The third Care & Support Alliance Care and Support: Decision Time debate took place on Monday 3rd October at the Conservative Party Conference. Here’s what happened:
19:00 – Sam Lister, Health Editor of The Times, starts the debate by introducing the panel:
- Imelda Redmond CBE, Chief Executive of Carers UK and Chair of the Care & Support Alliance
- Richard Humphries, Senior Fellow at the King’s Fund
- Andrew Dilnot CBE, Economist, Pro-Vice Chancellor of Oxford University and the man charged with the Government’s independent Commission on the Funding of Care and Support
- Rt Hon Stephen Dorrell MP, Chair of the Health Select Committee and former Health Secretary.
Sam Lister thanks the Care & Support Alliance a ‘powerful and prominent voice on social care’ and thanks sponsors Tunstall and Barchester Care. He reads an editorial in the British Medical Journal, which explored the ageing population and the improvements in medicine which leads to longer lives – but asked why the social care system is failing families?
19:04 – Sam Lister says that there has been new movement on social care recently, culminating with the Dilnot report. He missed covering the report because his first son was born on the day the report was released – he jokes he considered the name Dilnot.
Michelle Mitchell, Charity Director at Age UK asks the first question – beyond Andrew Dilnot’s recommendations which would cost £2 billion, what about the huge current needs of older and disabled people which aren’t being met?
19:07 – Andrew Dilnot answers that we must fund the system now and in the future. But it is no use just throwing money at the current system – the system has been broken since the 1960s. We need fundamental reform. He argues that the £2 billion cost is possible, it is one 400th of public spending, one 800th of the national economy. Can we not manage to spend this money on such an important issue? As a result, he is sure it will happen!
Sam Lister throws the question to Stephen Dorrell – is it going to happen?
Stephen Dorrell responds saying that the Dilnot report would deliver a fairer way of enabling people to pay care charges, and would bring more private sector funding into social care. However this is only one part of the solution. He believes there is no one solution to this decades old problem. There can be no solution so long as social care and health care are seen as so different. What we would all want is ‘integrated care’ as the divisions between health and social care are irrelevant to families, they just want good care.
19:12 – Stephen Dorrell ends by saying that the rhetoric of integration must be delivered on.
Sam Lister asks why the current Health and Social Care Bill hasn’t been an opportunity to deliver on integration? Stephen Dorrell says that the Bill has changed a lot since it was a White Paper, many changes which has moved in this direction.
Richard Humphries argues that this debate seems to have gone on forever. But whilst we discuss it endlessly the demographics are changing rapidly and getting away from us.
Asked about unmet need, Imelda Redmond says that the care sector has been aware of huge unmet need for a long time. Dilnot’s report is an answer to how you pay for care, but we’ve never claimed that how we pay for care is the only problem with the system.
19:18 – Anthony Houlden from National Autistic Society asks, when social care impacts on a whole host of other issues, why aren’t other Government departments aren’t asked to pay.
Stephen Dorrell says it is a fair point but unlikely to happen for most departments, however housing policy, he argues, is very relevant and must be considered alongside to social care.
Sam Lister asks why, if money can be found for bin collections, why not social care? Stephen Dorrell responds saying that arguing about political priorities isn’t going to deliver on what we want, particularly on spending the money we currently have better.
19:22 – Simon Chapman from National Council for Palliative Care asks how we can generate momentum from the public for urgent reform?
Imelda Redmond says that this question has dogged the care sector for a long time. ‘Social care’ is jargon – it isn’t real to families, who see elderly parents, disabled children and ill partners. To be fair to the public, why would you learn about about it unless you need it? People buy into the NHS because they touch it at different points in their lives, the NHS has a logo – there is nothing to unite the different parts of social care. We shouldn’t be unrealistic about the public understanding social care. But we must find a way of getting it on the agenda.
Richard Humphries argues that if you total up carers, people who use social care services and people who work on social care it is over a quarter of the population who are touched by social care. Yet we still don’t get traction. We need a wider social movement for change.
Sam Lister wonders if, sadly, the most progress has been made, has been made through crisis moments and scandals, because they generate the press? He asks Andrew Dilnot what lessons he learnt from compiling his report?
19:30 – Andrew Dilnot says that when you’re 65, you have a 75% chance of needing care. Yet there is nothing we can do to plan for it, insure against it, because the system is so broken. He is very frustrated also by the discussion of care as something which relates only to the end of life or inheritance. Actually care and support can allow people to lead fulfilled lives, should promote independence and aspiration.
Sam Lister ask what the solution is – perhaps to teach ‘grandparent studies’ in school – questioning how we get the public on board.
Andrew Dilnot says that we need leadership from politicians. He says that actually the Coalition Agreement is quite bold on social care, it needs to be delivered on.
Sam Lister says that there was discussion, when the Dilnot report was published there was talk of ‘strangling it at birth’ because of the cost. Stephen Dorrell responds that the discussions are ongoing, so if there was an attempt to kill it off, it didn’t work. He believes that public understanding would improve if health and social care were integrated into a more comprehensible system.
19:36 – the problem is the NHS policy is designed around the vision of patients who are generally healthy who fall ill, get treatment and are cured. This represents only 10% of patients. We need to redefine health care to properly cater for the reality health service face.
A Conservative Councillor asks how we can ensure that funding for social care isn’t hijacked for health care. A party member who runs care homes, asks if it is possible to ringfence social care funding?
Imelda Redmond says that Carers UK has always favoured ringfencing, so that carers funding actually reaches carers. But Government has made it clear this argument is lost. She says that actually we need to move resources, if we want care at home there will be difficult choices to be made. If we want it politicians will have to be brave, and the public will have to accept things like hospitals closing.
Richard Humphries praises the transfer of £1 billion from the NHS to social care, as it makes NHS managers think more about care services. He says that there is a quandry, Whitehall shouldn’t decide how to spend care funding in Cornwall or Coventry, but we don’t yet give local people a real say in decisions.
Ali Rogan from Tunstall asks why our system doesn’t have prevent at its heart?
19:45 – Andrew Dilnot argues for personal choice, families deciding and getting what they want, rather than social care commissioners deciding. People simply don’t have a choice about their own care.
Stephen Dorrell agrees, but says that personalisation isn’t the answer to prevention. We must provide services which intervene early to avoid unnecessary hospital admissions. The National Audit Office says that 30% of non-emergency hospital admissions are avoidable, that is a pretty big pot of cash. If you sort this out you’ve cracked this £2 billion funding problem. That’s why he wants integrated budgets, so commissioners look across health and social care and deliver services to solve challenges for both.
19:49 – Imelda Redmond quotes Professor Heinz Wolff, saying that we the technology is there to support families, we can stop inventing it and start delivering it to families.
Julia Unwin of Joseph Rowntree Foundation, says that for the first time in her life there is consensus on the need for reform. But what is the Treasury’s thinking.
Richard Humphries says that the Treasury is clearly willing to ease the purse strings when there is the political will: two examples this week are £250m for bins collections, £850m for a freeze on council tax – we need a compelling argument to state why social care investment needs to be further ahead in the queue. This must be an economic argument – the returns for families and the economy are very good for social care.
19:58 – Stephen Dorrell, a former Treasury Minister, says that it is right that Treasury challenges requests to spend more public funds. We need to prove that funding is needed, but admit the ‘dirty fact’ that lots of money is wasted in health and social care.
Steph from Barchester Homes and Steve Winyard from RNIB ask why we aren’t making more progress, we need a very powerful, broader coalition. What do we need to do to deliver it. Moira from PRTC notes that the medical profession is listened to, why not the social care profession?
Imelda Redmond, says that it is extraordinary that for the first time there is a great deal of agreement across the voluntary, private and local government sectors. We need passionate political leadership, from politicians who want this to be their legacy. The Care & Support Alliance isn’t going to go away or go quiet, but we need to take our campaign to another level.
20:05 – Sam Lister rounds up noting that we need people to remember this as the turning point for care and thanks the Care & Support Alliance and sponsors Tunstall and Barchester for hosting the event.
That’s it, thanks for tuning in and for everyone who tweeted!