Response to the Green Paper on Adult Social Care: 'Independence, Well-being and Choice'

1 Introduction

• 1.1 The Coalition for Quality in Care is a grouping of organisations and individuals concerned with the care of frail and vulnerable older people. It includes national charities, independent sector care providers, health and social care practitioners, older people's representative organisations and academic researchers.
• 1.2 CQC's main purpose is to promote and improve the quality of care in services for older people, in a range of settings, through campaigning, debate and example.
• 1.3 This submission addresses those issues in the Green Paper which are pertinent to CQC's stated concerns and does not consider the document in its totality.

The CQC response

• 2.1 The Green Paper acknowledges the demographic pressures facing society over the next 15 years and the rapid increase in the numbers, particularly, of very old people, but does not consider the implications of this particular aspect. There is too little consideration of the needs of the current cohort of very old people who will need increasing levels of social care during this period; it fails to include residential (and nursing) care as a necessary part of the care spectrum for this group of very frail and vulnerable individuals. While the Green Paper argues that prevention can eventually reduce the need for higher level care provision, it cannot be a substitute for the current demand for high level care. Moreover, in the longer term, as more and more people live into very old age (90+), with associated levels of frailty and mental infirmity, demand for high level care is likely to increase proportionately. The assumption of cost neutrality is plainly wrong.

• 3.1 The call for debate on risk taking is welcome but more questionable is the underlying assumption that the burden of risk should pass from the local authority and the workforce to older people themselves and their families. Many very old people do not want (or have the capacity) to take on the responsibility to manage direct payments themselves and have no-one to assist them in such risk-taking even if they did. They have come to a time in life when they want to stop having to take risks.
• 3.2 The idea of direct payments and individual budgets are models drawn from rethinking services for people with learning disabilities and younger adults with physical disabilities. In many cases this is inappropriate for very old and physically frail people and people with dementia.
• 3.3 Even if direct payments and individual budgets are appropriate in some cases (and the CQC supports the right to direct payments in principle), there is no recognition of what happens if there is disagreement about the level of funding required. Would there be an appeals system?
• 3.4 In respect of the statement regarding the 'right to request not to go into residential care', the CQC believes in the principle of choice. Older people, as with younger adults, should have the right to choose whatever care setting they feel is appropriate to their needs.
• 3.5 The suggestion that moving priorities and emphasis to prevention in order to head off need for 'heavy end' services is overly optimistic (given the earlier acknowledgement of the growth in the very old age group). The expectation of cost neutrality is wholly unrealistic.