Fundamental reset for social care?

It would be remiss of any of these individuals not to advise families ... so often they do not and then is is often misinformation.

If anyone needs the precise criteria for CHC, they can be found here: www.gov.uk/government/publications/nhs-continuing-healthcare-checklist
Or contact beaconchc.co.uk who will advise over the phone for a particular individual ...it's free.

"As an aside- for DAR- 12 care domains- you can see the extent of detail and comprehensiveness of the assessment. But is it not a legal process it is a care assessment process."

I do understand that LemonJam. Thank you for clarifying; I certainly didn't want to mislead anyone. What I was trying to convey was that it's something most of us don't have to deal with so may feel out of our depth - that would be normal. That it is structured and that the people dealing with it will understand it in the way someone understands there own job. That there are sources of help (free and paid for) that it may be helpful to use.

I'm still interested in thoughts on the original question - "What should adult social care actually look like, and how should it be paid for?"

By the way Beacon CHC is funded by the government to provide the public with advice on applications. It is free, unless you ask them to actually take your care on or launch an appeal then they charge. But if you just need to know if someone should apply they will give good advice for free and tell you what to do next.

When I had to appeal my OH's refusal I organised the appeal myself but was able to run it past Beacon beforehand for no charge. If you ask them to take on the appeal themselves then there is a charge.

Feeling overwhelmed- I agree DAR- at the beginning of the process is entirely understandable and usual for families. I also understand husbands and wives of patient ma be elderly themselves and stressed and tired re their loved one in care home. Daughters, sons and or friends need to step in to help where they can if around. If not entirely understandable why people turn to legal firms.

But it is doable with a lawyer. All the lawyer can do is. gather evidence and write a slick appeal submission document. Trust me- they use a template, it's not onerous really and they have no knowledge of the patient. I spend time at many IRP meetings refocussing lawyers away from their legal jargon back to the assessment questions and care need evidence the panel is looking for.

What family's really need is:

1) a good explanation by ICB of the process with a written leaflet
2) a copy of a blank DST assessment document from the ICB to understand the process and questions asked for the care domains1)
3) to keep a diary over a few weeks of your loved ones care needs form your observations during care home visits and discussion with the carers- matched to the assessment questions in the care domains
4) to attend the DST assessment, with the diary observations and chip in with those observations of their loved one in each of the relevant care. need domains
5) ask a carer form the care home who knows patient to be present also
6) ask the DST Nurse assessor and Social worker assessor to record family and carer comments verbatim in the DST document.

Having a calm, logical friend or a relative who is comfortable with detail to guide the family through this is a huge asset. Someone who can write simple, plain English family observations for each care domain to put forward as an appeal document if initial assessment does not find eligibility is an asset. Much much cheaper than a solicitor.

Such a simple document would be warmly received by an Independent Review Panel and *would bear more weight than the legalese template submission documents from a lawyer.

Luckygirl3

By the way Beacon CHC is funded by the government to provide the public with advice on applications. It is free, unless you ask them to actually take your care on or launch an appeal then they charge. But if you just need to know if someone should apply they will give good advice for free and tell you what to do next.

When I had to appeal my OH's refusal I organised the appeal myself but was able to run it past Beacon beforehand for no charge. If you ask them to take on the appeal themselves then there is a charge.

Absolutely agree Luckgirl.

In my experience Beacon would be destination of choice to help family's understand the process if they cannot manage alone. Much, much better than Hugh James and better than Compass CHC.

Well done you for organising CHC appeal 👏👏👏

As to the question of how care should be both funded and organised, the basic problem, apart from the intrinsic complexity, is that any government who picks up this poisoned chalice is going to get clobbered at the ballot box, because there will be winners and losers and likely more tax. They know this - which is why it gets kicked down the road all the time!

I think it is important that the false distinction between health and social care should go somehow, both on a practical and a financial level.

As long as there are competing financial interests between the health authorities and the local authority social services departments this chaos will continue.

It seems to me that if for instance someone at home needs help then the relevant people should be sent in whether they are wearing a health or a social care hat and that the means of paying for this should be uniform. Ditto if in residential or nursing care.

The dialogue (a nice neutral word!) between these two is responsible for a great deal of bed blocking as setting up care can get delayed.

There is often a very fine line between what is social care and what is medical - at the extremes it is obvious, but in the main there is a mixture of both and in the end that should not matter or be a consideration in providing what is needed. These crazy minutely-detailed assessments that take up time and money (and generate canny lawyers' involvement as they see a chance to make some dosh!) need to go.

The truth is that at present however hard people try to create foolproof assessment criteria there is still an element of interpretation and the iniquitous postcode lottery holds good.

Good professional assessment of needs by both health and SSD should be done for each person for the purpose of ensuring that their needs are met, rather than to decide who pays.

If there were an overarching payment system for all this then the costly and time-consuming layer of assessment could go.

DaisyAnneReturns

I'm still interested in thoughts on the original question - "What should adult social care actually look like, and how should it be paid for?"

It's a tough one because of the costs involved.

Social care would I guess look like it is now and as set out in the NHS CHC Framework document. That is any continuing care need that is not a professional health care need.

The. simplest way perhaps would be an insurance based model, perhaps with a ring fenced dedicated NI contribution during working lives to build up the pot necessary to fund Social Care.

Someone else has mentioned current late middle age. already STATE PENSION age popped have not paid into such a. scheme- so perhaps levy a % proportion on estate at death on a sliding scale downwards from those already over SP age downwards to a middle age threshold?

It needs a bold plan, with some options therein and cross party working and engagement. The electorate would need understand this is not a lefty problem, not a quick fix problem, has costs, not shoot down incumbent cabinet bold plan in the media, but all to engage over a period to agree a solution.

propped = people

A joint system between health and SSD was tried here many moons ago as a pilot project - it was not a success as interests were too entrenched on either side.

It needs a national solution with one local funding pot for care, whatever its nature.

It definitely needs a national solution- the fundamental issue is how can the pot be funded?

Ah yes - how can the pot be funded!?

That's the critical question ......

I asked Chatgpt about whether funding is more integrated in Europe and this is what they came up with ....

The short answer is yes, in many European countries health and social care are funded or commissioned jointly to a much greater extent than in England, although the exact model varies enormously. England is actually something of an outlier in having such a sharp divide between NHS healthcare (free) and means-tested social care.

They went on to provide more detail which I can paste if people are interested.

Let us hope that Casey is looking at examples from other nations.

This for instance .....

The Scandinavian model

Denmark is often regarded as the gold standard.

Older people are supported at home for as long as possible. Municipalities are responsible for:

home care
personal care
rehabilitation
nursing care
equipment
housing adaptations

District nurses, therapists and care workers work together as one local service. The municipality receives tax funding to provide both health-related community services and social care, so there is much less argument over "whose budget" something belongs to.

Luckygirl3

As to the question of how care should be both funded and organised, the basic problem, apart from the intrinsic complexity, is that any government who picks up this poisoned chalice is going to get clobbered at the ballot box, because there will be winners and losers and likely more tax. They know this - which is why it gets kicked down the road all the time!

I think it is important that the false distinction between health and social care should go somehow, both on a practical and a financial level.

As long as there are competing financial interests between the health authorities and the local authority social services departments this chaos will continue.

It seems to me that if for instance someone at home needs help then the relevant people should be sent in whether they are wearing a health or a social care hat and that the means of paying for this should be uniform. Ditto if in residential or nursing care.

The dialogue (a nice neutral word!) between these two is responsible for a great deal of bed blocking as setting up care can get delayed.

There is often a very fine line between what is social care and what is medical - at the extremes it is obvious, but in the main there is a mixture of both and in the end that should not matter or be a consideration in providing what is needed. These crazy minutely-detailed assessments that take up time and money (and generate canny lawyers' involvement as they see a chance to make some dosh!) need to go.

The truth is that at present however hard people try to create foolproof assessment criteria there is still an element of interpretation and the iniquitous postcode lottery holds good.

Good professional assessment of needs by both health and SSD should be done for each person for the purpose of ensuring that their needs are met, rather than to decide who pays.

If there were an overarching payment system for all this then the costly and time-consuming layer of assessment could go.

Currently in the UK we have the National Health Service, free at the.point of delivery for health care.

We have Local Authorities that means test and assess for Social Care and only fund below a certain threshold of assets.

Therefore, in the absence of a Health and Social Care state model/organisation there is a need for the distinction between the 2 and assessment- it is not currently a false distinction it is a necessary distinction therefore

As you rightly highlight there are competing finical interests between the NHS and LA currently. There are laws in place that the NHS only funds healthcare and does not have a remit or legal responsibility to fund Social Care .

This distinction can only be relinquished if the state sets up a Health and Social Care model with an overarching funding capacity to universally fund continuing care needs regardless of whether they are predominantly SC needs or Health Needs.

Thats is DAR's question- what would the model look like and where would the funding come from?

Your comment Good professional assessment of needs by both health and SSD should be done for each person for the purpose of ensuring that their needs are met, rather than to decide who pays is key in the current assessment process. The aim of the current assessment process is entirely about determining care needs as set out in my earlier post regarding mobility domain- there is absolutely no mention of finances throughout the assessment and it is NOT a financial assessment . The quality of the DST assessment which I must review is to determine that it was professional and good and adhered. the NHS CHC Framework.

The outcome of the assessment is a decision the person's care needs. Currently it. determines whther the person's care needs are Social or healthcare to match the current funding model and Laws. The state funding models determine what that means for the family not the DST assessment or the assessors or the IRP .

Luckygirl3

This for instance .....

The Scandinavian model

Denmark is often regarded as the gold standard.

Older people are supported at home for as long as possible. Municipalities are responsible for:

home care
personal care
rehabilitation
nursing care
equipment
housing adaptations

District nurses, therapists and care workers work together as one local service. The municipality receives tax funding to provide both health-related community services and social care, so there is much less argument over "whose budget" something belongs to.

There you go- that sounds more like a Health and Social care model for older people to stay at home as long as possible.

You say municipalities fund this model rather than the state. How are the municipalities funded? Could that work in the UK?

We dod have locality enablement teams on a similar basis in the UK working in 'partnership". Some also are gold standard. the only difference is that the District Nursing care and professional expertise rehabilitation in the UK is funded by the NHS and home adaptations, personal and social care assistants are funded by LA and means tested

Thus the home care enablement service provision is not fundamentally different its the funding model that differs

If the state provides the overall funding to the municipalities in Scandinavia there is not reason why that cant be done in the UK as long as there is a bigger pot of money.

The question and challenge in the UK is political and contentious. That is - how to raise this additional money? Which party puts forward a plan to raise this money? Will other parties support this plan to raise this money? Is the electorate prepared to pay higher taxes (or an alternative payment) to raise this additional pot of money?

Denmark, an effective welfare, criminal justice and other public services. Sensibly the Danish people recognise this means higher taxes but a stronger society

There is not universally integrated domiciliary health and social care funding across the EU. The EU commission shows that there are divergent funding models and most member states currently spilt responsibilities horizontally between health (medical) and social (daily living) assistance.

Predominantly Health is funded usually by a tax funded or statutory health insurance model that funds nursing, medical treatments and rehabilitation. Social care is often decentralised to local municipalities or regional authorities funded through local taxes and subject to means testing for daily assistance as currently in the UK.

Full financial integration remains a challenge across much of the EU. Ireland and Portugal align H and SC budgets for example at national and regional level.

Some countries have hybrid and. localised models like France where there is means testing but heavily subsidised by the state,

Decentralised models like Italy and Spain fund services regionally which causes disparity in integrated access. .

To combat this fragmentation the EU is increasingly partially supporting models of integrated domiciliary care through the European Social Fund (ESF+) and targeted research programmes like the Value Care Project

The question and challenge in the UK is political and contentious. That is - how to raise this additional money? Which party puts forward a plan to raise this money? Will other parties support this plan to raise this money? Is the electorate prepared to pay higher taxes (or an alternative payment) to raise this additional pot of money?

Well, you know just what I would say. The government should spend the money first and tax some of it back as it is spent.

A problem that I see with this is that a significant amount of our social care is privatised. Take children in care for example. When some providers charge up to 60,000per week for a single child placement you wonder just what is going on.

Clearly some of this excessive cost is reclaimed via income tax (though with poorly paid care workers this tax take must be minimal) and indirect taxation of the goods and services needed to run and maintain the homes but corporate profits are taxed at a lower rate than income tax, as are profits taken in the form of dividends.

While the government must always run a deficit to ensure that there is sufficient money circulating in the economy it would seem to me to be reasonable to to either increase taxation on profits or to take care back into public ownership in order to cut the costs. I do realise that this second option is difficult and would take time.

I haven't looked a adult social care costs but I suspect they are of a similar magnitude.

Asking the general public to pay more in tax to fund private company profits (and fund care which is not always of a satisfactory standard) seems wrong to me.

Is it the duty of a government to care for its citizens or is it to fund the excessive acquisition of wealth?

MazieD- it is the case that very few Local Authorities still own and manage adult care homes. Instead they commission and fund placements ( at a capped fee) in private run care home- many of which have been taken over by larger organisations- for those that have asserts below the £23k+ threshold.

These care homes are fundamentally profit driven and subsidised by self funding patients whose assets are above the LA threshold.

The same principle applies to children's care albeit LAs have a statutory duty to fund children's social care as I posted earlier. We've read stores in then papers of how private companies extort the LA who access is limited.

In that context a right wing party less likely to put forward state funded social and health care service model that changes the current profit driven private social care service provision models?

I think AB has some ideas re a state funded UK H and SC organisation- I await detail with interest.

It goes beyond that too, because there have always been private nursing and care homes, including for people with lifelong conditions and mental health conditions. A lot of charities operate facilities too. I don’t think bringing all care into the statutory sector would necessarily provide a better service for all groups, and it would be less cost effective. Not saying I have any answers, it’s a very multi layered situation.

I am unconvinced that in house LA run residential homes are more expensive as they had no profit motive or shareholders to appease. I found them excellent because they had secure training and good staff conditions and monitoring. The contact between the homes and the placing social workers was speedy and efficient and as a SW I was able to keep an eye on what was going on and get speedy changes where needed.

Maybe not inherently Luckygirl13, but in practice it costs the LA more to run a home than it does a private contractor. Partly because everybody gets charged the same, which isn’t the case in privately owned care homes. Also LA staff are paid at a standard rate, get increments, annual leave, sick pay, etc, so it costs more to staff an LA run facility - that’s one of the main reasons most LAs stopped providing in house care. The other limitation is around the range of clients in different care need groups in each LA area, they could not feasibly look after the full range of needs in area. It’s not simple to see the wood for the trees.