Equality implications of the Care and Support Green Paper Katherine Wilson Carers UK

This presentation will cover … Short overview of the Paper Equality implications, including of: –What’s in the Paper –What’s been left out

The Green Paper: an overview A National Care Service: The headlines Funding options: The headlines

National Care Service: Headlines Six expectations: Prevention services National assessment A joined-up service Information and advice Personalised care and support Fair funding

National Care Service: Headlines Prevention services – to stay independent and well, e.g. re-ablement help after hospital. But not clear how funded and how accessible. Standardised (and portable) national needs assessment process Joined up – between health, housing and social care and social care and disability benefits Information and advice – for everyone, including those who pay for their own care (self funders). Based on personalised care and support – extension of Personal Budgets approach.

National Care Service: Headlines To be underpinned by: Clear national rights and entitlements The ‘transformational’ agenda Putting People First to improve the way the system works for people Possibility of a new independent body to give evidence about what works and value for money – a NICE for social care A new system of fair funding …

Funding options: Headlines Partnership model – regardless of their wealth everyone would get a quarter or third of their basic costs paid by the state, the poorest would get all costs paid and those with less wealth two thirds. Approx £20- £22,000 per person Insurance model – voluntary payments, either a private or state backed scheme – based on above model. So, insuring against what the state does NOT pay for. Approx £20-£25,000.

Funding options: Headlines Comprehensive model – compulsory payment (approx £17- £20,000) into a state insurance scheme for people over retirement age in return for free basic care. Could be paid at retirement or over time or at death. Might be a sliding scale according to wealth. Looking at working life model alongside this 2 further options ruled out by the paper – pay for yourself and funding by direct taxation.

Equality implications: Overview What the Paper’s Equality Impact Assessment says, and What Carers UK thinks about the Paper, including what’s been left out …

Overall comments (EIA) EIA - aim of the Paper is to improve equality and diversity within the system. Provisions for joined- up working, wider range of care and support and better quality services (based on best evidence about what works) are overall likely to have a positive impact on all service users. Carers UK view – some positive impacts, (e.g. access to information) but also some potentially negative ones. Key equality issues have not been addressed in the Paper …

EIA - Prevention EIA – the system needs to ensure that this doesn’t lead to an adverse impact on those with a higher level of need. Funding of low level need would seem to be particularly beneficial for older people and people from LGBT groups. Carers UK – reality needs to match rhetoric. Not clear how funded or how widely accessible support will be (e.g. telehealthcare). Local authorities with hard pressed budgets will continue to focus on those most in need, leaving the rest of families (the majority needing help) struggling without sufficient support.

EIA - National Assessment EIA - easier transition between services. Could potentially lead to more people presenting themselves for assessment. Carers UK – recognise advantages but we do have increasing concerns about Resource Allocation Systems which actively discriminate against disabled and older people and carers by automatically downgrading risk if a carer is present. Carers need to be seen as rights holders, not simply as part of the care system. Assessment processes should be ‘carer blind’. People also need advocacy and support to access assessments. Otherwise only a small proportion of people who need services will actually access them.

EIA - Information and advice EIA - Should help to improve the situation for all equality groups. Carers UK – welcome the proposals including for those who self fund. The right information at the right time is crucial for families in making decisions and securing their entitlements. Key issue continues to be … how many people will actually access services as a result?

EIA – Personalised care EIA – extension of Personal Budget approach will need to ensure that greater cultural sensitivity is recognised and equality strands have greater choice and control. Likely to have a more positive impact on older people who currently appear to benefit less than other groups. Carers UK – recognise advantages but concern that the modelling assumes a very high level of carer input. Carers need to be seen as rights holders too – there shouldn’t be an assumption that they will care. Also how many people will actually access services as a result? Will this be part of the continuing trend towards better services for increasingly smaller numbers?

EIA view – Funding options Partnership option – probably most benefits older people who have saved but will benefit all equality strands. Insurance option – as above plus those groups who choose to purchase insurance. BUT those who couldn’t afford to would still have unmet need. Comprehensive – most benefit to those with savings. BUT not to those who don’t. Women would benefit most especially those who fund their own care.

Carers UK view - Funding options A mixture of approaches is needed – the following issues have not been addressed: The model suggested is based very heavily on the baby- boomers but the generation coming behind them is unlikely to have access to the same level of assets. Needs of working age people (4.4 million carers in this category, 3 million of whom currently juggle work and care). Needs of young disabled adults and their carers. Needs of lower earning groups, e.g. the 13.4 million adults in 7.6 million low earner households.

EIA – Disability benefits EIA - the exact impact will depend on the final design of the system. Integrating disability benefits (e.g. AA) into the care & support system may help improve the situation for those from BME groups as more accessible although these groups are often not in touch with social care. Carers UK – serious concerns that no mention of the different equality issues which would be thrown up if AA (and not DLA) was placed in the social care system.

EIA – Disability benefits Carers UK - removal of vital income through AA and access to Carers Allowance would increase inequality (one of current conditions is caring for someone with middle or higher rate DLA care component or higher rate AA) If AA were to be removed but DLA remained this would create inconsistency and unfairness and older people would lose out. AA is seen to be a clear entitlement which also provides flexibility for families e.g. in covering additional costs of disability.

EIA - Carers We welcome the first step that DH has taken to look at carers within the context of the EIA. With the new provisions of the Equality Bill all future EIAs will need to consider the position of carers (i.e. by association with disabled people). The Paper’s vision is good but we don’t believe it satisfies the conditions of the EIA. Some proposals could impact positively on carers’ equality (e.g. development of telehealthcare), but others would either increase inequality or not address the inequality that currently exists...

EIA - Carers Key inequalities not addressed … Carers’ rights. There are still assumptions that families (and individual carers) will provide care without regard to their own choices or rights. We need … a rights based approach to caring. As well as their important role as partners in providing care, carers have a right to their own life, to be able to work, to have good health etc.

EIA - Carers We are particularly concerned that the inequalities faced by working age carers - which also impact on the people they are caring for - are not addressed. Caring can have the same negative impact that parenting a child used to. Experienced workers are falling out of work because of a lack of affordable and flexible care services (1 in 5 give up work to care) Carers then face harsh financial and health penalties which also impact on the people they are looking after We need a care and support infrastructure to enable carers to stay in, and return to, work and to exercise basic rights, i.e. to have their own life, health etc,

EIA - Carers Parents now, rightly, have access to better childcare services; the Green Paper makes no reference to similar economic and societal inequalities affecting carers (which also impact on the people they look after). The next stage of the Care and Support consultation must address these issues. Social care is a significant issue, not just for people in receipt of it but also for their families and carers (and for our wider economy.) This was recognised a generation ago for parents. Now - as with childcare policy - policy needs to be joined up across the care and employment sectors to tackle these remaining inequalities.

A footnote: Personal Care at Home Bill Will invest £670 million in making personal care free of charge to those most in need in their own homes. A welcome initiative but, again, this is better services being provided to fewer people… …we also need a response to the population’s different levels of needs for care and support on a much wider scale.

Carers UK and Employers for Carers Websites: