Consultation document on Government White Paper:
Our health, our care, our say
A new direction for community services
Prepared by Peter Tihanyi, Head of Policy, Operations
Introduction

Along with other leading advocates for national social care, we are invited to make recommendations on the proposals within the recently-published White Paper on social care and health.

The White Paper, published January 30, 2006, has a section on carers. The Trust welcomes the Government's emphasis on a new deal for carers but is mindful of the mechanisms that need to be in place to ensure the proposals will be implemented at local level.

The four key aims of the White Paper are:

·  Better health, independence and well being for service users

·  More responsive services and better co-ordination between health and social care

·  Better support for those with the greatest need to live independently

·  More services available closer to the community

· 

The following document thus summarises the critical chapters most relevant to carers.

There is a twelve week consultation for this White Paper and we would welcome your general views and specific responses to the questions under each chapter heading and, where possible, the views of carers. We will send a co-ordinated response with recommendations to the DoH by end March 2006.

Please send your comments to or for further clarification ring 020 7709 1308. For hard copies of the White Paper, order online at The Stationery Office (TSO) 020 7219 3866 or visit http://www.tso.co.uk/bookshop. An executive summary is available at http://www.gh.gov.uk/ourhealthourcareoursay.

Chapter 1: Our ambition for community-based care

This area describes the consultation contents from both the Green Paper Independence, Well-being and Choice and the pre-White Paper public consultation: Your health, your care, your say. It describes the challenges for health and social care and the new strategic direction which includes:

  More services in local communities closer to peoples homes

  Supporting independence and well-being

  Supporting choice and giving people a say

  Supporting people with high levels of need

  A sustained re-alignment of the health and social care system

  Support for the active engaged citizen

Chapter 2: Enabling health independence and well-being

Targets in this chapter focus on specific groups: children, people of working age, older people, disabled people and those with high support needs. The proposed NHS Lifechecks will help those at critical points assess their own health risks. There will also be an emphasis on improved emotional well-being by the publication of manual and self help programmes. The roles of Directors of Public Health and Directors of Adult Social Services will also be strengthened to reflect this committment. There will also be a new appointment to the Depatment of Health’s Board which focuses on social care.

Feedback:

iof Adult Social Services.

 Comments on the appointment of a Director for Social Care on the Board of the Department of Health.

 What are your views on the NHS “Life Check”, with particular reference to those patients who are also carers?

Chapter 3: Better access to general practice

This chapter focuses on how best to help service-users register with their GP of choice and sets objectives in offering greater access to healthcare professionals. There are also provisions in making GP services more equal and in allowing greater funding allocated to patients. Ideas suggesting the funding of NHS walk-in-centres and the giving of service-users more information on local services have also been put forward.

Chapter 4: Better access to community services

This section discusses giving service-users more choice and control over their health care and features the 2001 legislation which governs direct payments to parents of disabled children. Changes to the law in making direct payments means councils are now assessed on the take-up of such payments by the Commission of Social Care Inspection.(CSCI)

Individual budgets however are a new approach. Thirteen pilots, beginning 2006, will develop tailored budgets for older and disabled service-users. The pilots will run for 18 months to two years and if successful will form the spearhead of a national implementation that could begin in 2009/10.

The rest of the chapter deals with developments of health services in the community. It discusses community pharmacies and rapid access to sexual and mental health services as well as a new approach to cancer screening. Pilots to evaluate access to allied health and therapy service, concentrating on a self-referral system to physiotherapists, are also proposed. The improvement of access to services for vulnerable groups including teenagers, those with learning disabilities, offenders, the elderly and end of life care is also discussed.

Feedback:

 Should direct payments be increased for carers' services?

 Should carers have some say in how the person they care for individual budgets is used and or spent?

 Should individual budgets be extended to apply to carers’services?

Chapter 5: Support for people with longer term needs

This chapter contains a specific section on carers.

With over 15 million people with longer-term health needs, a high percentage of NHS resources rightly goes towards their support. This section therefore discusses appropriate methods for empowering service-users in gaining better access to information and care plans. New support measures include:

·  Updating and extending the Prime Ministers’ 1999 Strategy for Carers which will reflect development in carers rights building on the Carers (Equal Opportunities) Act 2004.

·  Establishing an information service/helpline for carers (potentially run by a voluntary organisation by 2007/8)

·  Establishing short-term, home-based respite support for carers in crisis or emergency situations across all local authority areas for full implemention by 2007/8

·  Allocation of specific funding for the creation of an Expert Carers programme which will be modelled on the Expert Patient Programme, the space allocation for which (it is proposed) will be increased from the current 12,000 places a year to over 100,000 by 2012

·  The appointment of carers leads in both social care and health

·  Ensuring that those who request a personal health and social care plan will have their needs taken care of by 2008

·  Ensuring all those with a long-term condition are offered a care plan

·  Providing technology to improve care in the home

·  Ensuring good community and healthcare facilities assist in the reduction of acute hospital use

Feedback :

 Please give us your views on how the Carers Strategy should be up-dated?

 How can carers’ health and well-being be promoted?

 What do you think are the particular health needs of young carers ?

 What do you think of The Trust forming a joint partnership to tender for the national helpline?

 How do you think your centre can link into a National helpline and provide carers who ring with relevant local information?

 What elements should be involved in creating an Expert Carers' Program? Would your centre help in devising such a program?

 What forms of emergency home-based respite care would your carers find most helpful?

 Who should appoint a carers lead in the statutory services? What position should they hold? What should their role primarily consist of? What do you think of the idea of all cared for people with a long-term condition having an integrated care plan?

Chapter 6: Care closer to home

This chapter discusses providing specialist care more locally . The DoH is working with the speciality associations and the Royal Colleges to define clinically safe pathways that provide the right care in the right setting. There is a commitment to have demonstration sites in six specialities to define appropriate models of care in 2006/07 (time of study 12 months). There will be a shifting of resources, particularly the growth in health spending which is to be directed more towards preventative primary, community care and social care services.

Feedback:

 Would having a range of specialist services closer to home have a big impact on carers?

Chapter 7: Ensuring the reforms put people in control

This chapter discusses ideas and the services that engage citizens and respond to their concerns. Local authorities will be called upon to develop the market in offering a broader range of services to meet the needs of an increasingly elderly and culturally rich population. Strengthening local capacity through the close interaction with providers will help develop strategic workforce plans.

There is a commitment in this chapter to providing the first programme of a national commissioning framework by summer 2006 and with subsequent parts allocated later on in the year. Finally, the development of the voluntary sector includes proposals on developing a Social Enterprise Unit and from April 2007, the DoH will establish a fund to provide advice to social pioneers wanting to develop new models to deliver health and social care packages.

Feedback

o  What role can the Network play as social entrepreneurs?

o  What infrastucture and support mechanisms need to be in place to enable Carers' Centre to successfully tender and deliver health and social care packages at local level?

o  How can The Trust support the Network in this direction?

Chapter 8: Making sure change happens

This chapter discusses the need for high quality information. During 2006 the DoH will review the provision of health and social care information to ensure that people who use the services have the information they need in the format they need it. They will do this in partnership with service-users and their representative organisations. Chapter eight also debates the fundamental changes in developing better integration between the NHS and social care. Key to this will be the joint service and workforce planning dovetailed into service planning. It is essential for carers to understand the services that are available in order for them to make an informed choice. Competencies for workers specifically trained to help individuals with health or social care needs will be developed by the DoH who will ensure, it is proposed, that the competencies are built into other key roles to aid service-user support.

Feedback:

 Please give us any ideas you have about how information can best be given to patients and carers both as patients in their own right and also in their carers role?

Appendix B: Independence well-being and choice

The vision for social care for adults in England is presented here. It is a vision for all adults and people who care for or support other adults. It recommends that services should be person-centred, seamless and proactive and that independence not dependence should be essential in terms of support. To achieve these aims the local authority and Director of Adult Social Services will have a key strategic and leadership role and will work with a range of partners including Primary Care Trusts and the independent and voluntary sectors.

Deadline for consultative feedback by Monday, March 20, 2006

The Trust will make comments to the DoH end March 2006. Email your views and recommendations to

ptihanyi.27.2.06.policy/white paper