AGENDA ITEM 5

BOROUGH OF POOLE

HEALTH AND SOCIAL CARE SCRUTINY COMMITTEE

1 SEPTEMBER 2009

REPORT OF THE INTERIM DIRECTOR FOR ADULT SOCIAL CARE ON THE CARE AND SUPPORT GREEN PAPER AND

THE TOTAL PLACE PILOT

1. PURPOSE OF REPORT

1.1 To inform Members of two major policy initiatives that will impact on both health and social care agencies locally.

2. INTRODUCTION

2.1 'Shaping the Future of Care Together', the Green Paper on the vision for a new care and support system, was presented by the Secretary of State for Health, Andy Burnham, MP, to Parliament on 14 July 2009. The paper recognised that as people live longer their need for care and support increases. The current care and support system was designed in the 1940's and there is a requirement to develop a system that fits our needs in the 21st Century. Clearly, this paper will impact on the future design of services and require consideration by Members and officers on how to respond by the consultation deadline of 13 November 2009. The government will use the consultation to inform and finalise their proposals in a White Paper on care and support in 2010.

2.2 On 30 July 2009, the Government announced, via the Secretary of State for Communities and Local Government (John Denham, MP), the successful pilot sites for testing Total Place. This is an ambitious check on the use of public money to ensure every pound spent is delivering value for money and putting customers first. This is starting across Dorset, Poole and Bournemouth. The work could radically change the way services are delivered by examining all the spending going into an area, cutting bureaucracy and making the best use of resources.

3. CAREANDSUPPORTGREENPAPER

3.1 During 2008 the Government ran a six-month engagement process seeking views on the challenges faced for the future and problems within the current care and support system. The Green Paper offers several options for debate around how a new national care service can be built.

3.2 Care and support describes the activities, services and relationships that help people to stay as independent, active, safe and well as possible.

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This ranges from family and friends to state-funded support such as care in their own home or a care home, financial support from the benefits system and help with housing.

3.3 Our existing social care system is regarded as a legacy, not a single bold reform like the creation of the NHS but a series of more limited and incremental steps. Some people qualify for support through disability benefits but, until now, the state has provided social care only to people on low incomes who cannot afford to pay for themselves. Those who can pay for themselves have been expected to do so with no support from the state; sometimes having to use their savings or value of their of house to pay for care until they only have £23,000 left. This is often seen as unfair.

3.4 It is regarded nationally that our existing system makes poor use of its limited resources and that money could often be better invested in prevention, rehabilitation and keeping people active and healthy. This very clearly links to the aspirations of the Total Place pilots.

3.5 The Government believes there are six things that everyone in the country should be able to expect:

  • right to support to help you stay independent (prevention);
  • right to have your care and support needs assessed in the same way wherever you are (national assessment);
  • services will work around you and work together more smoothly (a joined-up service);
  • you can understand and find your way through the care and support system easily (information and advice);
  • services you use will be based on your personal circumstances and need (personalised care and support);
  • everyone who qualifies for care and support from the state will get some help meeting the cost of care and support needs (fair funding).

3.6 The Government would like to see; greater joined up working, a wider range of services in care and support, better quality and innovation and it also identifies options for the future funding. There are five options identified:

  • Pay for yourself - this is ruled out because it would leave many people without care and support;
  • Partnership - in this system, everyone who qualifies for care and support would be entitled to have a set proportion, for example a quarter or a third of their basic care and support costs paid for by the state;
  • Insurance - in this system, everyone would be entitled to have a share of their care and support costs met, but people could elect to pay an additional insurance scheme to cover their share of the contribution;

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  • Comprehensive - in this system, everyone over retirement age who had the resources to do so would be required to pay into a state insurance scheme. This would entitle them to state funded basic care and support. No further call would be made on their savings;
  • Tax-funded - in this system, people would pay tax throughout their lives which would be used to pay for all the people who currently needed care. This is ruled out because it places a heavy burden on people of working age.

3.7 The Government believes that the care and support system should be fair and universal. Moving to a universal system has important consequences for the way in which care and support works across England; especially for the way in which money for care and support is raised and spent. The government proposes to have a national assessment process and determine what proportion of someone's care package would be funded by the state. Beyond this there could be two different approaches:

  • A part national, part local system. In this system, people would know what level of support they were entitled to and what proportion will be state funded but local authorities would be responsible for deciding how much an individual should receive to spend overall on care and support;
  • A fully national system. In this system the Government would decide how much funding people should get, instead of local authorities. This system would require all funding to be raised through a national taxation scheme rather than through Council Tax.

4. THE TOTAL PLACE PILOT

4.1 Dorset, Poole and Bournemouth is one of 13 pilot sites who will scrutinise spend, impact and any overlaps or gaps in the theme:

  • to help improve services for older people through better collaboration and drawing on the experiences of their customers;

The themes across the 13 pilot sites are varied from children's health and well-being to how resources are used towards housing to help regeneration.

4.3 A consultant has been appointed from the list approved by the Leadership Centre for Local Government to act as Project Director, paid for from the pilot funding.

4.4 The theme is services for older people and in the first phase four work streams have been identified:

  • Integrated delivery and interagency collaboration in the provision of

services and support for older people;

  • Inverting the triangle of care and self- spend and personalisation;
  • Support services;
  • Access to non-emergency advice and support.

4.5 A small team has been put together to lead and manage this project which is accountable to a Project Board made up of the Chief Executives or equivalent of the participating organisations.

5. CONCLUSION

5.1 The Green Paper on the vision for a new care and support system at the very least highlights future policy direction and potentially could radically alter the funding and delivery of social care.

5.2 The Total Place pilot compliments the direction in considering how resources are used across agencies to meet a given community's needs. There will also be a resource requirement in terms of lead officer input over the next six to nine months to fulfil the expectations of the national programme between Dorset, Poole and Bournemouth agencies.

Harry Capron, Interim Deputy Director of Adult Social Services

Background Papers:

  • 'Shaping the Future of Care Together'. The Green Paper on the future of care and support, 14 July 2009, HM Government;
  • Total Place, project initiation document, 8 July 2009. Project Sponsor, David Jenkins, Dorset County Council

Contact Officers: Harry Capron, telephone 261030 John Dermody, telephone 261132

13 August 2009

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