to increase. In particular, greater support and investment is needed for informal or voluntary carers, as they may not necessarily be aware of their rights and if support is available to them. This could include more information and increased respite access, such as the service provided by the Blackpool Borough Council Primary Night Care Service4 or the Age Concern service ‘Link-Up Carers’ that provides network support for carers.5
Information and Advice
As a general principle, advice and information services on care services, entitlements, rights and allowances should be widely available and easily accessible. This not only applies to older people, but also younger, disabled people who may be in need of greater levels of care, as well as the families and carers of those receiving personal care. This could be supported by a 24hour helpline for advice, support and information, as used by the ‘Friends of Senior Citizens’ organisation.6
Seamless care
The individual should always be at the centre of the care system. Previous ways of working have meant people facing barriers when moving between health and social care services, especially with continuing healthcare. Particular problems with accessing equipment or who pays for adaptations have been long standing issues that have caused distress for some individuals within the system.7 Any new system should put in place mechanisms which ensure that any disputes about responsibilities for the funding of care do not adversely affect the individual. It must be ensured that arbitrary boundaries relating to care in other settings, such as health or education, are reduced to a minimum. The system must be co-operative and transparent to limit the possibility of the service user stumbling upon obstacles when on a pathway of care.
Although we are able to provide comments on some of the more specific issues, we feel the big questions remain unaswered. These are clearly very complex issues, and it is almost impossible to weigh abstract principles in the absence of information on the consequences of choosing one over another, including costs. While the Assembly Government is to be congratulated in seeking to stimulate public debate in this vital area, it should not be seduced into thinking that this document - or even the promised Green Paper - is in any way sufficient for this purpose. We would therefore strongly urge the Assembly Government to initiate a more inclusive and informed public debate, in which citizens are enabled to think through the implications of different approaches for the people concerned, and take into account the informed views of both current and future service users. A combination of strategies would be useful, including perhaps a deliberative process such as citizens juries.
Yours sincerely
Vivienne Sugar
Chair, Consumer Focus Wales
Cadeirydd, Llais Defnyddwyr Cymru
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