reforming social care - appendices

7/29/2019 Reforming Social Care - Appendices

1/64


2/64

2

Contents

Written responses

Appendix i -Bradford Alzheimers Society. ................................................................... 3

Appendix ii - Bradford Alliance on Community Care ................................................... 25

Appendix iii - Bradford & District Age UK .................................................................... 27

Appendix iv -Carers Resource. ................................................................................... 29

Appendix v - Bradford Metropolitan District Council. ................................................. 33


3/64

3

Appendix iBradford Alzheimers Society

People with living dementia and carers in Bradford A consultation

Response to the Social Care White Paper and draft bill.

Background

The Alzheimers Society in Bradford was approached by David Ward MP for

Bradford East to contribute to the Bradford response to the Governments

consultation on the Social Care white Paper and draft bill. We were asked to

consult directly with people living with dementia and their carers in order to

get their views on proposed changes and their current experiences of social

care services.

The term 'dementia' is used to describe the symptoms that occur when the

brain is affected by specific diseases and conditions. Symptoms of dementia

include loss of memory, confusion and problems with speech and

understanding. The most common types of dementia are Alzheimers disease

and Vascular dementia.

There are currently 800,000 people with dementia in the UK; this is expected

to rise to over a million people with dementia by 2021.

Though dementia is not caused by age, people are more susceptible as they

get older. One in a hundred people between sixty five and sixty nine are

estimated to have dementia, this rises to one in six for people over eighty.

Dementia in people under the age of 65 is comparatively rare. There are over

17,000 younger people with dementia in the UK, many of these are often in

work, have children living at home and have on-going financial commitments.

However, this number is likely to be an under estimate and the true figure may

be up to three times higher. As people are being diagnosed earlier the need

for dementia specific health and social services is likely to rise.

The majority of people are cared for by unpaid carers such as family members

who are estimated to save the UK eight billion pounds per year in care costs.

There is no current cure for dementia, but with proper information and social

and emotional support people can live well with the condition reducing the

need for early social and healthcare interventions.

In Bradford there are estimated to be over 5,500 people living with a dementia

however only 52% of these have a diagnosis. This rate is expected to rise

with the increased national emphasis on early diagnosis and the continued roll

out of memory clinics across Bradford District.


4/64


5/64

5

Often they want to talk to him and he cant answer. They wont talk to me but

he cant do it.

Question 2 - Do you believe that people who need help getting washed

and dressed should be entitled to means tested care?

The overall response was yes. Carers in the first meeting especially felt that

there should not need to be assessed to access services.

Yes but why should it be means tested? If you need help, you should

get it.

Question 3 - Should the amount and type of care you can get depend on

where you live?

These discussions centred on possible changes to the Fair Access to Care

eligibility criteria, most people felt that this should remain at the moderate

level; concern was expressed that if the entry requirements for service were

standardised across the country these would be at a higher level than

moderate and this would adversely affect people in Bradford

No. Everyone should be entitled to the same, regardless.

Isuppose theres got to be a line drawn somewhere but we all need help.

There would be an impact on our service, (if the FAC level was raised) youd

get families not being able to give that support. Thered be families who

couldnt support them because they work etc and thered be guilt that they

couldnt help.

I go with moderate; it should be all over, even the Queen.

This question was extended to cover proposals that there could be eligibility

criteria for carers and the proposal for carers budgets. Reaction to this was

mixed with some people thinking it was a good idea and thinking you should

get access to support automatically. There was strong feeling that the support

carers gave and the benefits of this to the state were not recognised.

If you need help, you need help.

I suppose theres got to be a line drawn somewhere but we all need help.

Question 4 What would most improve the standard of social care in

the UK?

Tougher standards for providers and improved inspections

Most people supported this; there was a feeling that care homes in particular

currently had a poor standard of care. Staff also thought services such asthose Alzheimers Society provide would benefit from inspection.


6/64

6

Should care homes and services be subject to tougher standards?

Yes, some homes, you wouldnt put your dog in. The standards should be

higher, staff should be trained and plenty of them. Why should dementia care

or elderly care be any different to childcare? There are lots of standards and

inspections for that.

Yes, even if it includes us.

More taxpayer funding for social care.

Feelings were mixed about this, some people felt that they were already being

penalised for working or having worked and having savings , other people

notably staff members felt it depended where the money was spent

Itd be the same people who have to pay again those who are working or

those who have income/savings. Those who dont or have never worked will

get away with it.

An insurance system to allow people to meet unexpected care costs.

There were mixed feelings again about this, the main concern was cost with

people being concerned they could not afford it.

It might help to pay up front but it depends how much itd be

Universal and legal entitlements to social care.

Most people agreed that access to social care should be free; examples were

given as to how charging for services adversely affect people. There was a

strong feeling that dementia was an illness so services should be free at the

point of delivery as health needs.

Yes. Everyone should be entitled to care. It should be like the NHS.

The social needs are what help his health. Why are the needs of a pwd seen

as social and not health? When P gave up work, he went down and down

and down. He had nothing to do, the social worker sorted out for him to go toMary Seacole Court and he loved it. It gave him somewhere to go, a purpose

and now hes got the bill, he wont go.

Dementia is an illness and you should receive appropriate care.

Question 5 Where do you think extra money needed to fund the social

care system should be raised.

Higher general taxation.


7/64

7

Feelings again were mixed, some people did not want higher taxes, other

people saw it as the best option but concerns were raised where the money

would be spent.

Taxes are high enough as it is.

I suppose if we all paid a bit more, it would cover it would it?

How can we be sure where the money goes? Im sure if people knew it was

going on later life care/dementia care, people would be happier with it.

Those receiving care should pay more.

People were against this option for reasons previously highlighted.

The costs have already gone up, if they go up any more, no one will be able

to afford it.

Its penalising those again who are already paying etc.

Tax the estates of those who receive care after the pass away.

People were against this option.

That would mean you cant leave anything to your family which isnt right.

You might live the highlife and spend the lot or you might save etc. It would

be sad that youve chosen to lead that lifestyle and are penalised.

Cut benefits for wealthy older people

There was some support for this but people wanted to know what is seen as

wealthy, there was a concern that it would affect many people with assets

such as a house and savings

I think ifit means cut benefits for those with loads and loads of money then

yes.

Would that mean the same people are penalised again? It all seems tomean that if youve got savings or youve worked, you pay.

They should cut the fuel payments of those who live abroad or go abroad for

a number of weeks. You should only get it if youre using the heating etc.

Its who they class as really rich its usually those people who own their

own home and work.

Question 6 - The Dilnot Commission recommended a 35,000 cap on

lifetime contributions to social care, what do you think of this?


8/64

8

Concerns were expressed that again people were penalised for buying a

house and saving and had to pay for services. Overall people generally

agreed with the idea of a cap, there were concerns that the 35,000 proposed

would be too high for some people. There were suggestions for a sliding scale

dependant on the assets people had.

35,000isnt a lot, if youve had to sell your house or anything, itd soon go.

I think its wrong that the bit of money you save goes against you. I save like

mad so we can go on holiday and itll go against me.

Yes I agree that there should be a cap but they should also look at the

corresponding amount and at what people get charged or some people are

not going to be any better off.

Well we havent got anything(illness and dementia stopped the ability to earn)so it doesnt affect us.

Question 7 - Should people be expected to sell their house if needed to

fund the costs of their care?

People were against this option.

If they make you move and sell your house, hed be totally disorientated. Its

just a retrograde step. Hes not known where anything is, hed be in a state.

Question 8 - Should individuals receiving state funded care get todecide for themselves how their care budget is spent?

This question was not asked, due to time constraints.

Question 9 - Do you think loneliness is a major health and care issue for

elderly people?

This question was not asked, due to time constraints.

Question 10 - How do you think we can best support elderly people who

are living in social isolation?

This was briefly touched on in the staff consultation; it was agreed people with

dementia living on their own needed support to continue to live on their own if

they wished to.

I think we need more funding and there needs to be outreach teams to

support these people and possibly rather than people going into permanent

care, to have companions so theyd go and live with the person. Itd have to

be a service network.

Paul Smithson


9/64

9

Support Services Manager

Alzheimers Society

Appendix 1

Carers Support Group18/8/12

5 Carers Present

What could have made accessing care easier?

We werent told anything. If it hadnt been for the Alzheimers Society, we

wouldnt have known anything. C came to see us, explained about the illness

and told us where to go for benefits, support. C also told us about Mary

Seacole Court and I went with E to look at it. Otherwise, it was like plaiting

fog.

You shouldnt have to fight for everything, when you go to the Drs,

they should tell you whats going to happen, where to go next and how to get

help. Instead, youve got to find everything out yourself.

Do you think people who need help getting washed and dressed should

be entitled to means tested help?

Yes but why should it be means tested? If you need help, you should

get it.

Everyone should get help, it shouldnt matter who you are or what

youve got.

Perhaps if youve got enough money you could pay for it but what if

youve scrimped and saved all your life, its not your fault that you have some

savings. Those that have never worked live in council houses etc., they dont

have to pay for it. Its all wrong.

We were brought up to save for a rainy day and now were penalised.

Should the amount and type of care you get depend on where you live?

No. Everyone should be entitled to the same, regardless.

No, it shouldnt be a postcode lottery. Theres always been a North

South divide and this is the same.

Should there be an eligibility level of when carers get support?

No. If you need help, you need help.


10/64

10

You should get it straight away, the sooner you get support, the better

and the more you can cope.

I suppose theres got to be a line drawn somewhere but we all need

help.

Should carers have personal budgets?

It depends what its for

Will that mean they penalise you for it?

It depends what you can spend it on and how its managed. I cant

look after my own money let alone anything else.

I suppose that will be means tested and that you wont get it if you have

savings. Penalised again.

Where could extra money come from to improve social care?

Paying more tax?

Itd be the same people who have to pay again those who are

working or those who have income/savings. Those who dont or have never

worked will get away with it.

Its different if you cant work but if you are able, youd be the ones

paying for it.

An insurance type system?

I suppose itd help but itd be another bill. We cant afford to live as it

is.

It might help to pay up front but it depends how much itd be

Im not sure; it sounds like it might be a trick question

Should social care be free?

Yes. Everyone should be entitled to care. It should be like the NHS.

Youve paid into the system all your life so you should get something

back. It should be like family allowance. If youve got someone who needs

care, they should get it.

If you cant get it from the state, where else can you get it if you cant

afford to pay for it?


11/64

11

Should care homes and services be subject to tougher standards?

Yes, some homes, you wouldnt put your dog in. The standards should

be higher, staff should be trained and plenty of them. Why should dementia

care or elderly care be any different to childcare? There are lots of standards

and inspections for that.

Some of the homes we looked at were a disgrace, how could I put him

in there?

Where should the money (for extra social care services) come from?

Higher tax?

Taxes are high enough as it is.

I suppose if we all paid a bit more, it would cover it would it?

Itd be the same people penalised again, those who are working.

Those who dont work would get away with it.

(Should there be) Increased charges

The costs have already gone up, if they go up any more, no one will be

able to afford it.

Same people penalised again.

Weve just got letters to say the charges are going up and weve to pay

for transport so hes on about not going any more.

(Should they)Tax estates after death

That would mean you cant leave anything to your family which isnt

right.

Yes, people save all their lives to be able to leave their home etc. to

their family and that would mean they cant.

(Should they) Cut benefits for wealthy people

It depends on what they call wealthy

Would that mean the same people are penalised again? It all seems to

mean that if youve got savings or youve worked, you pay. If youve sponged

off society all your life, you get more for free.

I think it means cut benefits for those with loads and loads of money

then yes.

What do you think of the proposals in the Dilnot report?


12/64

12

35,000 isnt a lot, if youve had to sell your house or anything, itd

soon go.

Its all so complicated; I dont know what to think

Well we havent got anything so it doesnt affect us.


13/64

13

Appendix 2

Consultation Meeting 2, Monday 3 September 2012

Present - 3 people with Dementia, 3 carers.

How easy was it getting help from Social services? What could have

been better?

Once youve got onto the system its ok, its getting onto the system.

I didnt get any help at all. Ive been like this 40 year and got no help.

If they could just give you one person and say this is what you can have, this

is what you cant have.you shouldnt have to spend your time practically

begging.

How hard/easy was it to get a diagnosis?

Weve never been approached really have you?

D: I pushed M to go.

S: In Pscase, they didnt believe it because he was so young.

D: They asked T when did World War 1 finish and he said how old do you

think I am?

They need somebody that can tell you, once you give a description of whats

wrong, this is who you need to speak to, theres the telephone number.

Youre struggling to get your Doctor to take notice.

You need to know your entitlements. Nobody says this is what youre entitled

to.

Do you think its because were of the generation that dont believe in asking,

claiming?

S: I was on the phone to this woman, DWP for 2 hours; I said Im not comingoff this phone until someone tells me what I need to know. If the womans

husband hadnt had dementia, we wouldnt have got anywhere.

Often they want to talk to him and he cant answer. They wont talk to me but

he cant do it.

I know theyve got to do security checks but he cant use the phone. All the

bills come out of my account anyway but they wont talk to you, they want to

talk to him. I told them Id got LPA but they said I needed to be an appointee

as well. You shouldnt have to go through all that. It was just a struggle.


14/64

14

Do people think that everyone should have the same access to care?

Yes, if you need it? Its like the North South divide.

Why should everything depend on your postcode?

S: I think everyone should be classed as moderate. Why should you have to

wait until your quality of life goes down before you get help?

D: Its going to cost them more in the long run. If the carers got to give up

work to look after them, then the government would have to pay to support the

carer.

M: I go with moderate; it should be all over, even the Queen.

D: It costs more the longer they wait. In Mscase, shes got Type 2 diabetes.

We priced up how much it was costing to admit her, the bed etc. and we threw

it at them. All she wanted was the pump instead of injecting. Its been a great

improvement and theres far less waste.

P: Why separate it? Why should they? Course you should (be entitled to the

same care as everyone else in the country).

S: Everythings always been a postcode lottery. What differentiates people?

Its not your postcode, its your need. I think its unfair that someone in Halifax

should wait longer than someone in Bradford.

Carers entitlements - If you were a carer, should you be able to get

help? Should there be eligibility criteria in order to get services?

Yes.

S: Its like the moderate thing isnt it? Dont leave it till its too late. If they did

an assessment, you didnt have to take it up till you need it.

D: I think often the carer needs help as well.

D: Ive got gout etc and I have to ring my daughter to come out of college to

look after M.

If the government gave more money to social care, what should they

spend it on?

M: Personally, I think there are people worse off than me. Its difficult isnt it?

D: Why should we be giving more money for Social Services to waste?


15/64

15

S: Im still working and paying into this system and Im being penalised for

working. How does that work out? Its wrong. Why are you penalised for

looking after your money, for working, being left money by relatives and then

youre penalised. We havent gone out drinking, had holidays, I love my

house, why should we lose it?

D: This bit about assetsits all wrong, weve saved to pay for our house and

were no better off.

It seems too unfair.

There are people who havent paid a penny into the system and theyve no

inclination to pay. Its the injustice of it. Nobody asks to get dementia, its one

of the cruellest things you can getwhy should we be penalised?

I would have thought it should be free because the people like me (P) itsgood for you. Youve got something to do. S is giving me tasks all the time,

she gets on me.

S: We got a bill for Mary Seacole (a day centre for younger people with

dementia) and now he says he wont go. Id just sorted everything out

S: The social needs are what help his health. Why are the needs of a pwd

seen as social and not health? When P gave up work, he went down and

down and down. He had nothing to do, the social worker sorted out for him to

go to Mary Seacole Court and he loved it. It gave him somewhere to go, apurpose and now hes got the bill, he wont go.

T: I used to go to a day centre but they were all dying. Id go in and say

wheres so and so, oh he dropped dead yesterday.

Social care to be run as business.

Less aid to other countries.

Should not borrow to give away.

Dont want to pay more as funding from both ends

Money needs to go to right places should not charge more, cannot afford, it if

you give up work.

M: My carer has had 12 heart attacks and was on the sick so we were lucky.

P: Whats that fountain in town about? They built that andwe cant go to day

centre. Or that bridge in Manchester road.

What do you think of if you get social care and you die, theyll tax your estatemore?


16/64

16

S: It begins with F and ends with O.

T: I cant see the logic in that at all. Why should they?

M: youve already paid into the system. Theyre taxing you twice.

D: My husband hasnt worked for 40 years, not because he didnt want to,

because hes had three brain haemorrhages.

M: I miss work.

D: They have to get the money from somewhere though dont they?

Over 65s get lots of entitlements such as free TV licence, bus pass etc,

Should those better off not get those benefits?

S: youve got to think of how they got that money. Is it because theyveworked and saved?

We went on holiday this is year with a charity and it was the first time wed

ever been away.

Capping social care costs - do you think people should only pay so

much money for services and then stop when they have reached a limit?

S: Its better than them taking everything. I did think its a better idea to put a

cap on it but what if youre living in a house and it needs a new roof? Its not

a lot of money to have for these things. If youre getting older, itd worry you

to death that you didnt have enough money for these things.

D I think Ill go home and top myself. (Humour).

S: Its penalising the same people again.

T: I think its wrong that the bit of money you save goes against you. I save

like mad so we can go on holiday and itll go against me.

D: If you dont work and you have no money, youre being paid to live.

S: what its saying is that if youve not worked and youve been on benefits,

dont worry because you can go in a home and be looked after wonderfully,

the state will pay. It doesnt take a lot of thinking about does it.

If youre an alcoholic and you have a dog, you get extra benefits. You get an

allowance per day for the dog and yet P has to pay to go to the day centre.

S: people always tell me how well P looks because you cant see it like a

broken arm or leg. They dont know how hard it is.

Do you think shops etc give enough help to people with dementia?


17/64

17

P: No, people dont think theres anything wrong with you but there is. My

heads buzzing.

T: I had a problem with my pin number. It took my money back. We had a

right carry on with the bank. They dont understand.

P: We went to Harrogate and I was messing about with my money in the

machine.

I make a joke of myself, you have to now. If youve got it, youve got it. S has

got a lot to put up with me.

S I just tell people now. Its like changing rooms, I think just let me go in with

him. People dont understand.

Why should people think thats theres anything wrong with him when they

look alright? Its hard.

D: Tesco, were quite well known in there. The staff in that store, if they see

the pair of us, they come to see if they can help us. If they see you put your

card in, theyll come and say take your card, dont forget your card. But,

youve got to be known to get the help.

Do you think shop assistants etc need to know more?

S: I think they get training for people who have wheelchairs but they dont get

training for illnesses you cant see.

T: Yes they should.

M: In church, they thought I was praying so they left me but Id collapsed.

T: in supermarkets some ofhelp but most of them dont.

P: How do you get people to know you need help without having it written on

your head?

M: you need a badge.

You need a fairy wand. Everybodys individual.

What would you do with your fairy wand M? What would you change?

M: His socks!

D: Would you want people to know though? S: No, you wouldnt, its a fine

line. I just tell people hes got a bit of dementiayou dont want to say it

straight off. Youre still you arent you.


18/64

18

M: You know its an elephant but you dont know what problems the

elephants got.

Paul explained what would happen to this report.

S: But will something be done or will it just be another report?

D: I think its all a bit scary. I wouldnt want to be a politician.

S: its how they spend the money theyve got.

D: I used to work for the police and they used to waste money like mad.

S: I think people want to see how its being spent. Weve never claimed a

penny and I dont want to claim now but needs must. It should be pro ratad.

There should be something that looks at how much money youve put in over

a lifetime.

P: Somethings got to change at some stage.

S: Its just a ludicrous situation.

Day service charges:

They said everyone had a letter in July (no one has)

If they make you move and sell your house, hed be totally disorientated. Its

just a retrograde step. Hes not known where anything is, hed be in a state.

S: Its like where would we all be without the Alzheimers Society? We would

be absolutely lost.

How easy was it to find out about the Alzheimers Society?

S: When we got Ps diagnosis. I said what do we do now? They said theyd

send a nurse who happened to be in the wrong job. If wed been in our 70s

God knows what would happen. I spoke to someone else first but I dont think

they could tell what I was saying because I was sobbing that much. Then I

spoke to C (staff member)at the Alzheimers Society and in the same

afternoon she came and that was wonderful.

D: We knew C as well so we were ok. We knew quite a few people with it too

so we were lucky. It should be up in Doctors surgeries because theyre the

first person you get to see.

S: Surely the Dr should ring up and make an appointment for someone to see

you as theyre the first person you go to. We got passed from pillar to post,

everythings a struggle.


19/64

19

Appendix 3

Consultation with Alzheimers Staff team Monday 17th September 2012.

5 staff present

Do you believe people who need help should be entitled to means tested

care? Should people who have low/moderate needs should they have

access to care?

I think itd have a big impact. It may be that they can manage to put their

clothes on but dont get washed or have a shower.

It might be that they need prompting or supervision otherwise they dont do it.

If they didnt get that, there would be a deterioration in their personal care.

There would be an impact on our service; youd get families not being able to

give that support. Thered be families who couldnt support them because

they work etc and thered be guilt that they couldnt help.

I think thered be a massive impact. If the early interventions arent made,

things would just come to crisis more quickly. People would end up in

hospital or the things they need would be more serious, more costly and

require more staff, time input etc.

There should be a minimum. I dont see why councils should just do the

minimum but there should be a bottom line. It seems unfair that if you live in

Kirklees and live one street over, youd miss out.

Itd be unfair. It should be the same but we dont want to make things worse

for us in Bradford.

I think that if youve got a good care package thats working for you and your

family and you move area, you should be able to continue with that package.

It shouldnt lessen just because youre moving area.

If you need help, it shouldnt be left until youre so poorly, you cant make useof services. We bang on about people getting early diagnosis so they can plan

for the future and get help and services but whats the point if there arent any

services. People should be enabled to live life well with dementia, not wait

until theyre dying.

I agree that carers should get support early on.

What about the impact of these changes on the people already in receipt of

services.


20/64

20

People shouldnt lose services; its not their fault that theyre ill. Its also

someone somewhere who has made that decision about her care.

It shouldnt be a case of if you shout loudly and push, you get more or if you

complain, you get more. If youre quiet and passive, you dont get anything or

not as much. It should be equal.

You shouldnt get more than you deserve/entitled to.

Everything seems to be about carers, respite etc. This is important but it

should also be about whats right for the person, providing stimulation, a

purpose etc.

Theres very little evidence that older people in Bradford are getting personal

budgets anyway. If there are very few people getting PB, what hope have

carers got?

What do people think or would people like to see any of the following

initiatives?

Tougher standards for services and care homes.

Yes, even if it includes us.

Standards are poor at the moment in care homes so increased inspections

can only be a good thing.

Often inspections are done with notice so they can put things into place so its

often a camouflaged type of inspection not a true picture. They shouldnt be

given notice.

I wouldnt put my parents in any of the care homes in Bradford at the moment,

the standards are so low.

Would you like to see more taxpayer money spent on social care and if

so on what.

Appropriate day care facilities.

Better trained staff.

Companionship where people can have more one to one. For those that dont

fit into ordinary day care.

Services for people with dementia who live alone personal assistants.

More flexible home care serviceswhere its not as time restricted and wheretheyre more flexible and are able to do the things that people actually need


21/64

21

such as prompting with meds etc, , making a proper meal not just a micro

meal.

Preparing people better for the future and culturally appropriate services.

Generations are changing and hopefully this will come in time.

What about an Insurance system to help people meet unexpected care

costs?

Very unsure, will it mean that people who havent worked, dont own their own

home etc will still get paid for care?

Does it mean that those who already pay for their own care etc will be

penalised. It always seems that those people are penalised and have to pay

for everything.

It could be an option that people can decide not to take.

I cant see how it would work.

How about universal legal entitlements to free social care?

Dementia is an illness and you should receive appropriate care.

I know it might not be possible but yes.

Yes. It is an illness like any other, why are the needs classed as social and

not nursing when they are health needs?

Its not easy to answer.

I think you should possibly have to pay an amount for day care, sitting service

etc but I think if youre at home needing personal care..theres a reason why

you need that help and I dont think you should have to pay for that.

Its not a straightforward question and its complicated.

It should be on a level with other terminal illnesses.

You dont choose to have dementia do you? If youve got a terminal illness,

you should get the help?

It should be a level playing field.

Why should you have to worry about how youre going to pay for care when

youve got dementia?

Where should we get the money for more services from?

Higher taxes?


22/64

22

It seems like the tax system is the fairest or national insurance.

Id like to know how much wed have to pay more across the country to enable

us to provide more care. If its not a massive amount then yes, I think we

should do it.

CI think its the fairest way.

It depends on where it was going.

I agree that in principle it sounds fair but it depends where it goes.

How can we be sure where the money goes? Im sure if people knew it was

going on later life care/dementia care, people would be happier with it.

Should they increase charges for those who get social care?

No.

People would just refuse to take up services.

Its penalising those again who are already paying etc.

People who get help with smoking, drugs, alcohol problems etc, they all get

free care. It doesnt make sense.

I dont like the idea of a blame culture.

Should we tax the estates of people who get care after they die?

Penalised again just for being ill.

I dont agree with that.

I do feel that people who are really wealthy should pay more but..

It could be that theres a social fund and say 2p in every pound goes into this

fund to pay for care etc. This would mean we know where the money is

going.

I dont see how it would work and who makes the decision about where it

goes?

Should they cut benefits for wealthy people?

They should cut the fuel payments of those who live abroad or go abroad for a

number of weeks. You should only get it if youre using the heating etc.

Its who they class as really rich its usually those people who own their own

home and work.


23/64

23

Sometimes, owning your own home etc can make you poorer than those who

dont.

Having your own home etc doesnt mean you have a large amount of

disposable income to pay for care/day care etc.

Where homes are worth more etc, are they going to have to pay more?

What do people think of the Dilnot commissions recommendations for a

maximum cap on service charges?

Yes, definitely.

I think its a good idea but it depends where the cap is.

Should it depend on what youve got? What your assets are?

Yes I agree that there should be a cap but they should also look at the

corresponding amount and at what people get charged or some people are

not going to be any better off.

There should be some sort of sliding scale cap?

Should you be expected to sell your house to pay for care costs?

NO.

Should estates of those who receive services be taxed higher afterdeath?

No I dont agree.

Dementia is an illness that so cruelly takes away your life and you should

have the help to live as life as comfortably as you can.

I agree and I agree

(From a South Asian perspective) the whole thing is quite difficult to get a

view and perspective. Somebody who chooses to live Ilkley way it may be asmall house but worth moresomebody who lives in Manninghamthey

come to a stage where they become the rightful owners and they become ill

so its taken away to pay for their care.

You might live the highlife and spend the lot or you might save etc. It would

be sad that youve chosen to lead that lifestyle and are penalised.

How do you think we can best support people with dementia who are

socially isolated, who live on their own and dont have immediate family

support?


24/64

24

I think we need more funding and there needs to be outreach teams to

support these people and possibly rather than people going into permanent

care, to have companions so theyd go and live with the person. Itd have to

be a service network.

Sometimes, people have chosen to live in remote areas or in isolation.


25/64

25

Appendix ii - Caring for our future discussion event 20

th

September 2012

The meeting organised by the Bradford & District Disabled Peoples Forum

(DPF) brought together local politicians, disabled & older people to discuss

the white paper and draft bill Caring for our future published in July 2012.

The Government is holding a consultation on the draft bill which closes on the

19th October 2012. This meeting built on the success of the March 2012 DPFopen meeting creating opportunities for disabled people to meet with and

discuss issues with local politicians. Labour, Liberal Democrat, Conservative,

Respect and Independent councillors attended the event.

After introductions the meeting heard from David Ward MP and Keith Nathan

Chief Executive of Bradford & District Age UK about some of the challenges

facing care and support both nationally and locally. In the Bradford district

care and support is available to people with moderate support needs unlike

most parts of the country. One of the challenges for our district is to ensure

that this can continue.

The draft Bill aims to provide legislation around care & support that is fit for

purpose for many years to come:

Providing a minimum standard that should be available

Promotes independence & well-being

Responds to the challenges of a growing aging population.

In order to promote discussion there followed a number of facilitated

discussion groups around principles that underpin the reform of social care


26/64

26

agenda. All participants at the event had a chance to join in discussion around

each theme. Some key points raised under each theme were:

Choice:

I want my disability taken into account & services to be aware

Get the message out about what is available

Choice of services that are relevant to the individual

You fit into services needs as opposed to them meeting yours

Dignity and respect:

Dignity and respect means different things to

different people

Ensure training around D&R is more than the

minimum

Do people know they can complain? Is therefear of reprisal

Continuity need to spend time with person

receiving care involve family members

Joined up services:

A right to know information should be made clear

Improved access to services (physical &

communication)

Take positive models as method to developgood practice

One stop shops

Personalisation:

Need a personal assessment e.g. 2 people with

visual impairments have very different needs & wants

Personalisation could drive up service standards

How much choice have you really got?

Develop understandings of different disabilities & impairments

awareness training

These are just examples of the issues raised. At the end of the meeting

copies were made available of further information on the draft bill & white

paper in a variety of formats. Participants were encouraged to make their own

response to the Governments consultation or to the local consultation being

run by David Ward. The DPF will make a response based on the information

collected before October 19th

For copies of the complete flipchart notes, the DPF consultation response or

for any further information please contact email:[email protected] 01274 481590.
mailto:[email protected]:[email protected]:[email protected]:[email protected]


27/64

27

Appendix iiiBradford & District Age UK

Social Care in Bradford and the draft Care and Support Bill

We were for hoping for clarity and certainty about the Governments

plans for helping with the costs of care and are deeply disappointed

that we got neither from the draft Bill or Mondays Mid-Term Review.

Meanwhile the social care system is careering towards breaking point,

starved of funds, with investment failing to keep pace with the growing

needs of a growing ageing population.

There is an urgent need to know - for all those working in and cared for by the

system - when and how the Government plans to put the Dilnot reforms intoaction and ensure that all older people receive the care support that they

need.

Population projections for selected years and age groups, Bradford Metropolitan

District.

From a none too bright starting pointin 2006/2007 BMDC in its 2007-2012

Adult Services Five Year Strategy admitted to a low spend on Adult Social

Care compared with similar local authorities (it was 10% lower than

Calderdale; 15% lower than Wakefield and 25% lower than Leeds and

Kirklees)significant improvements were made - until 2010.

The progress made included an emphasis on working more closely with the

communities and the voluntary sector, supporting longer-term preventive

work, and supporting people in their own home. In 2009/2010 the District

deservedly won Beacon status for this effort.

The cuts programme since 2010 is forcing this into reverse. The local authority

is struggling to maintain its level of support whilst demand is increasing and its

resources are axed. (see the table above) and, for the first time, we are

seeing growing numbers of elders among our poorest communities. Bradford

AGE GROUP 2007 2012 2022 2026 %

Increase

200726

50-64 79,000 84,700 95,700 96,300 21.9

65-69 18,400 21,300 23,800 25,900 40.8

70-74 17,000 16,600 21,500 21,400 25.975-79 13,900 14,400 17,200 19,600 41.0

80-84 10,500 10,600 11,800 12,900 22.9

85+ 8,800 9,900 12,700 14,000 59.1

All 65+ 68,600 72,800 87,000 93,800 36.7


28/64

28

(in the top 10% of deprivation in the country) has suffered a cut equivalent to

147.60 per head of its population over the period 2010/2011 to 2012/2013.

This compares with North Norfolk which has lost 35.26 by comparison.

Rationing by price is reducing the numbers able to take up services whilst

they are still (theoretically) available.

More and more people are discussing concerns about declining standards /

pressure on the deliverers of care producing less help, and not as it is needed

by the client.

Pressure on reducing numbers of staff and beds in the NHS are now

producing instances of very poor planning and care in the discharge of

vulnerable peopleboth at Airedale and BRIthis used to be very rare.

Age UK locally and nationally welcomes the commitment in the draft Bill to

introduce a national threshold, signalling an end to the unfair postcode

lottery. We have called on Government to ensure a new threshold is set at a

decent minimum level (we believe this should be moderate - as it is inBradford - or its equivalent in the new system) and that eligibility criteria are

based on outcomes social care should achieve.

We are supportive of the draft Bills response to the Law Commissions

recommendations, in that it retains and clarifies most of the current rights ofolder and disabled people and adds important new legislation, including

rights to services for carers, and legislation to safeguard adults at risk of abuse.

We have doubts about the Governments perennial dream of everyone self-

referring for services/support through (cheap) online systems. In our view whilsta number ofd formats should be available, older people, and other

vulnerable groups, want to talk to someone, face-to-face, in a secure

environment. In a recent evaluation and survey of our Bradford Starting Point

information and advice service (used by over 600 people each month) 60%

wanted to sit and talk to someone as their preferred method of contact.

Age UK is pleased that personalisation remains a guiding principle for the

care and support system. Improving the quality of managed personalbudgets is particularly important for older people who do not choose a cash

payment for their care. However, it remains vital that personalisation is seen inbroader terms than simply rolling out personal budgets and direct payments.

Delaying on clarifying funding for the Dilnot proposals until 2015 or beyond is

inexcusable. It is necessary to implement Dilnots proposals and fund them

properly.


29/64

29

October 2012

Appendix iv - Response to Consultation on the Draft Care and Support

Bill incorporating responses from carer focus groups and local

Councillors who attended a review meeting at the Carers Resource.

The key points identified by our carers are:

(a) Recognition of how caring affects our lives, health, finances.

(b) Better signposting of support services by NHS staff

(c) Regular / separate carer need assessments

(d) Standardisation of carer need assessments & support services an

end to postcode lottery

(e) More emotional support face-to-face & via help-lines

(f) More training in moving / handling / communication, medicines

(g) More peer support to share tips etc.

(h) Carer counsellors to help deal with relationship issues, loss etc.

In response to the aspects of the Bill which affect carers our group andin discussion with their local councillors, the following insights,

suggestions and conclusions were collated:

Identification and Recognition this is an absolutely vital area in order for

any of the other changes/recommendations within the Bill to be possible and it

is an area which we believe needs strengthening.

With the definition of regular and substantial having been removed for the

amount of caring input there is now a suggestion of eligibility criteria for

access to services but still no indication of what constitutes a carer in the firstplace. The term needs to be reclaimed from the confusion currently with a

paid care assistant role.

Rather than judging whether someone is a carer based on input/levels/hours

of caring could an outcomes/impact framework be devised to identify a carer

based on the impact the role is having on their lives rather than what they are

actually doing as this would be a fairer indication.

Our carers are worried that they may not even be identified as carers, never

mind receiving the levels of recognition and respect as expert care partnersthat they deserve.


30/64

30

I would like to know how much care I have to give before I qualify for help.

We wish we werent taken for granted.

I want others to listen to me more Im an expert caring alone at home but

not when my husband goes into hospital.

The latter quote from a carer also shows the need for much closer links to

health than are currently included in the Bill. There are a number of reasons

why this is important:

Integrated care and support is the main focus for locality teams on the

ground at present and therefore it seems logical that any changes to

the processes/statutes relating to this should have am integrated

approach at the heart

Clinical Commissioning Groups will be a new and powerful group andcurrently the commissioning framework which is guiding their work has

no mention of the word carer at all. In this case it is possible that GPs

and primary health care teams could feel completely absolved from

responsibility of identifying (and supporting) carers whereas in actual

fact they have a critical role to play. Many carers express dismay that

their GPs do not recognise them or signpost them for support, a

number have had unpleasant experiences of taking the person they

care for to appointments and their expertise and vital role is simply not

recognised or appreciated.

Finally Social care will only come into contact with 5% of the population

in a given year and therefore whilst we approve of their being given a

broader role and more responsibility on them to assess and support

carers without the identification and throughput of carers for

assessment and support coming from health this will be a missed

opportunity for improving the lives of carers.

Its important that doctors, nurses etc. know how we can get help.

Grouping Carers

In actual fact we would argue that carers are currently grouped if not

merged into the people they care for. It is rare to see a statement about

carers in their own right much more regularly seen is patients andcarersor

service users andcarers

We believe it is vitally important for carers to be recognised in their own right.

As a carer, I want to have my own assessment

Carers should have their needs assessed SEPARATELY from the personthey care for in order to be able to be open and honest about their feelings


31/64

31

and ability to cope. Undertaking joint assessments often means carers feel

obliged to agree with decisions or statements made by those they look after or

professionals undertaking the assessments.

Portability and Standardisation.

The aspect of portability is very helpful and removes elements of the postcode

lottery which previously existed. In order for this to happen there needs to be

an increased standardisation of assessments across geographies and

disciplines. In addition there needs to be standardisation of the packages of

service available.

I want to know what services are available when we need them.

There is also an opportunity here to alter the unfavourable perceptions

created simply through the unhelpful and off putting terminology CarersAssessment many carers are concerned that the process is looking at their

ability to care and to test them in a negative, non-constructive way. To alter

this to be a Carers Needs Assessment or a Carer Support Assessment would

make the whole process more positive from the outset.

However, on the point of take up there are some further points to make:

The assessment needs to be useful, relevant and have outcome sand

services attachedthis brings issues of determining what is a carer service

and this will be more relevant and crucial if charging for carer services isbeing introduced.

As a carer, I want to have my own assessment, and to be confident that it will

result in me getting some help.

The assessment as currently delivered offers only a snapshot in time and

could be very different depending if carer and/or cared for are having good or

bad days. Perhaps some aspect of ongoing self assessment could be

introduced over a period of time before a formal assessment is carried out to

give more of an accurate indication

Carer Services

I would like those who plan services to understand that short breaks are not

the only answer, we have other needs, too.

We know what we need. I wish those who plan services would let us help

them.

This is a very complex area and needs careful consideration.


32/64

32

Respite and Sitting services are currently the most common form of provision

offered if a carer is seen through an assessment to be struggling. However

these are services TO THE CARED FOR and therefore only the cared-fors

income should be assessed if this alters then the carers income could be

considered too.

Rarely a carer is offered some practical assistance with household tasks

once again it is debateable whether these are services to the carer if they are

required as a result of the carer having too much else to do for the cared for

person to find time to do the additional tasks.

Actual services to carers as requested by the carers we involved in our

groups and talking to local councillors include:

1. More emotional support face-to-face and via help-lines

2. More training in moving / handling / communication, medicines3. More peer support to share tips etc.

4. Carer counsellors to help deal with relationship issues, loss etc.

Emotional support somebody to talk to face to face and share concerns and

issues with is absolutely vital for carers and is what used to be delivered by

Carers Organisations. However most of the funding for this type of service

has been removed having been branded as tea and sympathy and as

actions which create dependence. The carers we report dispute this concept

it is vital to them to know there is someone at the end of a phone who can

listen non-judgementally, understand and communicate clearly.

Training following on from the above comment many carers specifically

want training in aspects such as moving and handling, communication skills,

medication handling skills etc. They are happy to care and often do intensive

amounts of caring tasks which previously would have been carried out by

health/social care professionals however in order to undertake these activities

confidently and safely they want the same access to training as those

professionals and currently this is either completely unavailable or is too

expensive to be accessible to most carers.

Peer Support opportunities to get together with others to talk and share tips,

solutions etc. Carers are the experts and carers can often tackle, challenge

and solve many concerns and issues amongst themselves when they are

given the opportunities to come together and facilitated to discuss topics and

situations.

Listening services specifically for carers many carers find (after extensive

waits for NHS services) the support given by a generic counsellor is not

suitable for them as carers, particularly in aspects such as relationship

support and care planning help. Specialist carer services understand better.


33/64

33

Appendix v - Bradford Metropolitan District Council.

Report of the Interim Director of Adult and

Community Services on the White Paper; Caring for

our Future: Reforming Care and Support and the

Draft Care and Support Bill (the Bill).

Summary statement:

Reforms to Adult Social Care have been proposed and discussed for many years

with different governments considering and then moving away from implementing

significant or radical proposals. A number of factors have now been recognised as

joining to make this area ready for reform. This report seeks to understand the

context nationally that has led to this opportunity for reform and what this could mean

for Bradford District.

Janice Simpson

Interim Strategic Director, Adult and Community Services

December 2012


34/64


35/64

35

1 Introduction

1.1 Reforms to Adult Social Care have been proposed and discussed for many

years with different governments considering and then moving away from

implementing significant or radical proposals.

1.2 The importance of these reforms cannot be underestimated for thousands of

people who rely on council commissioned services daily or who are facing the

uncertainties of how to fund care and support needs. The reforms are of

great importance for the future sustainability of local government and are

highly relevant to one of the fastest growing work sectors in the United

Kingdom.

1.3 A number of factors have been recognised as combining to make this area

ready for reform. This report seeks to understand the context nationally that

has led to this opportunity for reform and what this could mean for Bradford

District.

2 The Context of Adult Social Care Reform

2.1 The Law Commission review of social care legislation, May 2011 and the

Dilnot commission report in July 2011 set out ideas around legal and funding

reform. These led to the three papers published on 11th July 2012 outlining

the plans for social care for the future. The White Paper; Caring for our

Future: Reforming Care and Support, Caring for our Future; Progress Report

on Funding Reformand the Draft Care and Support Bill (the Bill). Nationally

local authorities are delivering Adult social care in the context of demographic

pressures, reduced budgets and with rising expectations. Demographic

changes are recognised as presenting the greatest challenges to delivery of

Adult social care.

2.2 According to the latest official Office for National Statistics (ONS) population

estimates demographic changes in Bradford District will present similar

challenges. In the 2011 Census results updated to end of June 2011 there

are 69,800 over 65 year olds living in the District, making up 13.3% of the

total population. This age group is predominantly female, 56.7% are female

and 43.3% male. The number of over 65s has increased by 2,000 (2.9%)

over the past ten years.

2.3 ONS Population projections for 2021 expect there to be somewhere in the

region of 84,700 over 65 year olds in ten years time. This is an increase of


36/64

36

nearly 15,000 (21.5%) on todays numbers and just below the scale of

increase expected nationally of 23.6% for England.

2.4 At the end of June 2011 it is estimated that there were 34,100 people over the

age of 75. This is about half of all over 65 year olds and 6.5% of the total

population of the District. Again as expected the figures show that the over 75

year old population is predominantly female, 61% are female and 39% male.

The number of over 75s has increased by 2,400 (7.6%) over the past ten

years.



just over 5,000 (14.7%) on todays numbers but below the scale of increaseexpected on a national scale of 27.2 % for England.

2.6 At the end of June 2011 it is estimated that there were 9,700 people over the

age of 85. This is about 14% of all over 65 year olds and 2% of the total

population of the District. Again as expected the figures show that the over 85

year old population is predominantly female, 68.6% are female and 31.4%

male. The number of over 85s has increased by 1,400 (16.7%) over the past

ten years.



3,000, nearly one third on todays numbers just below the scale of increase

expected on a national scale of 38.5 % for England. Over 85 year olds are

the most significant consumers of adult social care and increases in this

population will lead to increased demands on adult social care services with

impact on the budget. Charts in Appendix 3 show the changing

demographics in the District.

2.8 Appendix 4 shows numbers of people over 65 predicted to have dementia by

2030 by age and gender for Bradford District. Dementia affects people over

the age of 65 mainly although it can affect younger people. The prevalence of

early onset dementia is higher in men than women for those aged 50 65

while in later life late onset dementia is marginally more prevalent in women

than in men. The prevalence of early onset and late onset dementia increases

with age doubling with every five year increase across the entire age range.

Tables A and B in Appendix 4 show the estimates of prevalence of early and

late onset dementia for Bradford by age group. Prevalence of dementia in the95+ age group is 25 times higher than the 65 69 age group.


37/64

37

2.9 Over the same period there is a projected increase of 32% in the number of

people with disabilities 18 64. This is significant as the funding pressures

rising from an increase in people with learning disabilities can pose real

pressures. Although much more difficult to understand without accuratefigures through the census there is an expectation that numbers of adults with

a severe learning disability, with sensory or physical impairment or with

mental health needs will increase in Bradford District in line with national

projections.

2.10 LGA figures suggest that the 2010 Spending Review set out real term

reductions of 28% in central government grant to local government by 2014-

15 which compares with overall reductions of 8.3% across all departmental

budgets. In the last two years the Council has had to reduce spending by over72 million and will have to make more savings in future. The Local

Government Association (LGA), which represents local authorities, has

estimated that, if councils keep pace with increases in demand for social care

and waste disposal, then other services will face cuts of over 66% by 2019. If

the costs of capital borrowing and concessionary fares for pensioners are

also taken into account then in reality there would be virtually no funding left

for other services. Their point is that Local Authorities are in a position where

savings from prevention and service re design can keep pace with rising

demand or with budget cuts but not both

2.11 A consultation has been held in Bradford District on the proposals in the

White Paper and the Bill. The results have been presented to the Social Care

Overview and Scrutiny committee (SCOC) and submitted to the Department

of Health (D of H). The consultation was very well attended and the SCOC

supported the views expressed in the consultation. The submission to the D

of H is included as Appendix 1 and a list of all organisations attending as

Appendix 2. A summary of the key points from the consultation is included for

each of the five main statements from the White Paper in section 4.

3 The Local Government Association (LGA), the Society of Local

Authority Chief Executives (SOLACE) and the Directors of Adult Social

Services (ADASS) policy position

3.1 The LGA, SOLACE and ADASS have published a guide for council leaders

and chief executives on the proposed reform of adult and social care and

support. This shows a shared number of high level positions on the care and


38/64

38

support reform debate. The guide suggests that any future system must seek

to improve the individuals experience of care and support.

The LGA suggest 3 key tests to show that the system will be better for the

proposed changes:

Improving the individuals experience

A clear time table for action

A clear role for local governmentStability, predictability and transparency are essential as is sufficient funding

and a clear role for local government. The promotion of prevention and

recovery is recognised as of key importance as is utilising the totality of

resources within the entirety of the system. The governments proposals as

expressed in the white paper and draft bill are viewed as providing a good

basis to deliver a reformed care and support bill.

3.2 The commitment, albeit in principle, to the main funding model from the Dilnot

Commission is welcomed. The concern is the lack of a commitment to

funding the proposed reforms. The 2010 Spending review set out real term

reductions of 28% in central government grant to local government and local

authorities are operating in the tightest financial constraints in living memory.

The white paper and the draft bill offer little progress on how such a modern

and stable system could be funded and this will remain a question until details

are provided of how it can be fully resourced. Social care funding needs tobe on a sustainable footing for its own future but also for that of local

government as a whole, as the funding gap brings pressure upon all parts of

the local government system as it tries to respond to the demands on adult

social care.

4 The White Paper; Caring for our Future: Reforming Care and Support

The White Paper has two core principles. The first is based on promoting

peoples independence and wellbeing ensuring that everyone has a

responsibility to contribute to prevent, postpone and minimise peoples need

for formal care and support. The second is that people should be in control of

their own care and support. Alongside this is the view that as a society there

is a need to understand that people with care needs have something to offer

and must be supported to achieve their potential. Recognising people as

assets as well as accessing services. The principles are expressed in the

White Paper as five statements of how people with care needs and those who

care for them would experience care and support in the reformed care and

support system:


39/64

39

1. I am supported to maintain my independence for as long as possible2. I understand how care and support works and what my entitlements

and responsibilities are3. I am happy with the quality of my care and support4. I know that the person giving me care will treat me with dignity and

respect5. I am in control of my care and support

The following section explores each of these five I statements, states the

areas covered by each I statement and gives a summary of the key points

from the consultation and comments on the position in Bradford District.

4.1 I am supported to maintain my independence for as long as possible

The White Paper states people will be supported to stay active, connected

and independent through:

Strengthening support within communities

Housing

Summary of consultation position

4.1.1 Participants in the consultation in Bradford welcomed the emphasis on

supporting an individual to maintain their independence for as long aspossible. A broader approach to supporting people to retain independence

would be welcomed with the broader skills in communities, including those

accessing care, better utilised. The proposals must be understood in the

context of other strategies, guidance and legislation being implemented that

also impact on individuals rather than viewing this in isolation, for example

welfare reform. Housing was seen as integral to retaining independence with

affordable sustainable housing and opportunities for house swapping

priorities.

Bradford District

4.1.2 The proposed duty on local authorities (LAs) to ensure people receive

preventative services is welcomed in principle, as is the embedding of

wellbeing as a purpose within the Bill, providing an overarching and unifying

purpose for social care for the first time. The current statutory duties of LAs

do not necessarily reflect the outcomes that the sector would want to achieve.

Currently no organisation or sector has a statutory duty to ensure people are

helped to be as well and independent as they can be, and the main focus is to

meet the needs of people above certain thresholds. This new duty would shift


40/64

40

the balance towards more preventative services, however there would need

to be sufficient resources to enable this to happen.

4.1.3 A co production approach is required across agencies from both the public

and voluntary sectors. A key element of this is the need to work with local

communities for them to shape and design the services they want and need.

Bradfords Adult and Community Services have a strong history of partnership

working across the voluntary and public sector agencies and with older

people as evidenced by the national Beacon award for engagement with older

people in 2009. There is concern that the resources, particularly in terms of

pump priming monies, and the developmental expertise that will be needed to

build capacity in the Voluntary and Community Sector (VCS) will not be

available to effect real change.

4.1.4 The signposting services provided in Bradford by Adult and Community

Services central Access point and also the VCS Carers Resource aim to

sustain peoples independence for as long as possible. Bradford has

commissioned VCS partners to carry out a similar function, details of which

can be found in DIVAhttp://www.divabradford.org.uk/. The DIVA online

directory was originally developed to build on several existing information

sources about VCS groups in the Bradford District and is the primary

portal for the VCS in the Bradford District.

4.1.5 Bradford has seven extra care housing schemes across the district. Thisincludes the award winning Wagtail Close which provides independent livingfor people with sensory needs as well as those living with a physical disability.The scheme was built in partnership with Hanover Housing in 2002 and wasthe first of its kind nationally to specialise in accommodation for this particularclient group.

4.1.6 With the support of training from the National development Team for Inclusion

(NDTi) and Inclusion North, the Support Planning Champions pilot being runby Adult Services across Bradford sees a group of trained volunteers workingwith service users with a Learning Disability to develop their support plan.The pilot has a particular emphasis on helping the person move into theirown housing accommodation. The volunteers are mainly carers themselvesso have the experience and empathy to be able to deliver joint support plansin a new and creative way.

4.1.7 There needs to be a shift from crisis intervention to early intervention to

prevent or delay the need for more costly and complex interventions. Part of

the challenge is how this is funded, and how resources are managed to

sustain the lower level, preventative services at the same time as managing

increasing demand and supporting more frail and vulnerable people in their
http://www.divabradford.org.uk/http://www.divabradford.org.uk/http://www.divabradford.org.uk/http://www.divabradford.org.uk/


41/64

41

communities for longer. Individuals need to be identified earlier, using a

whole system approach to identify people who may be developing care and

support needs earlier. For example:

The funeral director who may detect depression, isolation or

loneliness in a bereaved older person at a life crisis point Fire prevention staff who may see indications of wider concerns

when visiting homes of vulnerable people

GPs looking more holistically at patients needs

Harnessing community assets to provide support and identificationof people who may be in need

Providing the appropriate range of housing options available topeople at the right time to support recovery and independence

Aiming to mainstream components of the local care and support system, this

is not just the province of specialist adult social care services and

responsibility, but the responsibility of the whole health and social care

system, the whole council, local communities as well as individualsthemselves.

4.2 I understand how care and support works and what my entitlements and

responsibilities are

Better understanding through access to quality information is a key theme

throughout the proposals, the White Paper states people will be supported

through:

Better information and advice

Assessment, eligibility and portability for people who use careand services

Carers support


4.2.1 There was strong support in the consultation for high quality information and

advice to enable people to take greater control over their own care and

support and plan for their futures. The emphasis on on-line services was not

supported with many people unable to access these through language,disability, culture and poverty. Advocacy and support is essential for people

to understand information and navigate services. It is not enough to just

make information available. The principles of a nationally agreed threshold

and the right to care and support both for carers and those cared for was

welcomed in principle although the real value of this cannot be understood

without an understanding of how this would be funded. Improved and easier

portability would address a real difficulty though again the real benefit will be

in the how this is implemented. The white paper and bill were viewed as

positive in their recognition of the distinct role of carers. This must be backed

up with a real commitment to action that takes account of the challenges insharing information and safeguarding carers and those they care for.


42/64

42

Bradford District

4.2.2 In November 2010 as part of Bradfords Adult Services improvement

programme a Central Access Service was introduced. This provided the adult

population with one central contact point for Adult Social Care services. This

in turn ensured a holistic screening and effective signposting process, with far

clearer different service pathways being developed to facilitate this. In

addition to screening and signposting being carried out by a range of Social

Care professionals, the service very uniquely provides for those different

disciplines to be available to carry out assessments of need, jointly if required,

in those cases that need an immediate response, most noticeable of these

situations are those where there are safeguarding issues.

4.2.3 The Access Service has been recognised nationally as good practice by the

LGA as part of its Adult Social Efficiency programme. The success of the

programme has led to work to integrate other agencies into Access, including

colleagues from Health and the new 111 service and VCS services.

4.2.4 The different levels of eligibility that exist nationally can stop individuals

moving to a different authority area which can restrict opportunities for the

whole family. The proposal to establish a national minimum level of eligibility

is a move towards addressing what is recognised as a barrier to manypeople. It does not fully address this issue as there is still the opportunity for

Authorities to be more generous. Also while Authorities might honour the

assessment and level of need identified by another the level of provision

provided to meet that need could differ from Authority to Authority. This is

partly due to the way Authorities calculate the level of Indicative Budget which

is produced by their Resource Allocation System. The values used in these

systems are based on local market costs which will be different. The added

complication to this issue is the complex relationship between the

assessment of need and the care plan/personal budget designed to meet that

need. The budget transferred under personalisation might be constanthowever this would not necessarily bring the same level of service in other

authorities. There would be no guarantee that the service required would be

available to suit a persons needs.

4.2.5 To assist with ease of transfer the recommendation would be to introduce a

national agreement on length of transfer times, possibly of two weeks. At

present in Bradford an individual is supported for a minimum of 2 weeks in

another Authority to allow that Authority to carry out their own assessment


43/64

43

4.2.6 Bradford Adult and Community Services are working closely with partners inHealth and with Carers Resource to develop quality, proactive andaccessible services for carers across the district. Carers resource hasrecently been commissioned to deliver the specialist multi agency winter FirstContact service. Carers Resource also deliver a new Home from HospitalService as well as overseeing the delivery of small grants of up to 200 fromthe Carers grant scheme. They will also carry out Carers Assessment onbehalf of Adult Services where an emergency plan is being completed andwhere a carer consents to an assessment with a support plan beingcompleted. Caution is required when separating this from the person caredfor as a holistic and inclusive approach often produces the best outcomes andis most frequently requested by carers. Challenges arise around protection ofdata and information sharing with safeguarding the carer also very important.

4.3 I am happy with the quality of my care and support

The White Paper states people will be supported to understand what high

quality care and support looks like and the roles and responsibilities of

organisations through:

Defining high quality care

Improving quality

Keeping people safe

A better local care market


4.3.1 The consultation felt that the white paper concentrated on approach and

principle which is very aspirational and easy to agree to but more difficult to

deliver operationally. Information is required on how this will be funded and

managed and what support would be available if anyone wanted to challenge

decisions. Quality of support provided by none professional carers was

questioned as the emphasis on raising standards appeared to be work based

qualifications. The emphasis on comparison websites to demonstrate quality

was questioned. Many people do not have access to IT and websites were

not viewed as being able to provide a full and accurate picture of the servicesprovided. This did not take account of the full range of tools available for

example Healthwatch and Overview and Scrutiny Committees.

Bradford District

4.3.2 The new Bradford Quality Assessment Framework (BQAF) has been

developed to be rolled out across all care homes across the district. This

innovative framework has been adapted from the Quality Assessment

Framework (QAF), a national tool used to monitor quality across a range of

Supporting People services. The BQAF has also been adapted to ensure the


44/64

44

Care Quality Commission (CQC) essential standards and their outcomes are

incorporated into the document, giving a quality assessment framework which

can now be used for all CQC regulated services. The aim is to link its

outcomes to a local directory of care homes and to the Council website. With

the intention of listing all homes on the website that have a BQAF rating and

providing each home with a certificate for display on their premises.

4.3.3 Proposals to strengthen adult safeguarding are welcomed, particularly withregard to the new duty on local authorities to make enquiries where an adultwith care and support needs is at risk of abuse or neglect. The convening ofstatutory safeguarding adults boards with core membership from the policeand NHS organisations and the carrying out of safeguarding adults reviews insituations where an adult with care and support needs experiencing abuse orneglect dies is welcomed. These proposals reflect many aspects of currentpractice and arrangements but it is an important step forward to establish astatutory framework for adult safeguarding which provides parity withchildrens safeguarding.

4.3.4 The market development theme will focus on how commissioners and

providers interact to make sure the market delivers the range, choice and

quality of services that people require to meet their needs. There needs to be

more focus on partnerships between commissioners and providers in

developing services. The proposals will strengthen the role of local

government as a place shaper, shaping the market, managing potential or

actual market failure, and working constructively with providers. In Bradford

there has been work with care home and home care providers through the

local forums. More work is required to develop the local market and give

people easier access to a wider range of local provision as alternatives to

traditional block contracts across a wider range of services. Bradford is, for

example, looking at trialling Slivers of Time and well as the Shop4Support

emarket option. There is the continuing challenge of agreeing fees, agreeing

transparent models with providers that ensure value for money for the rate

payers, sustainability of the market and measurable, good quality services.

4.3.5 Slivers of Time in Bradford will be run as a pilot for a year and will offer two

online platforms for people to book paid care and respite care. It will enable

people to determine what service they want in these areas and who the

provider should be.

4.3.6 Connect to Support is a regional initiative which Bradford is developing to be

used locally. This online service will enable local people to have access to a

range of local social care services and the VCS. The aim will be to provide

people with more choice and control over how and what services they want touse.


45/64

45

4.3.7 It is important to identify self funders who may be near to coming into the

system, offering advice, information, signposting and where necessary

assessment (for example when considering care home admission).

4.4 I know that the person giving me care will treat me with dignity and

respect

The White Paper states the care and support workforce is an expanding

sector, people will be confident of the skills of people employed in this sector

through investment in:

Workforce Role of Principal Social Worker to be established

There will be a Chief Social Worker appointed nationally


4.4.1 A dignity and care code and a framework for training were both welcomed by

people at the consultation although how effective these could be was queried

especially with the current constraints on funding and lack of information on

future plans.

Bradford District

4.4.2 In Bradford, the Adult and Community Services department already offer

training to PAs on how to treat the people with dignity and respect. The

department has provided training to its home care workers based in a 6 week

support service BEST and residential care staff

4.4.3 The White Papers commitment to focusing the role of social workers on

interpersonal support, to promote choice and control, and to better meet

peoples needs and goalsis welcomed howeverthere needs to be a clearer

definition of what is meant by the term interpersonal support. There is

concern about how the existing pressures on social workers could be

managed in order to make

reforming social care - appendices

Documents