Indeed. It operates very well already in Torbay, but it cannot be dictated centrally. We need to get the hurdles out of the way, allow people to work together locally and facilitate that. We heard on the draft Bill Committee that joint funding streams were the best way to move that forward.
Unfortunately, in Torbay in the crunch year 2015 we will see the funding drop below 90% of projected expenditure. At that point, rather than driving further integration, it will cause systems to start to fall apart because people need to protect their own silos. That is a real danger. As the Bill proceeds to Committee, I hope we look very carefully at the effect of the funding gap and make sure that we are not setting a system up to fail. One of the problems with the Bill is that it sets up many new statutory responsibilities. Councils will have to fund care accounts, which will undoubtedly be complex, bureaucratic and subject to challenge. Councils will have responsibilities for carers’ assessments. There will be increasing numbers of eligible people as the thresholds and caps change. We will see safeguarding adults boards, more rights to information and advocacy, and for many, deferred payments, if they have not already been making those.
Once we create these additional statutory responsibilities, there will be less money to go around for the very things that are at heart of the well-being and prevention principle. That is what concerns me. Would it not be a tragedy if we set up carers’ assessments but there was no funding left for services to respond to needs? Voluntary organisations in my community can function incredibly efficiently on very little money. They do not need to be fully funded, but they need some funding. If that money dries up, I worry about how we will move forward with a genuine well-being and prevention principle.
I want the Bill to succeed. In the remaining minutes I shall touch on those aspects that I think are, sadly, still missing, which were recommended by the draft Bill Committee. One is how we calculate care costs according
to their actual cost, not the cost to the council. For a person living in their own accommodation, it sometimes costs a great deal more to access support than it would cost a council to provide it. We need to look at that again.
There is a small but important area relating to powers of entry in exceptional circumstances for those who are subject to abuse in their own home. It would be wrong for us to ignore that possibility. Although the overwhelming majority of carers of course do a wonderful job in challenging circumstances, there are occasions, sadly, when people can be at risk from those who love them. Very often that is as a result of the intensely challenging circumstances that carers face. We need to reserve a power of entry in exceptional circumstances where there are very serious concerns about individuals who may be vulnerable and unable to communicate easily.
Another issue is free social care at the end of life. We know that 73% of people would like to be able to die at home. In my experience working as a GP in rural areas, where that broke down for most people was as a result of a lack of social care, and the challenge of caring for somebody right at the end of their life, when they may, for example, be doubly incontinent. Until people are in that situation, they may not understand how incredibly demanding it is to have to be with someone 24 hours a day, trying to stay awake and provide the intensive support they need. Allowing everybody to access free social care in those terrible final days would be a very important step forward.
Finally, the duty of candour we have introduced for foundation trusts is welcome, but I think that it should be extended to social care.