The NPC responded to the Fabian Society call for evidence on a Road Map to Social Care.
You can download the response below.
NPC evidence for the consultation
Road Map to Social Care
Introduction
The National Pensioners’ Convention (NPC) is Britain’s biggest independent organisation of older people, representing around one thousand local, regional, and national pensioner groups with a total of 1.1 million members. The NPC is run by and for pensioners and campaigns for improvements to the income, health and welfare of both today’s and tomorrow’s pensioners.
Every pensioner has the right to choice, dignity, independence and security as an integral and valued member of society and we wish to submit views to the Fabian Society for the consultation on Road Map to Social Care'. Our response has been compiled by our Health & Social Care Working Party and will concentrate on the experiences and concerns of our members who are, by definition, in the older age range.
Call for evidence: questions
1. What should care and support for adults in England look like in 10 to 15 years’ time? What should it achieve? What values should inform it? How should it be run?
· There should be a fully funded stand-alone National Care Services, free at the point of need alongside a fully funded NHS, regulated by an independent monitoring unit.
· Both services funded by taxation, paid for by the re-distribution of wealth, i.e. harmonising income tax levels; harmonising corporation tax levels; reforming NI system so those that earn most, pay most rather than being subsidised by low income earners.
· The values should be a universal service for all with equal access across England. No post code lottery, no means testing. These values put patients at the heart of the service with choice around the provision of services they need, who delivers them, how and where they are delivered. They also ensure equality, dignity, the right to a continuing ‘good’ life – whatever kept us contented and in good mental health in earlier years, or suits us best now, the right to be seen and appreciated as individuals and not simply a cohort to be managed.
· All care workers must be registered.
· Services should be tailored to an individual’s assessed needs rather than drawn from a list of possible services in order to provide them.
· Disabled working age adult support and services with the emphasis on independence, choice and rights.
· Patients with protected characteristics (including age) must be respected and services delivered to their specific cultural, gender and sexual orientation.
· Services must cover physical and mental health delivery/support.
· An enhanced Public Health Service to ensure access to clean air, waste disposal, pest control, healthy eating, and other critical patient-centred information provision.
· Place more emphasis on the wider determinates of health – different but complimentary to Public Health. Things like acceptable living and working conditions, good wages and pensions for a quality of life and reduced inequality.
· Preventative care is an absolute must if the health of the nation is to be improved, along with ensuring that individuals are aware of the impact of the lack of a good diet, use of drugs and alcohol and other unhealthy pursuits.
· Other preventative services that deal with poverty and tackling loneliness, isolation and social exclusion enabling wellness.
· Investment in cheaper community based services like adult Education and libraries to prevent or delay need for costly domiciliary or residential services.
· Assessments carried out by fully trained and regulated assessors, including those required under the Care Act fully funded and accountable.
· Community care services fully funded and locally managed, overseen by the independent monitoring unit
· All care homes (residential/nursing and extra care) should be publicly owned, delivered and run with accountability structures on public service contracts. Care homes should be in the heart of a community with access to shops, cafes, libraries, cinemas or theatres etc.
· Those receiving care at home must be given adequate time slots for the best quality care and attention and continuity of care givers. All visits to take account of the dignity of the patient; i.e. not getting people up late and then put back to bed early evening. This service should also be publicly owned, delivered and accountable.
· Local authorities to be fully funded to provide quality care services through in house workforces.
· Voluntary Sector providers with a track record of public sector delivery to be fully funded to provide specific services for areas of each community; i.e. for those who need help shopping, getting to GP/hairdresser etc.
· There also needs to be the ‘social’ element of care for individuals on the grounds that the ability to get out and about, meet friends, join a club, have meals on wheels etc. stimulates older people and those with complex health problems and enhances their quality of life.
· Individuals who choose to be cared for by family or friends should have the option without having to become an employer. Local Authorities to give relevant support and information in the care package. Informal/family carers must be given respect and value and an increase in allowances.
· Pensioners should receive a carers allowance if they fulfil the criteria. Older carers often have ill health themselves and suffer poverty on top. If they are caring for someone, they should be paid regardless of the state pension income.
· End of Life care needs close attention to ensure that those in the last days of their life are treated with the utmost respect, dignity and given choices.
· Specific health professionals to be allocated to, and responsible for, care home residents. In the case of older people, these should be trained geriatricians.
· Access to GP’s and other health professionals. Digital First is fast becoming Digital only and impacts on older people and those without the financial means to have broadband or purchase devices. There will always be individuals who will not have access to technology. Technology has a place in health provision, but the exclusion of patients not online is discrimination under the Equalities Act 2010.
2. What level of demand will there be for care and support in England over the coming years? What will be the costs and benefits of adequately meeting this need? What will happen if it isn’t met? What are the implications for equality, diversity and inclusion?
· Longevity forecasts are up and down, but given the demographics of age, it is expected that the older population will increase over the next 5/10 years.
· Whilst it may be wrong to assume that not all older people will require a high level of care, or care at all, the NPC does know that those individuals retiring now are doing so with greater health needs than those before them. This means that they will spend the majority of their retirement in ill health.
· If we want a health and care service second to none, then it will cost. The NPC have consulted with its members and the public on paying more for the NHS and care to be universal, free services. The consensus has been that people would be willing to pay more, but it has to be ring-fenced and used only on those services, with spending monitored and accountable.
· Currently, there are unknowns around the impact of COVID/Long COVID on the health of the nation. There could well be a long term need for health and care services along with individual support for sufferers. We believe that those suffering after effects of COVID and those with Long COVID should be treated as though they have a disability and receive financial and other support to allow them to continue to work or at least have some quality of life.
· Sir Michael Marmot’s report shows that the health of the population in England was at its worst at the onset of the pandemic. To recover from this and also build on the good health of the nation means no more funding cuts – it means investing in the future so this does not happen again.
· If we cannot meet the need in the future, those services existing will be overwhelmed, an increasing number of individuals will not be able to access care and care homes will become the norm to cover the gaps. This is often not the choice an individual will make as we all prefer to stay in our own homes as long as possible.
· Already around 1.6 million people cannot access the care they need even if they can pay for it.
3. What reforms to care and support in England should be initiated in the first year of a new government elected in 2024?
· Domiciliary care/care at home: as contracts run out, services should be brought in house by Local Authorities.
· The workforce should be transferred onto public sector contracts and rates of pay, conditions of service, access to training and career progression. There may well be differences in job descriptions and pay from one Authority to another. We argue for a national pay and conditions and suggest that care provision is worthy of being linked to a point on the NHS scale rather than local government. Value and respect.
· Raising the standards of the fabric/maintenance of buildings and their furnishings.
· Raising the standard of meals in care homes in order to eradicate malnutrition and poor diets.
· A minimum number of staff per resident; implementing good practice, training and value for the care giver.
· A genuine strategy for the creation of a National Care Service (as above) and mechanisms to ensure full funding streams need to be tried and tested.
· Full consultation with all stakeholders.
4. What further reforms should be initiated or planned over the course of one parliament?
· A planned withdrawal from contracts issued to equity funded providers. These contracts are profit driven and have no place in the care sector, particularly when providers put profits into off-shore accounts and pay little or no tax to government.
· Further planned withdrawal from private provision as contracts come up for renewal.
· A workforce strategy that enables a national mandatory training programme for all care staff (including managers). Workers are often transient, and this would enable them to take their qualifications with them. It must also give value and respect for the jobs they do in caring for people, therefore we have recommended public service contracts and conditions of service with potentially a link to a pay scale in the NHS.
· An independent monitoring unit to oversee budgets, regulated care homes, regulated care in the community.
· Second stage consultation with all stakeholders
5. Specifically, what changes should an incoming government consider with respect to:
· Rights, control and personalisation for service users, carers and families
The NPC has a manifesto for health and well-being for older people which should be the foundation for all services, not just those for older people. We also have a Dignity Code that can be woven into good practice models across England and across all services. We believe in choice and advocacy where a person is without capacity. These documents are attached at the end of our submission. Different sectors of society and those with protected characteristics should be assured of service delivery relevant to their characteristic.
· Workforce reform
As already stated, care workforce change is a must to attract more staff to enable ratios of staff to individuals to be safer and also deliver quality care. The value of the work they do is not reflected in their working conditions and pay. Zero hours’ contracts have no place in the care sector – if there is a job it should be contracted for the hours required.
· Financial allocations and funding mechanisms
Local Authorities must be fully funded to provide a range of social and care services that enable individuals to be part of the wider community in which they live. The funding should be applied by formula to the specific needs of each locality. For example, the North East has the highest incidence of industrial related illnesses and health conditions. Other localities may not, but have higher incidences of other needs. Robust reviews of needs in the local communities need to be undertaken and funding applied as necessary. Every locality has the same basic services with added local functions which may change over time.
· Organisational structures for commissioning and delivery
We do not accept that care should be subsumed in the NHS under the guise of Integrated Care Systems/Boards. This re-creates the underfunding of care that has dogged services for time immemorial. Single service budgets. Individuals that require hospital care are paid for by the NHS, those needing care paid for out of the care budget. Where there are combined services either at home or in hospital, then each budget contributes their level of cost. Integrated services can be delivered without integrated budgets.
· National and local leadership and accountability
Any public service must be accountable for its spending and decisions. The independent monitoring unit would oversee spending. In terms of leadership, the current set up has done nothing for care in the past – time for a radical re-think.
· Boundaries, interactions and integration with other parts of government, and with the rest of society
Our health is impacted upon by other factors such as income, poor or unaffordable housing, poor or unaffordable transport, digital exclusion, access to GPs, hospitals and pharmacies.
Government decisions tend to be made without any holistic view or understanding of the impact on health. For example, not investing in insulating all homes costs the NHS billions in hospital services because individuals are made ill by cold, mouldy homes. Joined up thinking in decision making has to be a consideration otherwise nothing will improve for the funding invested.
Supplemental papers attached to this email response:
1. Goodbye Cinderella – A New Settlement for Care
2. NPC Manifesto for Older People’s Rights to Health & Well-being
3. NPC Dignity Code
Should you require any further information, please use the contact information supplied below.