Notes from the 3rd TE&M Forum
Social Care Provision with regard what are the responsibilities of the individual and what are the responsibilities of the state?
The decision to remove GP responsibility for call out and out-of-hours support within the community was a mistake and should be reversed. The reliance on 111 and 999 services has resulted in too much emphasis on ad-hoc referral to A&E. This has resulted in an excessive demand on hospitals. Also, clinical solutions are often arrived at without any previous personal knowledge of the patients.
The COMMUNITY HUBS which were set up by local councils to support people within a community during the Covid Crisis have worked very well and have brought people and communities closer together. The local knowledge of council staff and volunteers has been a key and positive ingredient.
Social care should be focused around the individual and their community, with self-help playing as large a part as possible.
Home care needs to have more continuity, to encourage personal relationships between care staff and patients. This would result in reduced stress to patients.
More emphasis on effective education and training is required, to improve lifestyle choices and maintaining a good quality of life. Covid has emphasised the true consequences of obesity in our society.
Funding of Care and the need for “Joined up Solutions”:
There is a general funding problem, not just for Long Term Care but for the whole system of Social Care, which needs to be properly resourced and reformed. This will be particularly pertinent if there is to be a general “levelling up” across the UK, as the Government is currently proposing.
The obvious option for funding is through an increase in general taxation. However, this may be broadly unpopular unless the electorate can be convinced of the genuine need and the long term benefits to everyone. The specific form of taxation that is used is debateable. It could be based around an income tax or a more standard insurance levy, which would therefore be identifiable as a specific health and welfare provision.
The DISABLED FACILITIES GRANT and the HOSPITAL RELEASE SCHEME are examples of schemes intended to keep people in their own home, free up hospital beds and get people out of hospital more quickly, where possible. The flow of hospital bed usage, for emergency and scheduled treatments is greatly improved if these schemes are applied effectively. Perversely, these schemes are currently funded from Borough Council and County Council budgets not by the NHS or Central Government. The funding and the responsibility for these and similar schemes should go together, where they can be delivered most effectively.
The re-distribution of child benefit should be considered to allow a focus on helping children who have specific economic, educational and or mental health needs. The primary responsibility for supporting multiple children should lie with parents not the state.
There is a heavy reliance on charitable institutions such as hospices and health initiatives supported by the private sector or voluntary groups. This is generally delivered without the appropriate level of support from government departments. Similarly, the Local Leisure Trusts are wholly funded by Local Councils but they also contribute significant wider health benefits. Funding in these areas needs to be re-considered as a value for money option for targeting government support.
There should be a greater emphasis on housing the elderly in care homes closer to relatives so that they and their families can maintain a better connection and balance in their lives.
The overall cost of care accommodation needs to be reduced and controlled by setting the levels of government subsidy and allowing “fringe benefits” to increase with the level of personal contributions.
More specific boundaries should be established around the obligatory level of personal funding for care and the potential impact on personal assets. The individual payments could be required on the basis of contributions either pre or post mortem. E.g. Inheritance tax based.
Planning and Development Solutions:
More small properties are required, which are suitable for older people as couples and single person accommodation. Unfortunately, current trend is in the opposite direction, with existing small properties being extended as much as planning permission permits.
We should encourage more community developments / purpose built villages for senior citizens with owned property but with accessible care services are to be encouraged.
We should encourage the development of “Super Communities” with a range of large, medium and small accommodation, where people can move house locally, with minimum personal disruption. There are developments in Japan and Scandinavia which have already demonstrated the wider benefits of this planning model.