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Q. What is the Sutherland
Report?
With respect to Old
Age: Long Term Care – Rights and Responsibilities was presented to the
UK Parliament in March 1999. This was one year after the Royal Commission
on Long Term Care was established by the-then Secretary of State for Health,
Frank Dobson. The Commission would be chaired by Professor Sir Stewart
Sutherland, Principal and Vice-Chancellor of the University of Edinburgh.
The Commission was
given the remit of examining the short and long-term options for a sustainable
system of funding of long-term care for elderly people in the United Kingdom,
both in their own homes and in other settings. Within 12 months,
the Commission should recommend how, and in what circumstances, the cost
of such care should be apportioned between public funds and individuals.
Q. Why was it deemed
necessary to set up the Commission?
We live in an increasingly
ageing population. In the last 70 years the number of over 65s has
more than doubled. Between 1995 and 2025 the number of over 80s will
increase by 50% and the number of the very old – the over 90s – will double.
Already 1 in 5 people is over 60. This presents a very real challenge
for government – improving the lives of an ever increasing section of society
in a way that delivers the best results for the greatest number of people.
Q. What did the Commission
recommend?
The Commission made
the following recommendations:
Main recommendations:
· The costs
of care for those individuals who need it should be split between living
costs, housing costs and personal care. Personal care should be available
after an assessment, according to need and paid for from general taxation:
the rest should be subject to a co-payment according to means.
· The Government
should establish a National Care Commission which will monitor longitudinal
trends, including demography and spending, ensure transparency and accountability
in the system, represent the interests of consumers, encourage innovation,
keep under review the market for residential care, nursing care, and set
national benchmarks, now and in the future.
On funding they recommend:
· The Government
should ascertain precisely how much money, whether from NHS, Local Authority
Social Services and Housing budgets, or from Social Security budgets, goes
to supporting older people in residential settings and in people's homes.
· The value
of the home should be disregarded for up to three months after admission
to care in a residential setting (with appropriate safeguards to prevent
abuse) and the opportunity for rehabilitation should be included as an
integral and initial part of any care assessment before any irreversible
decisions on long-term care are taken.
· Measures
should be taken to bring about increased efficiency and improved quality
in the system, including a more client centred approach, a single point
of contact for the client with devolved budgeting, budgets shared between
health, social services and other statutory bodies and greater integration
of budgets for aids and adaptations.
· The Commission
set out a number of other changes to the current system, such as changing
the limits of the means-test, or making nursing care free, which would
be of value in themselves, but which would be subsumed by our main recommendation.
· The resources
which underpin the Residential Allowance in Income Support should be transferred
to local authorities.
· The Government
should consider whether "preserved rights" payments in social security
should be brought within the post 1993 system of community care funding,
or whether some other solution can be found to address the shortfall in
funding experienced by this group.
· The Government's
proposals on pooled budgets should be taken further, with pooled budgets
being implemented nationally.
· Budgets
for aids and adaptations should be included in and accessible from a single
budget pool and a scheme should be developed which would enable Local Authorities
to make loans for aids and adaptations for individuals with housing assets.
· The system
for making direct payments should be extended to the over 65s, subject
to proper safeguards and monitoring.
On the provision
of services they recommend:
· Further
research on the cost effectiveness of rehabilitation should be treated
as a priority, but that this should not prevent the development of a national
strategy on rehabilitation led by the Government to be emphasised in the
performance framework for the NHS and Social Services.
· Further
longitudinal research is required to track the process and outcomes of
preventive interventions and to assess their impact both on quality of
life and long-term costs.
· It should
be a priority for Government to improve cultural awareness in services
offered to black and ethnic minority elders.
· The role
of advocacy should be developed locally, with backing from central Government.
· There should
to be wider consultation on the provision of aids and adaptations and on
what should under a new system be free and what should be subject to a
charge.
On help for carers
they recommend:
· Better services
should be offered to those people who currently have a carer.
· The Government
should consider a national carer support package.
On information and
projections they recommend:
· The National
Care Commission should be made responsible for making and publishing projections
about the overall cost of long-term care at least every five years.
· The Government
should set up a national survey to provide reliable data to monitor trends
in health expectancy.
· The Government
should conduct a scrutiny of the shift in resources between various sectors
since the early 1980s, and should consider whether there should be a transfer
of resources between the NHS and social service budgets given changes in
relative responsibilities.
· A more
transparent grant and expenditure allocation system should be established.
This is a task which could be referred to the National Care Commission.
· Further
longitudinal research is required to track the processes and outcomes of
preventive interventions and to assess their impact both on quality of
life and long-term costs.
In relation to younger
disabled people they recommend:
· In the light
of the Commission's main recommendations, the Government should consider
how the provision of care according to need would relate to Independent
Living Fund provision for the personal care needs of younger disabled people.
Q. How has the Westminster
Government responded to the report?
The controversy over
the Westminster Government’s response has focused on the two headline recommendations
– those relating to the funding of personal care from general taxation
and the establishment of a National Care Commission.
In relation to the
first recommendation, the UK Government has rejected the recommendation
that the provision of free personal care should be funded from general
taxation. The Government has stated that in the nest few years, it
will be making an unprecedented investment in the NHS, and that the money
they are putting in would more than cover the costs of implementing Sutherland
in full. However, they believe that this would not be the best use
of resources. It would be a substantial investment which would only
benefit a limited number of people.
Nonetheless, the
Government has committed itself to act on several other key recommendations
by the Commission. For example:
· Free nursing
care in all settings, including nursing homes from October 2001
· A three
month disregard beginning in April 2001 on the value of any home owned
by an individual who has to enter residential or nursing home care
· There will
be an increase from £16,000 to around £18,000 in the capital
disregard for calculating the contribution to care home costs
· Under provisions
of the Care Standards Act 2000 statutory guidance will be published to
address the variations in charging for domiciliary care
· Extension
of the direct payments for care to individuals over 65
The second headline
recommendation – the establishment of a National Care Commission to set
up national benchmarks in the quality of care – has been implemented by
the Government with the Care Standards Act 2000. The remit of the
newly established Commission extends to cover a much wider range of services
than simply residential and nursing care.
Q. How has the Scottish
Executive responded to the report?
Again, the Executive
has committed itself to implementing the vast majority of the Sutherland
Report immediately. The Executive has already announced that:
· They will
establish a Scottish Commission on the Regulation of Care in a Bill which
will be introduced to the Parliament’s Health and Community Care Committee
on Wednesday 17th January 2001
· They have
extended the system from making direct payments to the over 65s
· They have
launched a Strategy for Carers in Scotland
However, the main
controversy has related, once again, to the funding of personal care, paid
for out of general taxation. The Executive is still actively considering
its response to this recommendation. But they point out that they
are committed to a wide-ranging package of measures, designed to bring
the maximum benefit to the greatest number of people. This includes:
· Free NHS
nursing care in nursing homes from October 2001
· Increasing
the number of people who are able to secure a loan against the value of
their home from the local authority to avoid having to sell up to fund
their residential care
· Disregarding
value of the home from capital means assessment for the first three months
of residential care and increasing capital limits to real 1996 levels
· The provision
of intensive home care packages for 1,000 extra people to receive their
care at home rather than in a care home or in hospital
· The establishment
of multi-disciplinary teams in every part of Scotland ready to respond
rapidly to provide intensive personal care packages for up to 18,000 people
per year. It is essential that there is support readily available
to cover crisis situations and avoid the unnecessary admission of older
people into hospital, and also to support people requiring a short period
of personal intensive care when they come home from hospital
· The provision
of free home care for an initial period of up to four weeks when people
come out of hospital, for all those who are assessed as needing it.
This is particularly important since many vulnerable and frail people decline
support at this stage because they feel that they cannot afford the charges
· The equivalent
of 22,000 weeks of extra respite care provision for care users to provide
temporary care to relieve informal carers who need a break
· A new home
maintenance/domestic support service in each local authority area, to provide
flexible services to older people at home according to need.
Q. When will the
Executive announce whether or not it will fund full personal care for all?
At the moment, it
is unclear when this will happen. The Executive is currently studying
the resource implications of full implementation and will only give its
final answer once this is clear.
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