Déjà vu…or why most people don’t know who #Dilnot is and don’t care!

I fully expect that over the next couple of days there will be many tweets sent and words written about the publication of the Dilnot Commission on the Funding of Care and Support; there is likely to be much musing about what it covers, what it doesn’t, whether its remit was right, how else we could address the challenges and so on and so on. From mid morning tomorrow you’ll be able to access the report on the DH dedicated website here. The following day (Tue 5 July at 11.30am) you can join David Behan, the Director General for Social Care for a live discussion about the implications here. There will be a lot of activity, which is good and right and proper.

So why the provocative, damn right rude and possible cynical title to this blog post?

Well because I do drive myself to distraction when I realise how many times I sit down to write a blog post and realise that it is all rather déjà vu. What started as a simple reflection earlier this evening, about how many times I have started a post that talks about the problems with social care…extended into a bit of a twitter conversation with Harriet Clarke, who draw my attention to work she had done looking at Long Term Funding for Older People over ten years ago, you can see a snippet here and here. These are not new problems and I’m sure Dilnot has done all he can but we’ve yet to see whether our politicians can reach a consensus on funding for social care.

Last November I was reflecting on the state of social care research and guess what the number one reflection was? Yip, identity:

Reflection One: Identity – I believe that social care has an identity crisis! When we talk about social care and the role that it can play in supporting people, we all talk about very different things. There is not one thing meant by it and without clear definitions or parameters it is hard to make clear arguments.

I believe the biggest challenge to social care, to society, for a useful legacy from the work of Dilnot, is identity. So many people don’t know what social care is, they don’t understand care and support and don’t care that they don’t. A couple of weeks ago I provided an intro to Dilnot here and a slightly dismayed reflection on it here. The dismay came from the same place.

The work of Dilnot, his commissioners, the DH staff supporting him, and of course us, the service users, carers and workers who have provided evidence and engaged with his work, will I hope, make a difference. I know that the government will publish a Social Care White Paper, they are waiting to respond to the Law Commission and Dilnot together – check out David’s coverage on that here:

I know that for a brief interlude tomorrow my world will feel a little brighter, those of us who toil in social care circles will step a little lighter, we’ll believe that we have reached new ground. Let’s not get complacent though, Dilnot is really only the first step of the next journey. We’ve a long way to go…and may I suggest that we start with the basics and focus on really engaging the general public with what social care is, what it does and why they need to care.

Are you planning on getting old?

I’ve just written a blog post about the Dilnot Commission looking at the funding of care and support. I wrote it and tweeted about it and realised that the vast majority of people in my twitterstream wouldn’t look twice at such a post. There in lies the problem – it’s vaguely technical, too detailed, and about something that few of us would realise we needed to know about.

But we do. Most of us will get old. Some of us will become disabled or get ill during our lives. We all need some care and support occasionally.

If you recognise that any of these things are likely to feature in your life then you might want to take a look at the Dilnot Commission findings in the next couple of weeks. By the time most of us are older and needing support, the State is unlikely to be providing it. Reading comments on the Observer article: Middle class face £35k bill to help pay for care in their own age, I was struck by how many people think that their National Insurance or Tax contributions should be enough to provide care. They’re not. Something different needs to happen. If you’re interested in more detail check out my earlier blog post here.

#Dilnot Commission – funding care and support

Almost a year ago the Government set up the Dilnot Commission to look at the future funding of care and support in England. Chaired by Andrew Dilnot, with the support of two commissioners Jo Williams and Norman Warner, the Commission is charged with making recommendations on how to achieve an affordable and sustainable funding system/s for care and support for all adults in England, at home and in other settings. Andrew explains it in the 60 second video below:

What is care and support?

Care and support is usually referred to as social care. It is enabling support, it helps people to be independent, active and healthy throughout their lives. It is the support required to enable people to do day-to-day things such as live at home, work, cook, shop, care for their family, engage with their friends, family and community, and essentially lead a fulfilling and independent life for as long as possible.

This support is provided by a range of services, including support to live independently, benefits for disabled people, practical support such as meals on wheels, day centres and care homes, home adaptations and adjustments and other housing support. Services are also available to provide support for carers.

Who needs care and support, who provides it and who funds it currently?

All of us, at some stage in our lives, are likely to require care and support. Most people who currently use care and support services are people who are disabled, who have a long term health condition or illness, people who have had an accident or injury, and older people.

Care and support is provided by local authorities who pay for (commission) or provide support services, funded by general and local taxes. These services are means and needs tested. People who are not eligible for support from local authorities, pay and provide for support themselves or with the help of their families. Voluntary and community organisations provide some support, as do private companies. Support is also provided by family and friends, there are 5.2million carers in England and Wales, you can read a post about one of them here.

Care and support is funded in three ways: people pay for some or all the charges for the support they receive; families provide support or pay towards its cost; you and I, everyone in society, pays through local and general taxes.

So what are the commission doing and why?

The Commission are looking at future options for funding care and support. They are using five criteria to assess options: sustainability and resilience; fairness; choice; value for money; and ease of use and understanding.

They need to do this because the current system is not sustainable. We are living longer than before and we are living healthier lives – this means that we need more care and support than we have done in the past. This is a good news story and it requires a positive response. The other reason is that our expectations have changed, people expect and want more choice and control, and care and support needs to change to meet this expectation.

What do we know so far?

The Commission launched a call for evidence at the end of last year to gather ideas about what future options could look like. You can read the summary of the 250 responses they received in the summary document on their website here. They also commissioned TNS-BRMB to carry out qualitative research to gather the views of the general public, a summary of their results can be found here. The final report and recommendations will be published on 4 July.

What we absolutely do know is that change needs to happen. I also think we can safely assume that this is going to get swallowed up into a political issue, see the report in today’s Observer, and @rich_w‘s blog post commentary “Our politicians have a moral imperative to ensure the future of social care funding is known, sustainable and fair“.

I agree wholeheartedly with Rich, at least I think our politicians *should* have a moral imperative, that said I’m not sure they do, and I think that is the bigger problem here. I believe that social care has an identity crisis, and if not an identity crisis certainly an image problem, consequently it is not high enough on the agenda of the general public or their politicians. The vast majority of people don’t recognise themselves as health or social care users, they are just people, who need some support. Until social care gets itself to a point where it can define clearly what it is, how it helps, and openly discuss its limitations (whether financial or otherwise) we’re in trouble.

I am looking forward to reading Dilnot’s report, and I’ve enjoyed the twitter discussions so far. I feel though that we need to continue to widen this conversation to ensure we really make a long term difference…and force our politicians to face up to their responsibilities.