The most important change is to fund social care properly so the quality of care is everywhere appropriate. The need for a properly skilled, motivated, well managed and properly remunerated workforce is essential. Moving all those employed as care providers onto some system like Agenda for Change is supported.
Early discussions with Royal Colleges and LGA is essential to ensure there is not unnecessary opposition to the principles. The small group of pro-market care professionals should be isolated and confronted. We should identify and promote pro public professionals of repute. We should continue to show the failures that marketisation has brought.
We support integration in the sense of making care person centered and support (in general) the description of this favoured by Patient Voices. Care planning for an individual must take into account environmental factors, housing and benefits.
We support structural integration as part of the move towards cultural and behavioural change; necessary to deliver integrated care. We also support structural integration where this will deliver economies of scale and more rational investment incentives. We do not see “integration” delivering major savings but it should deliver better care.
We support the need for commissioning by local authorities, in the sense of planning and specifying service requirements and deciding on priorities but only within a managed system. The use of procurement should be restricted by a preferred provider approach. We should look to growth of local authorities as providers of care not just procurers of care. Public investment in care infrastructure should be encouraged and incentivised.
The shift to local authorities must be gradual and must use so far as is possible, the existing organisational units. An incremental start would be for LA’s to widen the scope of local wellbeing strategies and then ensure they are implemented.
We agreed that assessment of needs (as started by the current Care Bill) was complicated and required some safeguards, but the principle of a single national portable assessment process suitably informed by shared decision making and advocacy as appropriate is the way forward.
We support the general principle that standards and basic entitlements are set nationally, and this is monitored and enforced. We support the principles around NICE and see that as extending into social care. The NHS Constitution should be widened to cover all care.
The principle that entitlement is set nationally but the delivery is determined locally must be tempered by the need for some genuine local autonomy, to make local democracy have greater meaning. Structures and systems for provision should be decided locally and we may see different approaches in different settings. Local authorities are not generally subject to top down enforcement as NHS bodies are.
The role of the local authority as the strategic commissioner is accepted but with due caution –
given the problems currently with commissioning of social care. The poor perception of local government and the hostility between local authorities and health bodies has to be addressed long before policy is announced and implementation planned.
We support the principle that a personal budget may be suitable for some – but there can be no compulsion or even direction. There can be no prohibition of top ups but the quality of care should be such as to make this less attractive and unnecessary.
We support the progressive change to providing social care free at the point of need as with health care but accept this will have to be implemented over time – progressively widening the scope of free (ie not means tested) entitlement. Some aspects of care (“hotel costs”) would remain means tested. We agreed that funding for this in the long term should come from progressive general taxation (as with health) but that there would have to be an alternative such as a levy on estates in the short term.