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Independence Day 2011

We have heard a great deal about the Dilnot report this month but in looking through the coverage in the press I’ve not seen a great deal of space given to the thoughts of those who are right up at the coal face in all of this - I refer of course to the care providers.

I feel strongly that the opinions of the care providers are massively important to the implementation of the outcomes of the now anticipated white paper. Without care providers we would have no care system to fund and the events at Southern Cross cannot fail to bring home the implications of funding constraints on care providers whatever business model they follow.

I have asked Roger Wharton, Executive Officer of our local Somerset ‘Registered Care Providers Association’ for some feedback. Roger attended the launch of the Dilnot Report at the Central Hall Westminster and has put some of his thoughts together for me. I would like to share them with you.

Dilnot.

“I met with Tim (Anstee) and loads of people from Partnership, cornered Dame Jo[i] from CQC, Peter Hay Chairman ADASS[ii] and others during the course of the day with some useful feedback from all of them. Of course any conversations were as a representative of care providers.

To summarise what was a long day with a variety of speakers, all with a leaning towards the theme of the day – Independence – I would say that the general consensus amongst and between all of the high level speakers was that there is a strong case for change and support for the recommendations that have come out of the Dilnot report. Several attempts have been made in the past to grasp the nettle of funding for Adult Social Care but for a variety of political reasons there has not been sufficient appetite to follow through.

This is a ‘final’ opportunity to grasp the nettle and there seems to be general cross party appetite to do so. The Shadow Social Service Minister, Emily Thornbury certainly made this clear, as did the Chair of the Health Select committee, Stephen Dorrell. The terms of the report are now well known so I won’t go into them here. Suffice it to say that the general principle is almost universally accepted but there will inevitably be elements contained in this that will be essential to success in delivering it.

One major concern is the possibly unintended consequence of effectively taking the 60% self funders into the state funded system once they have used up their allowance of £35000 plus hotel costs. As a self funder they are at liberty to choose their care whether at home or in residential care. Once their allowance is spent, will the Local Authority then say they will have to change their carers or move between residential homes to a cheaper option or pay the higher charges that the  service user was already paying? The latter is unlikely but with this increasing exposure to providers of a lower income then, inevitably, they will go out of business. It is therefore crucial that the self funders should be allowed to personally top up the state fee to the self funder fee to forestall a change of care home or carer at home. Under current legislation only third party top ups are allowed.

Secondly, timing. If the momentum is allowed to slip, this issue will be at risk of losing its way again. It is crucial that Government openly undertakes to set this into legislation (whether primary or secondary) in a given timescale. The thought at the conference is that this is achievable by next summer.

Thirdly, the strength of the personalisation agenda is such that if this continues there is danger of creating the mindset that residential care is no longer a solution. Commissioners will begin to avoid this as an option even for people with high needs. Care homes will suffer by default and capacity will reduce. The reality is that demographics alone will increase demand for care home beds, especially for dementia sufferers where overnight attention is necessary. Safety must be an integral ingredient in the assessment process, not cost.

And finally, a common and transferrable assessment process must be delivered which obviates subjectivity. Eligibility must not vary across the country.

Putting all this into context. The £2bn bill represents a quarter of 1% of public spending and 3% of the NHS budget.

Roger Wharton is the Executive Officer of the Registered Care Providers Association (RCPA) in Somerset, a retired RAF Officer, he ran his own nursing home in Yeovil until 2006 and in his RCPA role looks after the interests, views and concerns of care providers in the county.

[i] Dame Jo – Dame Jo Williams is the Chair of the Care Quality Commission

[ii] ADASS – Association of Directors of Adult Social Services


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