Revolution In Home Care For Old People

Elderly people are to be given money to pay for their own care in a move being hailed as one of the most radical welfare reforms in a generation.

They will have the right to decide how and where they spend the cash, instead of social workers dictating what help they need to live in their own homes. Personal budgets will also be set up for younger disabled people frustrated by their lack of choice.

Under the system, being rolled out from next April, older people or their chosen relatives will set up bank accounts into which councils will pay a monthly sum. Beneficiaries will receive the cash after means tests taking account of their health and personal needs. They will then be able to shop around for the best packages of care, and, for instance, may decide to spend more on cleaners, or help with food.

The move follows the six-month Dignity at Home campaign by The Observer, which has called for far more responsive services for the elderly. One key aim, backed by several charities, was to give people the right to choose their own home helps and personal carers.

After a series of pilot projects, ministers have become convinced that individual budgets are essential as the ‘baby-boomer’ generation, moving towards retirement, will demand far more control of their daily lives as well as a higher standard of service.

Around 900,000 people over 65 are currently unable to live independently without help, a number due to rise to more than 1.3 million by 2025, putting enormous pressure on services.

Health Secretary Alan Johnson, who will announce the new measure tomorrow, said it ‘represents a radical transfer of power from the state to the public. Everyone, irrespective of their illness or disability, has the right to self-determination and maximum control over their own lives.’

The shift of funding from local authorities to individuals is worth around £8bn a year and is likely to create a far more aggressive market as agencies compete to offer the best packages of care.

There will be concerns that some older people will feel frightened by the prospect of making choices over their care, and worries about unscrupulous relatives who may steal money. But ministers believe the risks have to be faced as they move to a model of care that puts recipients in the driving seat.

The move could also see an even greater change – the transfer of money from the NHS into the bank accounts of those with chronic, long-term conditions such as diabetes, who would like to buy their own care.

Social care minister Ivan Lewis said: ‘This is the end of a paternalistic and controlling culture and the beginning of a new way for older people and those with disabilities to be in charge of their lives.’ He acknowledged there were inherent risks: ‘Some may decide to spend money in unconventional ways; others may find making these choices very hard. We’ll have to face these challenges as they arise, but we know this is the right thing to do. The more power you put into the hands of people, the more you end up with the package of care they want. We can’t simply maintain a status quo where people have to receive the care handed out to them.’

For five years, ministers have recognised that demands for social care – and a more consumer-led approach – are outstripping councils’ ability to provide it. They are preparing a green paper on long-term reform of social care funds amid concern that in many parts of England only people with severe or complex needs become eligible for care.

A report by Sir Derek Wanless for the health body the King’s Fund found that almost 60 per cent of the social services budget for the elderly went on providing residential home placements, though many felt that if more care were available before people became very infirm it would lower the bill hugely.

One of those who has benefited enormously from having a personal budget is Chris Moon-Williams, whose parents, Beryl and Cyril Moon, are both at home and in their eighties. Moon-Williams, who lives in Worthing, West Sussex and works in social services, controls the £7,000-a-year budget they both receive for their personal care.

‘It is no exaggeration to say that this has transformed their lives,’ she said. ‘My mother is physically frail and has some memory problems. In the past, someone would come to get her up in the morning, at any time between 9am and noon. That really upset my father, who was her main carer.

‘When I was able to control their budget, I shopped around for their care, and interviewed different carers until I found the right person. Her carer now comes at 9am on the dot, but is also happy to take her to the GP, take them shopping and do other jobs that the previous person wasn’t allowed to do.

‘As I control the budget quite tightly, I can save a bit of money, which has meant they have both enjoyed the last week at a hotel in Bournemouth for the first time in ages. I’ve also used some of the money to buy a care alarm so I know if she’s fallen down. My father now has a carer who can take him for a walk, and once a week they go to the pub for a pint.’

Sir Simon Milton, chair of the Local Government Association, described it as a ‘landmark agreement’ between councils and the government: ‘It should provide the foundation to give people independence, choice and dignity over their lives.

‘By working together, we can begin to plan for and provide a modern, efficient service that should give people with the best possible care at the right time and in the right place.’