Promoting Independence,Protecting Individuals

Policies for a Caring Society

Policy Paper 60

Contents

Summary

Introduction: Principles and Values 51.1 A People centred Approach 81.2 The Role of Social Care 81.3 Fostering Self-Help and Self-Reliance 91.4 Self-Determination in Care 91.5 Prevention 101.6 The Problem of Abuse 101.7 Pressures on the System 111.8 Institutional Problems 12

Working Together for Well-Being 132.1 Empowering Service Users 132.2 Supporting Carers 152.3 Commissioning and Providing Care Services 162.4 Caring for Children 182.5 Caring for Adults 192.6 Tackling Discrimination and Protecting Rights 21

Protecting Vulnerable People 233.1 The Current System 233.2 Protecting Vulnerable Adults 243.3 Protecting Vulnerable Children 25

Governance, Organisation and Resources 274.1 Local Democratic Control of Health and Social Care 274.2 Resources 284.3 Charges for Social Care 294.4 Staff Training, Recruitment and Retention 29

Summary

Our Approach

Liberal Democrats believe in mainstreaming social care, taking not just a whole systemapproach but also a whole society approach, supporting communities not simply rescuingsocial casualties. Our approach is based on the principles of:

• Fostering self-help and self-reliance where possible.• Empowering service users and maximising their opportunities for self-determination.• Developing the capacity of local communities to address their own social care needs

with the active support of elected local government.• Recognising the massive contribution that carers make within the United Kingdom by

offering them enhanced support.• Making preventive work a priority within social care.• Tackling abuse of vulnerable individuals.• Valuing, supporting and developing skills in those who work in social care.• Reforming institutional structures that act as a barrier to providing integrated and

seamless care.

Key Proposals

We propose to empower service users by:

• Making access to direct payments for care services effective as of right rather than thepresent confused position.

• Supporting the development of user-driven cooperative and mutual care providers,which could be funded through direct payments.

• Strengthening advocacy services, particularly those from the voluntary sector.• Facilitating the direct involvement of service users so that they become equal partners

in planning and reviewing care provision.• Encouraging adequate funding for consultation and user involvement.

We propose to support carers by:

• Aiming to increase the Carers Allowance to properly reflect the personal and financialcost of care, initially by extending the Carers Premium to all carers in receipt of thebasic state pension.

• Ensuring local authorities give much greater attention to the needs of carers, driven bya carers strategy within the Community Plan.

We propose to care for children by:

• Ensuring the model of care used places the needs of children at the centre.• Incorporating the UN Convention on the Rights of the Child into domestic law and

establishing a politically independent Children’s Commissioner in England as part of ourproposed single Equality Commission.

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We propose to care for adults by:

• Amending the Care Standards Act 2000 to incorporate human rights standards andstatements on compliance into care contracts as a pre-condition for registration byCommission for Social Care Inspection.

• Outlawing age discrimination in the provision of services, not just in employmentmatters.

• Reforming legislation on mental capacity and the role of the Court of Protection tomaximise the continuing scope for autonomy of those lacking full capacity.

We propose to protect vulnerable people by:

• Creating a single independent Commission for Care Standards and Inspection out of theexisting Commission for Social Care Inspection and Commission for Healthcare Auditand Inspection, with clear statutory duties to safeguard and promote the welfare ofboth children and vulnerable adults.

• Developing the specialist skills required from health professionals, police officers, socialservices staff and others to identify abuse, to make a full assessment, to respond tohelp the victims and to seek to ensure that abuse does not re-occur.

• Placing Area Child Protection Committees on a statutory footing, with relevant agenciesunder a legal duty to participate, and giving the Chair of the ACPC a statutory duty toreport directly to councillors any concerns about the ability of local agencies tocontribute to child protection work.

• Streamlining the procedures for determining child protection court cases.

We propose to integrate social care with other services by:

• Transferring the commissioning role of Primary Care Trusts to elected Local Governmentat the same tier as social services, ending the arbitrary separation between health andother local services.

• Using the Community Planning process to ensure care needs are addressed holistically,bringing in issues such as provision of appropriate housing, community facilities, anddesign of the physical environment.

• Integrating health and social care planning for specialised services at regional level inthe context of broader regional strategies as part of our programme for the developmentof elected Regional Government in England.

We propose to improve resourcing for social care by:

• Implementing our general programme for reform of local government finance, includingmaking substantial savings from the abolition of the discredited and expensive systemfor the collection of Council Tax.

• Making efficiency gains from ending the duplication and bureaucracy of separate healthand social care commissioning.

• Abolishing the Government’s ‘bed-blocking’ fines, and directing funds set aside for itstraight to local authorities to pay for investment in capacity improvement such ascommunity, intermediate and long-term care.

• Establishing a comprehensive, independent review on the overall level of resourcesrequired for social care, modelled on the Wanless Inquiry into healthcare resources.

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We propose to address charging for social care by:

• Abolishing charges for personal care for those in long-term care, as recommended bythe Royal Commission on Long Term Care and already implemented in Scotland.

• Critically assessing the consequences of the current charging policy for non-residentialcare services within the comprehensive review of social care funding.

• Ensuring the Department of Health issues clear guidance to implement the judgment ofthe Court of Appeal in the 1999 Coughlan case, that where a person’s primary need foraccommodation is a health need, then the patient’s care funding is the responsibilityof the NHS and not the local authority.

We propose to value, support and develop skills in those who work in social care by:

• Establishing clear careers paths for personal development with social care work.• Encouraging the development of management skills with enhanced ancillary support

and provision of effective IT systems.• Encouraging entry to social work from a diverse range of people and movement between

health care, social care and other related types of work.• Reforming the inspection process so that it works to support and develop the skills of

practitioners, including through abolishing the arbitrary and meaningless ‘star rating’systems.

Note on Federal/State applicability: the great majority of this Policy Paper applies to England,with the main exceptions of proposals on the Carer’s Premium and VAT treatment which areFederal and reform to the Court of Protection which is England and Wales.

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1.1 A People Centred Approach

1.1.1 The starting point for any LiberalDemocrat social care policy must be thepromotion of the liberty of individuals andfamilies enslaved by their poverty, health orsocial circumstances, their dependence onothers or social or family circumstances andattitudes which would hinder their personaldevelopment and fulfilment at whatever age.The promotion of liberty depends on therecognition that each person has a uniquevalue, a right to self-determination, socialjustice, and a claim to live as an equal intheir community. It follows that all ourpolicies must be framed with theseintentions:

• Sustaining and fostering self-help andself-reliance wherever practicallypossible.

• Understanding what interventions areeffective in preventing deterioration anddependence.

• Ensuring that where needs require asubstantial and long term investment inthe care of individuals, that the servicespromote the personal autonomy,development and fulfilment of thosethey serve.

1.2 The Role of Social Care

1.2.1 Until 1968, personal social serviceswere provided by a number of local authoritydepartments (health, welfare and children’s),complemented with provision by voluntary,self-help and religious organisations. TheSeebohm Committee of 1968 recognised theemergence of a social work profession andrecommended the creation of integratedSocial Services Departments offering a singledoor for access to services. This paved the

way for large-scale state provision of socialcare. The vision offered by Seebohm was of aservice reaching beyond the ‘discovery andrescue of social casualties’ to promote well-being through community involvement andprevention. Sadly this vision has not beenrealised.

1.2.2 By the 1980s it was estimated thatthe annual value of personal social servicesprovided by government was £3,800 million,whilst those provided by charities werevalued at £400 million, and informal carewas estimated at £24,000 million. Over thelast two decades the dominant factor inanalysis of social care has been cost. Phrasessuch as ‘the mixed economy of care’underpinned the focus of key policyinitiatives such as the Griffiths Report andthe NHS and Community Care Act 1990.Under the present government, the five Actsreforming the NHS and the Wanless reporthave taken this approach further. In theabsence of a comprehensive analysis offuture demand for social care, services suchas residential and nursing care have beenconsidered primarily in terms of costs to thehealth service. Of course, controlling costsand delivering value for public money aregood things in themselves. However, alongthe way the preventive value of social carehas been ignored, and as social servicesdepartments and emergent care trusts faceincreasingly detailed targets set by centralgovernment, the role and purpose of socialcare has been overlooked.

1.2.3 As Liberal Democrats, we see a needto review the role of social care. It is ourbelief that while there is a need to improveprofessional standards within social care, andto ensure that care given meets standards,the aim of social care must be to enhance,not replace care within communities. Whilethere are some people who will always needconsiderable professional support, publicsocial care policy should always be judged by

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Introduction: Principles and Values

the effectiveness with which it enablespeople with needs to live within a safe,supportive community environment whereverpossible.

1.2.4 For many service users social careintervention may be short term in order tohelp them through an acute crisis. For othershelp may be longer term. In both cases, theefficacy of care should be determined not, asnow, solely by decreased use of healthservices, but also by the extent to whichindividuals remain as active participants andcontributors to communities. This will bedependent on the whole spectrum offacilities and support services available,going beyond the kind of services whichcome under a ‘social care’ heading: inparticular, availability of suitable housing,local shopping and leisure activities, andadvice and information services.

1.3 Fostering Self-Help and Self-Reliance

1.3.1 This means a strong emphasis onsupport for those relatives, friends andneighbours who wish to become carers. Thegoal should be early identification ofpotential carers, bespoke support andappropriate recognition of the financial costof caring through the tax and benefit system.

1.3.2 Personal and family self-reliance canbe promoted through good information,personal control of services, and throughother arrangements which encouragepersonal management of services. Communityself-reliance can take institutional formthrough ‘mutualised’ arrangements and co-operatives which may provide, manage orpurchase services.

1.3.3 The whole formal care system mustbe people-centred, assisting people with careneeds to retain control of their lives, andvaluing their views and experiences. Meetingsocial care needs means meeting the needsof each individual. Loneliness and loss of

confidence can be as debilitating as a long-term illness. Either through self-advocacy orindependent advocacy people with careneeds should be enabled to take charge oftheir care.

1.3.4 There are two main models thathave helped shape policy and practice: themedical or technical model, which focuses onthe disabilities and how they can be ‘fixed’;and the social model, which focuses on theperson and their abilities, viewing thedisability as in the main caused by theenvironment and society. It is this modelthat has the greatest importance for thedevelopment of social policy aimed atenabling people to live full and fulfillinglives. Our goal must be to shift the centre ofgravity in terms of the resources in our caresystem out of our hospitals and into thecommunity; and power from organisations,providers and professionals to users of theservices.

1.4 Self-Determination in Care

1.4.1 Some people will always need anenvironment providing total care, mostlyonly for relatively short periods of their lives.We must actively promote the commissioningof care in ways that protect and promoteself-determination, independence andpersonal management of care services, whilerecognising the complexities of shiftingpatterns of investment, employment andprovision. Improving and funding PersonalCare Plans and formal advocacy supportwithin a funder/provider model may assist inthis. Crucially we need to extend models ofcare based on maintaining a person’s abilityto live in a home of their own. There is ahierarchy of independent living situations:first the home a person was living in at thetime requirements for assistance arose; thenanother home adapted for independentliving; then a sheltered living environmentwith secure tenure; then extra care housingwith secure tenure; then an adult placement

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within a regulated scheme; thenresidential/nursing home care. We should aimto enable people to live as far up thishierarchy as possible.

1.5 Prevention

1.5.1 Access to low level home help andtimely provision of aids, adaptations andequipment, can make a significant differenceto the level of independence a person canenjoy and reduce the need for acute NHSintervention, therefore unlocking resourcesand reducing pressures on the NHS. Bytightening eligibility criteria and increasingcharges for these services, local authoritieshave restricted access to these services tothose who require the greatest help. There isa clear false economy in this logic.Prevention in the community rather thancure in hospital is better for the person, fortheir family and for the NHS.

1.5.2 Investment in early low-level homesupport can prevent the need for moreintensive support and reduce the likelihoodof hospital admission. Examples of the typesof scheme that could be made more widelyavailable include:

• ‘Staying Put’ and ‘Handy Person’ schemeswhere grants can be given to undertakea range of adaptions to a person’s home.

• ‘Home Security’ schemes to preventcrime and reduce the fear of crime.

• Gardening services.• Net and curtain cleaning services.• Good neighbour schemes, informal self-

help schemes where the currency is notcash, but time and skills.

1.5.3 As an overall measure to promotepreventive care, we would broaden the scopeof the Social Care Institute of Excellence toresearch and disseminate evidence basedmethods of preventive social care.

1.6 The Problem of Abuse

1.6.1 In March 2000 the Governmentpublished the guidance document No Secretswhich required local authorities and otheragencies to draw up adult protectionstrategies to tackle the abuse of vulnerableadults, including older people. The guidancewas issued under Section 7 of the LocalAuthority Social Services Act 1970. Althoughthis guidance is technically binding on LocalAuthorities, it is not a feature of the ‘Deliveryand Improvement’ statements required ofthem and it is not binding on other agenciessuch as the Police. No new funds wereearmarked to meet the extra costs of thiswork. As a direct result, while many localauthorities have drawn-up strategies theyhave not made significant progress. Researchby the charities Action on Elder Abuse andCounsel and Care suggests that the level ofreported abuse significantly understates thetrue position. The implementation ofpractical multi-agency working to detect andprevent abuse requires funding.

1.6.2 The numbers of child deaths fromneglect and abuse in the UK has not fallenfor almost thirty years, and tragic episodessuch as the death of Victoria Climbiereinforce the need for action. In the UKtoday, 36,000 children are on childprotection registers at any one time and oneto two children die every week from abuseand neglect. Inquiries into child abusedeaths are conducted in private and themajority are not published widely.Information about the findings of suchinquiries is not systematically collectednationally and nobody is sure how manyreports there are or where to find them. ACommissioner for Children in England wouldhelp ensure that children are betterprotected, by highlighting the problems withexisting systems, making recommendationsfor necessary changes and pressing theGovernment to act on the proposals made bychild abuse inquiries. Wales has alreadyestablished such a Commissioner and

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Scotland and Northern Ireland are consulting(see also section 3.3.8 on the Minister forChildren).

1.7 Pressures on the System

1.7.1 According to the most recent surveyof social service spending by the LocalGovernment Association (LGA), budgetarypressures have continued unabated. In theyear to March 2002, councils expected tooverspend their budgets by £218m. Children’sservices account for two-thirds of theoverspend. This is on top of the plannedexpenditure of £1bn in excess of what theGovernment thinks councils should bespending on social care.

1.7.2 According to the LGA, seven out often councils have tightened or propose totighten the way they ration care as a way ofcontrolling spending pressures. Only themost frail and dependent can be cared for.

1.7.3 Care is increasingly being rationedby:

• Denying any help to those with moderatecare needs or with carers.

• Making those with high care needs waiteither in a hospital bed or wait unseenin their own home.

• Setting limits either on how much theCouncil will pay for care or on thequantity or quality of the care provided.

• The impact of charging which deterssome people.

1.7.4 Targeting of care on those ingreatest need is leading to neglect ofpreventive and supportive measures whichcould be more effective in maintaining bothquality of life and independence, and in thelong term be more cost effective by reducingthe amount of acute or residential careneeded.

1.7.5 The greater demands for care arecreating an increasing gulf between the

grant based on Formula Funding Share (FFS)which councils receive for social care, andwhat they actually have to spend. Thiscreates both pressure on other budgets andpressure on the council tax.

1.7.6 Older people account forapproximately 62% of social care serviceusers, but only represent 47% of spending onsocial care. The Government Actuary’sDepartment projects that the number ofpeople in England aged 65 and over will risefrom 7.8 million in 1996 to 12.4 million in2031, an increase of 60 per cent. The numberof very elderly people (aged 85 and over) willrise even more rapidly, from 0.9 million in1996, to 1.7 million in 2031, an increase of88 per cent. This rise has been under way formany years, but there has been a lack offorward planning by government to takeaccount of it.

1.7.7 Between 1996 and 2001, thenumber of ‘children looked after’ or in care inEngland rose from 50,600 to 58,100, anincrease of 15%. There has been an increaseof 55% in the number of ‘children lookedafter’ who have suffered from incidences ofabuse or neglect.

1.7.8 Other factors behind the increaseddemand for children’s services include:

• Parental drug and alcohol abuse. Evenrelatively low levels of substance abusecan contribute to problems for childrenand families.

• A higher survival rate and greater lifeexpectancy of children with disabilities.

• Two thirds of children with disabilitieshave more than one impairment, aquarter have 5 or more impairments.

• The number of family break-ups has risensharply, as have pregnancies outsidelong-term relationships. As a result thereare more single parent families.

• Increased poverty puts more pressure onservices. There are a growing number ofchildren living in households withincomes below half average income.

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1.7.9 Two thirds of ‘children looked after’are placed in foster care, but Social ServicesDepartments are finding foster carersincreasingly difficult to recruit.

1.8 Institutional Problems

1.8.1 The institutional divisions betweenhealth and social care make it difficult toensure a seamless service or to allocatefunding rationally to achieve the bestoutcomes. Having two organisations with amultiplicity of different funding streams,different budget cycles, incompatibleaccounting regimes and computer systems,different accountability arrangements andcompeting cultures hampers effective policydevelopment and service delivery. Goodpartnership working can only go so far toameliorate these barriers.

1.8.2 An example of the difficultiescaused by such institutional divisions isdelayed discharges reducing the number ofbeds available in hospitals. Although unitcosts are not always well established, theaverage weekly cost of treating a patient inhospital can be around five times the cost ofsupporting an older person in a nursing homein England. The different governmentfunding approaches for the NHS and Social

Services create an uneven playing field andfuels this problem. The Government responsehas been to impose a system of penalties onlocal councils for failing to expeditedischarge.

1.8.3 The Government approach todelayed discharge fails to recognise that it isa symptom of a lack of capacity in the carehome and home care sectors andconsequential rationing of access to both.The imposition of fines is likely to underminepartnership working between the NHS andSocial Services and do nothing to put inplace the community services to reduce theneed for hospital admission in the first place.

1.8.4 As proposed in the Wanless report,there must be a whole systems approach tohealth and social care. Investment in socialcare would reduce unnecessary costs to theNHS and make for a seamless provision ofservice.

1.8.5 Adopting a ‘whole systems’ approachrequires investment in order that a range ofservices are developed and sustained to averthospital admission, offer home based careand ensure an adequate supply of care homeplaces.

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2.1 Empowering Service Users

2.1.1 Liberal Democrats believe in therights of the individual, and this naturallyextends to users of social services. Serviceusers should be able to exercise informedchoices, and to take part at all levels in theprovision of their care. This is linked to theseamless provision of health and social careservices and the rights of carers.

2.1.2 The user should be at the centre ofservice provision, and offered realopportunities to become involved in theplanning, commissioning and delivery ofservices. It must not just an exercise inticking boxes and really needs to meansomething to all those involved, not least tothose receiving the services. The problem isthat there is a danger of tokenism, and inmany cases a resistance by professionals tothe idea. There is also dispute about thelevel and nature of involvement which isappropriate.

2.1.3 Liberal Democrats have supportedindividual Personal Care Plans, with thefunding following the user. We have alsocalled for the extension of direct payments toolder people and have always beencommitted to the idea. We also believe inextending the availability of advocacyservices, whether self advocacy or by theservices of another person.

Direct Payments

2.1.4 Direct payments are cash paymentsmade in lieu of social service provision topeople who have been assessed as needingservices. They are a practical way oftranslating Liberal Democrat beliefs andpolicies into action and it is our goal to makesuch payments easier to access for all clientgroups.

2.1.5 Direct payments maximise choiceand control for service users and should beencouraged. Liberal Democrats havehistorically encouraged them and facilitatedtheir introduction early on in Kingston UponThames, for example. Although in theorySocial Services Departments are required tooffer direct payments, care managers oftenlack the knowledge and confidence requiredto encourage users to take up this option,and it is also viewed as more costly. There isa problem with the complexity, difficulty andlack of support for this option. However itcan be extended across a number of clientgroups.

2.1.6 We therefore propose that localauthorities are recommended to consult withservice users on the best way to expand theirdirect payments scheme and draw-up a localaction plan for promoting all aspects of theservice, including financial administrationand training. This might include theappointment of a senior Direct PaymentsManager in Social Services to lead this work.The condition that someone has to be‘willing and able’ to take up direct paymentsshould be made more clearly understood andshould not be clouded by resource issues,and fitting the service to people’s lifestylesshould be paramount. Further clarity isneeded on who is entitled to the services.

2.1.7 There are many benefits to directpayments for service users, and they can beintroduced to several client groups at anappropriate rate. Benefits include increasedself confidence from the independence thatcomes with this system, and, to cite oneexample, one person has found it useful toemploy a music therapist, so it is good forsmall providers.

2.1.8 Better ways to cope with directpayments, such as local groups in shelteredhousing or other units, should be activelyencouraged, along with the development of

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Working Together for Well Being

independent living centres, such as theSutton Centre for Independent Living andLearning. Mutuals and benefit organisationscan play a part in this, and this is aburgeoning method of dealing with directpayments. There also needs to be moreclarity around financial issues, such aswhether individuals should be asked to payVAT on their bills. There is pressure to ensurethat private care agencies and domiciliaryservices have the same VAT treatment aspublic sector providers, which LiberalDemocrats would support.

Advocacy

2.1.9 When someone is not confidentenough to take up a direct payments option,and for many other reasons, they should haveaccess to high quality advocacy services.These can be provided in a variety of ways,but we would especially recommend thefunding by local partnerships of voluntarysector advocacy services, which wouldtherefore be at arms length from theproviders. Advocacy is especially importantwhere we are encouraging personal careplans, with the money following the user.Any service user moving from one authorityto another would have to be confident andarticulate to negotiate their way round thenew system and keep the money. Advocacysupport is also vital for people with alearning disability, mental health problem orcommunication difficulty.

2.1.10 These, along with all services,should be culturally sensitive and sensitiveto all issues of diversity. They should also notfall into some hole between social servicesand health, where health funding is takingthe lead and social services get lost.

2.1.11 There is recent legislation onadvocacy, in particular the creation of newIndependent Complaints Advocacy Servicesin healthcare and the new duty on localauthorities to provide advocacy support forchildren under the Adoption and ChildrenAct. However it remains to be seen how this

will work in practice. We would aim toexpand and clarify legislation in this field.

Consultation

2.1.12 Service users should be consulted atall stages of care planning and delivery, withreal involvement and not just by tokengestures. They should be consulted whenthere are real options available. If theycannot be present at meetings, the localauthority should facilitate alternative waysfor service users to participate such asteleconferencing, use of the internet, andpostal and proxy voting. Servicecommissioners should take their meetings towhere users are, such as bingo halls or daycentres.

2.1.13 Many service users find it initiallydifficult to be involved, lay membership ofpanels and committees should be offeredtraining and be properly rewarded to beempowered in their roles. Service usersparticipating in meetings should be paidexpenses for travel and childcare, and thereshould be a clear policy on the circumstanceswhen they could be paid for their time.Liberal Democrats would also clarify theanomaly whereby users getting over a certainlevel of expenses for participation in theseprocesses lose their benefits correspondingly,which makes a nonsense of the process.

2.1.14 Service users should be involved inselection panels for key posts and awardingcontracts. All this needs to be properlycoordinated and funded, with a separate linein the budget so it does not fall betweenstools. Service users are key to ensuringquality outcomes, and different levels ofinvolvement are fine for different people andgroups. We should also avoid overburdeningparticular people, and try to combat cynicismby producing real results as a consequence ofconsultation.

2.1.15 Service users can be involved inplanning by sitting on commissioning

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bodies, but there must be a full range of userinterests represented, and some clear processby which user representatives communicatewith local users generally rather than justfollow personal agendas. They can becrucially involved in setting and monitoringstandards, at the heart of the proceedings.

2.1.16 The process of involving serviceusers should be transparent and on a regularbasis, and they should be given theopportunity to participate at every stage.This should mean more people are involvedand should help to combat cynicism. Therewill need to be a properly identified budgetfor publicity - to reach out to people - andfor such mechanisms as consultative days ormeetings of consultative fora on a regularbasis. Access to services is very important,and users can have a valuable input indesigning provision so that it is accessible,particularly, for example, transport. Stafftraining in working with users needs to beconsidered, and there is an opportunity costof irrelevant services which are not valued byusers.

2.2 Supporting Carers2.2.1 There are 5.7 million adult carers inBritain, and 200,000 young carers under 18,who look after a relative, friend or neighbourwho cannot manage without help because offrailty, sickness or disability. 1.25 millioncarers provide very substantial care of 50hours or more each week. There is asignificant turnover of carers: about 40% ofcarers start or end a period of caring eachyear. Many of us are likely to be carers atsome point in our lives. Over their life timesseven out of ten women will be carers andnearly six out of ten men.

2.2.2 Our society depends on the skill,commitment and good will of carers. It isestimated that the unpaid work of carers isworth £57.4 billion per year, this is roughlyequivalent to the whole budget for the NHS.

2.2.3 In recent years national policy hasstarted to recognise the contribution and

support needs of carers through the CarersRecognition and Services Act 1998, theCarers and Disabled Children Act 2000 andthe National Strategy for Carers (1999).However, the experience of many carers isthat their needs are ignored or only partiallymet. The starting point for providing supportto carers must be the recognition that theyare the front-line of providing care. Health,social care and benefits staff need to seecarers as partners and work with them inproviding care and support. Their needs,which are highly individual, should be metalongside the needs of the vulnerable peoplethey care for. All carers are entitled to a fullassessment of their needs but this frequentlyis not offered in practice. Further, carersshould be entitled to a full range of homesupport and respite services. Carers’ needsshould be assessed and met in relation to awide range of needs including their health,care support, respite, leisure, work andeducation, housing, information andadvocacy. We believe that carers deservemore than just words of recognition. Wewould aim to increase the Carers Allowanceto reflect properly the personal and financialcost of care, initially by extending the CarersPremium to all carers in receipt of the basicstate pension.

2.2.4 We believe that each Local Authorityshould include within its Community Plan alocal carers strategy. The strategy should bedevised in consultation with carers of allages, carers groups and providerorganisations. The strategy would inform thecommissioning intentions of the localauthority in discharging its new integratedhealth, housing and social care function. Thestrategy should map existing need andservices and set out how unmet need are tobe met. It should include young carers,respite care and advocacy and informationservices. Local strategies might also:

• Raise the profile of carers’ assessmentsand ensure that all carers are offered fullassessments.

• Give carers the right to access regularly

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respite care provided in a way that meetstheir needs and those of the vulnerableperson cared for.

• Promote new initiatives to meet andpromote the health of carers. This willinclude such issues as stress, diet, andleisure / lifestyle as well as particularhealth conditions, as these areimportant issues for many carers.

• Ensure that training is provided forcarers including lifting and handling (ofthose cared for).

• Promote initiatives in the use of theinternet for carers. This could be used tohelp carers in networking and providingmutual support, and through theprovision of information on services andeducational opportunities while they areproviding care at home.

2.2.5 At a national level we wouldimprove employment legislation to ensurethat employers respond positively to theflexible and changing needs of carers. Thiswould include the provision of special leavefor carers and carers transferring to part timeworking whenever this is possible for theemployer. Also, we will consult with carersabout how best to provide carers with helpre-entering the job market after a period ofcaring.

2.3 Commissioning and Providing Care Services

The Purchaser/Provider Split

2.3.1 In 1990 the NHS and CommunityCare Act introduced the purchaser/providersplit, which was seen as a means of.

• Making costs clearer enablingcompetitive tendering to reduce costs.

• Encouraging a wider range of providers.• Weaning local authorities away from a

culture of monopolistic provision.

• Improving and increasing the range ofchoice for service users.

2.3.2 The legislation led to localauthorities taking overall responsibility forplanning and funding the provision of care,while there was a move towards contractingwith a broad range of providers. A greaterspread between local authorities, privatecontractors and voluntary providers emerged,with an increasing trend towardsexternalisation, particularly of home careservices and residential care, encouraged bya new regime of government funding whichrequired 85% of funds transferred forcommunity care to be spent on independentproviders.

2.3.3 As set out in Quality, Innovation,Choice, Liberal Democrats favour an approachto public services based on public fundingbut a range of different types of provision. Inthis model, the key role of the publicauthority is in planning and purchasing care,and a clear separation between thepurchasing and providing roles should allowa greater focus on developing the particularmanagement skills needed for successfulcommissioning. It is important that thecommissioning function attracts talentedindividuals and is given sufficientrecognition and status, as it is the tool bywhich the needs of service users can be madeparamount and new and imaginative servicescan be introduced. Commissioners have a keyrole in identifying the absence of necessarytypes of provision and acting to ensure thoseservices are developed. For example, there isa general lack of services to meet the needsof severely disabled adults and children. It isa terrible missed opportunity ifcommissioners simply carry on buying thesame types of care from the same types ofprovider on the basis simply of availabilityand cost.

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Public Sector Providers

2.3.4 Social Services Departments,controlled by elected local councillors, arestill the largest single employers in the socialcare field. Liberal Democrats strongly believethat the ‘public sector’ option must never bedismissed as some relic of the past, as toomany on the Right appear to do. Many publicsector providers offer extremely highstandards of service, at good value formoney. In the past, failing public sectorproviders have been reformed and turnedround into successes. As generally largeproviders, local authorities are often able tosupport levels of training and staffdevelopment that are difficult for smallerorganisations. Direct public provision mayalso in some circumstances be required wheresome types of service will simply not beprovided by the private and voluntarysectors.

Private Sector Providers

2.3.5 Private provision can be of very highquality and the private sector can beparticularly good at innovation and makingspecialist provision for particular groups ofservice users, an example would be specialistservices for ethnic minority users. However,private provision is not always an option, forexample, local authorities in rural areas havehad difficulty in finding private providers ofhome care services.

2.3.6 There is a need to develop a moreco-operative approach to commissioningservices to ensure that private sectorproviders are able to invest. For example,there continue to be tensions between localauthority commissioners and care homeproviders over the level of fees. This hasbeen exacerbated by the Government’smishandling of the introduction of new carestandards for elderly people’s care homes.The result has been to put back the cause ofgood regulation and allow lower standards tobe applied to the care of the elderly.

Voluntary Sector Providers

2.3.7 The voluntary sector, which rangesfrom small local organisations to very largenational charities like Leonard Cheshire, hasa proud and honourable tradition in theprovision of social care. It has often been thepioneer of new services, in response tochanging needs. It has played an effectiverole as an advocate for service users,particularly in the fields of mental health,learning disability and physical disability.Small-scale local voluntary groups havepromoted self-help, built friendly networks oflocal support, and provided a broader rangeof support than professional institutions can.They can also go beyond traditional‘involvement’ of those in social care,changing the relationship with professionalsso that both are equal partners in thedelivery of social care.

2.3.8 It is important that the state doesnot simply treat the voluntary sector as adisempowered delivery mechanism in orderto get services provided on the cheap. Suchan approach will tend to underminecommunity self-help, increase dependenceon professionals and probably end upincreasing costs in the long run.

2.3.9 To make the partnership betweenlocal authorities as care planners andpurchasers and the voluntary sector asproviders work to maximum benefit, webelieve that care service commissioners needto take account of the special features of thevoluntary sector, with appropriate trainingwhere needed.

2.3.10 Re-developing a network of self-help requires mutual support systems atneighbourhood level, like time banks orother systems that generate the co-production of services between professionals,clients, carers and their families. These canbe based in NHS and other public servicecentres, and enable a level of mutual reliance- emphasising what people can do, ratherthan what they can’t. Experience in the UK

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and USA shows that this kind of approachcan make a major contribution to the qualityof life of people in social care, can helppeople to stay independent and can cutcosts. For example:

• The children’s mental health centreAbriando Puertas in Miami concentrateson the joint delivery of local socialservices, and a similar approach is beingpioneered in the UK by the SouthLondon & Maudsley NHS Trust.

• The Rushey Green Time Bank inLewisham has pioneered an approachwhereby patients also act as volunteers,checking on people at home, doing basicDIY and providing neighbourhoodsupport - with dramatic results for thoseinvolved.

• The US charity Home, Safe concentrateson training families in social care toprovide permanent neighbourhoodsupport for each other once the trainedprofessionals have gone.

Co-operative/Mutual Providers

2.3.9 In addition to public and privatesector options, care service providers mayinclude social enterprise organisations. Thekey characteristic of such organisations isthat although they may make an operatingprofit, this is reinvested into providingservices rather than distributed toshareholders. Non-Profit DistributingOrganisation (NPDO) is thus a better term forsuch bodies than the more usual Not-for-Profit.

2.3.10 In Policy Paper 53 Quality,Innovation, Choice (September 2002) weadvocated a new legal vehicle, the PublicBenefit Organisation (PBO), to resolvecertain problems with existing co-operativestructures and facilitate the development ofnew NPDO enterprises. This could include bytransferring existing public sector providerunits to PBO status.

2.3.11 Care services depend so much fortheir quality on the commitment anddedication of their workforce, and mutualsare potentially a structure which empowersthe workforce more than any other. If theworkforce feels that they ‘own’ theirinstitution, it seems likely that they will alsobe more committed to their task. We believethat PBOs may also help to engender greatercommunity support for local providers, aswell as providing more freedom for theorganisation’s own development, both interms of innovation and financial support. Inthe care field, user-owned mutual enterpriseswould be a mechanism for delivering user-centred services, with direct paymentsrecipients pooling their resources to fundtheir service provision co-operatively.

2.4 Caring for Children

2.4.1 There are 376,000 ‘looked after’, ‘inneed’ or ‘at risk’ children in England and nosingle reason why they are there. Despitethese children’s care being under thesupervision of the state it is remarkable howlittle it knows about the lives of thesechildren and what happens to them whenthey become adults. From the availableevidence, many children will never overcomethe multiple disadvantages that they haveexperienced and will never have theopportunity to realise their full potential. Forexample, only 9% of children in care get 5Grade A-C GCSEs, and 31% of children in carewill go to prison later in life.

2.4.2 In practice, children are not at theheart of planning and delivering the servicesthey need. Instead of helping, the caresystem can harm children through delays andbuck passing. The experience of far too manychildren is not of a co-ordinated response totheir needs involving social workers, healthprofessionals, teachers, and carers. Childrenneed parents, and if their birth parents letthem down, they need to be able to turn tosocial workers, health professionals,teachers, and carers, who place their needsfirst and work to ensure a secure and

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nurturing environment that can build achild’s resilience and self esteem.

2.4.3 There is no systematic collection ofdata about the social, psychological orphysical needs of vulnerable children. Thedelays in assessments, as well as multiplechanges of placement can result in mentaland physical health problems being missed.Better use of information technology canplay a major part here. We are aware of somelocal authorities which have developed inter-agency databases of people under 25 withdisabilities; this is updated monthly, andallows those on it or their carers to receiveregular bulletins on availability of services.Entry on the database is voluntary.

2.4.4 Even those vulnerable children whoare spotted find that no or slow referral toChildren and Adolescent Mental HealthServices (CAMHS) then compounds mentalhealth problems further, and makespreventative steps almost impossible. Inmany areas CAMHS are hardly available at all.

2.4.5 There is an urgent need torationalise the assessment tools used byagencies that work with children into acommon assessment framework. The aim ofsuch a framework would be to identify thosechildren and their families who arevulnerable and need additional support. Thedevelopment of a single assessmentframework would also inform thedevelopment of protocols for informationsharing between agencies.

2.4.6 The current system fails to recognisethe needs of the child. It fails to look at thechild as a whole; and ignores the effects ofthe child’s surrounding environment ofstability, schooling, healthcare, friends andfamily. Models of care for a child must focusmore on preventive forms of care to ensurethat any child has the opportunity to realisetheir full potential.

2.4.7 An example of such a model is the‘wraparound’ approach as developed in San

Diego and set out in the LGA paper‘Tomorrow’s Children’. This definable planningprocess results in a unique set of communityservices and natural supports that areindividualised for a child and a family toachieve a positive set of outcomes. It aims tobuild integrated services around the needs ofthe child and allows that child to continue intheir home environment.

2.4.8 Liberal Democrats believe adoptingthe wraparound approach would:

• Deliver the services needed to keepchildren in their local areas byintegrating and locating them in areaswhere the children go to school andtheir families live rather than removingthe child to where the services areprovided.

• Demarcate the way services are financed,adopting more multi-disciplinary crosspooling of funds with more flexiblyacross departments, and ensuringfunding of schemes was measured inoutcomes rather than inputs andoutputs.

• Decentralise the way decisions are madeby connecting neighbourhood residentsand community stakeholders in decisionsthat affect their well-being.

2.5 Caring for Adults

2.5.1 We are concerned about the limitedaccess due to rationing, and the poor qualityof much of the social care services forvulnerable adults. The government focus hasbeen on ‘getting people out of hospital tofree up a medical bed’ rather than focusingon the quality of people’s lives. LiberalDemocrats will press for quality of servicethat provide positive outcomes for serviceusers and their carers.

2.5.2 Over the last quarter of a centurythere has been a move away frominstitutional care to community care. Butthe closure of long-stay hospitals has not ledto adequate resources being devoted to

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providing services in the community.Government and local authorities mustimprove the level and quality of the fullrange of community based services, ifvulnerable people are to be able to make realchoices as to the service they receive.Further, Liberal Democrats will ensure thatthere are preventive services for vulnerablepeople who are living independently and sosupport them in an active lifestyle.

For Older People

2.5.3 We welcomed the thinking behindthe National Services Framework for OlderPeople when it was published in 2001. Itpromotes the need for ‘seamless’ servicesbetween health, social services and theindependent care sectors and it advocatesservices that are user focused where olderpeople are in the ‘driving seat’. But it fails togive sufficient weight to housing and healthyageing, and much of it is couched in terms ofunfunded aspirations.

2.5.4 We are concerned about the limitedavailability of the range of communitysupport services across the country.Frequently the quality of day care, home careand respite care services are poor. There is aparticular problem in the lack of provision ofspecialist help for those with dementia andthose who care for dementia sufferers athome. Government must encourage thedevelopment of home and residential basedspecialist dementia care and fund researchand disseminate the findings on the bestmodels of practice.

For People with a LearningDisability

2.5.5 We support the values andaspirations in the White Paper ‘ValuingPeople’ to bring the opportunities of living inand fully participating in the community toall people with a learning disability.However, the Government has not deliveredthese improvements. There is much to do in

bringing the standards of services up to thatof the best in providing living in ordinaryhousing, flexible direct care support,education and vocational training, and helpto get employment and voluntary work.

2.5.6 We believe that the government didnot go far enough in making Social Servicesthe lead agency. We believe that SocialServices should be the commissioner for alllearning disabilities services and that theNHS budgets should be completelytransferred to them. This long overduechange will be realised by our proposals tointegrate health and social carecommissioning within local authorities. Inour view this will hasten the serviceimprovements set out in ‘Valuing People’.

For People with a MentalHealth Problem

2.5.7 We oppose the Government’s plan toerode the rights of people who have a mentaldisorder in its new mental health legislation.The role of the Approved Social Worker in thecurrent Mental Health Act provides the rightsafeguard in situations where compulsorytreatment is under consideration. Ourproposal for the integration of health andsocial care commissioning would help toprogress the development agenda set out inthe National Services Framework for MentalHealth. Sadly we see little progress on theprovision of education regarding mentalhealth and in the reduction of stigma aroundmental illness. Liberal Democrats will makethese a priority for action.

For People with a PhysicalDisability

2.5.8 Through our plans for integratedcommissioning we will ensure that a closelink is made between health and social caresupport services. The development of singleequipment services should be a priority andsteps taken to speed up assessment and

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delivery of aids and adaptions. We willaddress the key issue of the nationalshortage of Occupational Therapists boththrough direct recruitment and by looking atways of opening access to equipmentservices through other suitably trained staff.

2.6 Tackling Discrimination and Protecting Rights

2.6.1 A key theme for Liberal Democrats istackling discrimination against disabled andvulnerable adults. Age discriminationlegislation should go beyond employmentand include the provision of goods andservices by both the public and privatesectors. We support the creation of a singleEquality Commission and legislation to placea duty to promote equality on all publicbodies. This would mean that the NHS andSocial Services providers would be under aduty not to discriminate unjustifiably on thebasis of age.

2.6.2 The legal position of vulnerableadults is in urgent need of reform. First,those vulnerable adults who live in private orcharitable care homes are unable to enforcerights under the Human Rights Act.Following a ruling by the Court of Appeal theonly way in which people can hope to securetheir rights is for them to ask the localauthority purchasing the placement on theirbehalf to enter into a contract which fullyprotected their rights. The currentGovernment has refused to act to extend theprotection of the Human Rights Act intoprivate and charity run care settings. Wewould amend the Care Standards Act 2000 toincorporate human rights standards andstatements on compliance as a pre-conditionto registration by the Commission for SocialCare Inspection (see Section 3).

2.6.3 Second, as the Law Commissionconcluded in 1995, “the law as it now standsis unsystematic and full of glaring gaps. Itdoes not rest on clear or modern foundations

of principle. It has failed to keep up withsocial and demographic changes (and)developments in our understanding of rightsand needs of those with mental disability.”In effect people deemed by others to lackcapacity have no legal rights - they becomenon-people. This position leaves the mostvulnerable, often elderly adults open toabuse.

2.6.4 The current ‘all or nothing approach’whereby authority is passed to thoseclaiming power of attorneys, or professionalsgiving healthcare and legal advice will nolonger do. Common law does recognise thatthird parties must act in someone’s ‘bestinterest’, but an incapacitated person’s bestinterest is about more than ‘managing’money or ‘rationing’ services to meet theircare needs; it is about ensuring that theyhave a decent quality of life, that they canexpress their needs and emotions, and thatthey are treated with respect as autonomousindividuals.

2.6.5 The government has shied awayfrom reform in this area, despite promises oflegislation year after year; the rights to life,privacy and family under the Human RightsAct must be given real form.

2.6.6 Our approach is for fundamentalreform to give all those currently assessed aslacking capacity, new rights to maximisetheir own preferences on how their day-to-day lives should experienced and managed,and to radically redefine the way in whichincapacity is treated in law.

2.6.7 We also propose reform of the Courtof Protection to extend its jurisdiction. Thisshould be a key plank of new legislation, toooften relatives and carers find themselves ina legal maze when one of their loved onesceases to be able to care for themselves.Powers of Attorney should be extended tocover health, welfare and financial issues - totake effect after registration and regulatedthrough the Court of Protection’s jurisdictionand that there should be tighter regulation

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of informal mechanisms of surrogacy such asappointeeships which are all too often opento abuse. Consumer rights should also beprotected; it is unreasonable to expect adultslacking capacity to fulfil all their contractualobligations, yet the policy of the Courts isthat contracts should always be honoured,especially if they supply the necessities ofeveryday life. These rules need to be revised,and we will look also at the scope for placinglegal duties on financial institutions in theirdealings with vulnerable clients andconsumers, so that they too will be expectedto act in vulnerable adults’ best interests.

2.6.8 Every child deserves to have theirrights protected and promoted. TheGovernment should legislate to incorporate

the UN Convention on the Rights of the Childinto domestic law and establish anindependent Children’s Commissioner. Thetask of a Children’s Commissioner would beto promote and protect the welfare andrights of all children. A Commissioner wouldoversee all inquiries into and reviews of childdeaths, monitor legislation and advise onnew legislation. He or she would monitor andcomment on the practice of public agencies.

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3.1 The Current System

3.1.1 In 2000 the government launchedNo Secrets the interagency guidance forPolice, Health and Social Services workingwith all the private and voluntary providersin the Care sector. The government definedsix main types of abuse, physical, sexual,psychological, financial, neglect anddiscriminatory abuse. Social Services weregiven the lead and coordinating role whichincluded responsibility for bringing all thelocal agencies together to promote effectiveinter-agency working, the identification ofabuse, assessment of risk and whether abusehas taken place, responding to help thosewho are abused and the prevention of abuse.Unfortunately, government did not allocateany additional resources to take on theseimportant and new responsibilities.

3.1.2 Since 1997 there have been anumber of developments and additions to thesystems for protecting the vulnerable,including the Criminal Record Bureau (CRB),the General Social Care Council (GSCC), andthe National Care Standards Commission(NCSC). The Department of Health has alsoissued guidance on child protection, QualityProtects.

3.1.3 The CRB has proved to be a poorlyplanned and executed system which has beenunable to cope with the level of demand forcriminal record checks since it commencedoperation in April 2002. In order to ‘manage’demand the Home Office and Department ofHealth decided to postpone indefinitelychecks on 300,000 domiciliary staff andagency nursing staff. Plans to implement theProtection of Vulnerable Adult (PoVA) Listhave also been postponed indefinitely.

3.1.4 The GSCC issues codes of conduct forsocial care workers and from 1st April 2003 itwill begin to register social care workersstarting with the estimated 80,000 qualified

social workers and then moving ontoqualified care home managers. Once aprofessional group are registered with theCouncil title will be protected and a personfound to be in breach of the relevant codecould be struck-off the register. There areestimated to be 1.2 million people in thesocial care workforce. The GSCC will register60,000 a year. At that rate of progress it willtake until 2023 to register the entireworkforce. This is plainly unacceptable andthe registration process must be accelerated.

3.1.5 The NCSC inspects care providersagainst nationally set minimum standards.There have been concerns about the lack ofconsistency in the application of regulationsby inspectors. We would expect the NCSC’ssuccessor to ensure that there is aconsistency of approach by all of itsinspectors. The NCSC and Social ServicesInspectorate are to be merged into a singlenew body known as the Commission forSocial Care Inspection (CSCI). The inspectionand audit of all health care will beundertaken by the Commission for HealthcareAudit and Inspection (CHAI). We haveserious concerns about the ‘independence’ ofthe two commissions and believe that theyshould be at least as independent ofGovernment as the National Audit Office.Liberal Democrats have long argued thatseamless services need a seamless system ofregulation and inspection which covers bothhealth and social care. We welcome theintention to co-locate the new inspectionbodies, but believe that their integrationinto a single Commission for Care Standardsand Inspection must be the end objective.We would also abandon the arbitrary andmeaningless ‘star rating’ systems for socialservices and health. In its place we wouldrequire the commission to decide for itselfhow best to ensure the public can makeinformed comparisons of performance in thedelivery of health and social care.

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Protecting Vulnerable People

3.2 Protecting Vulnerable Adults

3.2.1 The true scale of abuse of vulnerableadults is unknown. The Government hasfailed to undertaken systematic research togauge the level of abuse. The Department ofHealth should commission research alongsimilar lines to the US sentinel researchprogramme to establish a clear baselinefigure for abuse.

3.2.2 Action on Elder Abuse define abuseas ‘a single or repeated act or lack ofappropriate action occurring within anyrelationship where there is an expectation oftrust which causes harm or distress to anolder person’.

3.2.3 One form of abuse is theinappropriate use of restraints. Examples ofrestraint include inappropriate or overmedication, removing a persons walking aid,setting a heavy table in front of a residentschair to stop them getting up, tightlytucking in blankets, all of which canimmobilise a resident as effectively as straps.Such abuse creates barriers between theresidents and staff taking care of them andundermining residents’ confidence andautonomy. It emphasises the power of staffand the powerlessness of residents promotingincontinence and dependency.

3.2.4 A succession of studies both in theUK and abroad, have demonstrated that thelevels of prescribing far exceed the numbersof elderly people exhibiting conditions thatare treatable by the drugs. Particularly at riskare elderly people with dementia. Managingchallenging behaviour without trained staffis no excuse for reliance on chemicalsolutions. International evidence suggeststhat the annual reviews of prescribing toolder people proposed in the National ServiceFramework for Older People are inadequate,and that harm can be done to an olderperson in far less time than a year.

3.2.5 The CSCI will have a clear statutoryduty to safeguard and promote the welfare ofchildren and a statutory office of Children’sRights Director to see the duty is acted on.However, there is no equivalent duty or officefor vulnerable adults. This deliberateomission should be put right with thecreation of the office of Vulnerable AdultsRights Director and the placing of a clearduty to safeguard and promote the welfare ofvulnerable adults on both CSCI and theCommission for Health Audit and Inspection(CHAI).

3.2.6 Research has found thatimplementation of the No Secrets guidance ispatchy. Few local authorities have drawn upservice development plans to ensure thatsupport services are put in place to preventabuse and help the abused. Most localauthorities have yet to include in contractswith service providers a requirement thattheir policies for the protection of vulnerableare adhered to.

3.2.7 In developing services to prevent,detect and counter abuse the well being ofthe vulnerable person must be paramount.Work with vulnerable adults who are at risk ofabuse is a highly sensitive, highly skilful andhighly demanding role for professionals.Specialist skills are required from healthprofessionals, police officers and socialservices staff to identify abuse (when ithappens), to make a full assessment, torespond to help the victims and to seek toensure that abuse does not re-occur. As thisis a developing area of care-practice the workin both responding to abuse and preventingabuse will require investment of new careresources. This must include significanttraining resources for all direct care staff whowork with vulnerable adults. LiberalDemocrats will ensure that the staffing,training, and support for effectiveinteragency work and research resources areproperly assessed and allocated by centralgovernment.

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3.2.8 While our aim must be to preventabuse, we must ensure that the victims ofabuse have clear legal redress. Currentlythere is no specific statutory tort or offencecovering neglect or abuse of a vulnerableadult. We would consult on the best way toclose this loophole.

3.3 Protecting Vulnerable Children

3.3.1 Too many of the children who losetheir lives through abuse or neglect or leadlives marred by abuse or neglect did notregister on the child protection radar.Everyone, not just the state, has aresponsibility to protect children. For publicagencies, protecting children should be a keyresponsibility. All staff who have regularcontact with the public, such as council andNHS receptionists, leisure centre staff andlibrary staff should have child protectiontraining.

3.3.2 No policy on protecting children canignore the findings and recommendations ofthe Laming Inquiry into the death of VictoriaClimbie. The report documents unacceptablefailings of front-line practice and fatal flawsin the senior management of the localauthorities concerned. The principal reasonwhy Victoria Climbie was murdered is thattoo many of those with responsibility did notdo their job. As Laming says Victoria wouldhave been protected if nothing more thanbasic good practice had been put intooperation. She did not require a new systemas much as she required the performance ofbasic duties by those who saw her. So furthertraining for staff must be an issue, as is thequality of some who are working in the caresystem, the pressure under which they work,poor conditions and remuneration.

3.3.3 Adequate financing would of coursetake us at least some way to a solution.Laming does refer to the Standard SpendingAssessment (SSA), now Funding Formula

Spending (FFS), by which Local Authoritiesare provided with funding for their SocialServices Departments. Brent and Haringeyboth spent less on their children’s servicethan was assessed as necessary by centralgovernment. We have considered ring fencingbut reject this as it limits local discretion.Instead we would ensure greatertransparency and accountability through thework of CSCI. Funding Formula Spending initself only refers to the way in which moneyis divided rather than an objective measureof what would be required to provide aquality service.

3.3.4 Going beyond these basic issues, itis often the combination of different piecesof information, which when viewed togethercan confirm a suspicion and trigger aresponse. As the Laming Inquirydemonstrated, failure to integrateinformation meant that opportunities tosafeguard Victoria were missed. The way inwhich information is collected, interpreted,shared and acted upon is fundamental tobuilding a robust system for safeguardingchildren.

3.3.5 Arrangements for co-ordinating andplanning child protection at a local levelneed strengthening. Area Child ProtectionCommittees (ACPCs) must be put on astatutory footing and subject to regular jointinspection. All of the participating agenciesshould have a legal duty to participate in thework of the ACPC. The key tasks of the ACPCshould be setting standards and performancetargets for identifying and reducing theincidence of abuse, co-ordinating,monitoring and evaluating practice, ensuringlearning from good and bad practice andgathering and reporting on met and unmetneed.

3.3.6 The ACPC would contribute to localstrategic planning and commissioning byhighlighting priorities for servicedevelopment. The Chair of the ACPC wouldhave a statutory duty to report directly to

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councillors any concerns about the ability oflocal agencies to contribute to childprotection work.

3.3.7 The establishment of the post ofChildren’s Rights Director within the NCSChas meant a clear focus on the needs ofvulnerable children who are in care. But thewrit of the Director is strictly limited toservices regulated by the NCSC and is not asubstitute for a Children’s Commissioner. Thecreation of CSCI should mean that theDirector will cover all aspects of children andfamily services. However, the Director’s roleshould be extended to include servicesregulated by CHAI.

3.3.8 We welcome the recent creation of aMinister for Children in the DfES withresponsibility for children policy acrossgovernment (with the exception of children’shealth which remains at the Department ofHealth). However, this post does not obviatethe need for an independent Children’sCommissioner, and there remains a concernover how the transition from childhood toadulthood is dealt with in policy terms giventhat vulnerable adults are dealt with in DoH.

3.3.9 Home Office figures show that thenumber of child homicides has not fallen forthirty years. We have cut child deaths on ourroads and reduced the risk of disease andillness in children, but the child death ratesas a result of neglect and abuse haveremained unchanged.

3.3.10 Framing effective policy requiresinformation, but there is a disturbing lack ofinformation on the causes and circumstancesof unexpected or suspicious child deaths. TheUN Committee on the Rights of the Child inits most recent report expressed concern thatthere is no systematic follow-up for childdeaths in this country. There is no permanentdatabase of child death cases. The full extentof child death in this country remains largelyhidden. The UN Committee expressed itsalarm at the lack of a co-ordinated strategyto reduce child deaths. To take such a

strategy forward we will establish a system ofstatutory child death inquiries, and includein future British crime surveys all crimescommitted against children. These reviewswill be overseen by the Children’sCommissioner.

3.3.11 If a child is to be permanentlyremoved from their family, a court considersthe issue. A delay in making and thenimplementing that decision impacts on thedevelopment of the child. Research showsthat a child’s primary attachments are madebetween the ages of 18 months and threeyears, and that the older the child the lesslikely they are to attract interest from anadoptive family. And yet court proceedingsare slow. The Children Act envisagedproceedings lasting a few months. Theyroutinely last 18 months and longer. By thetime an adoptive placement is found, thewhole process could have taken two to threeyears. Reasons for delay include time totaken to instruct expert witnesses and lack ofcourt availability. We would require theDepartment of Constitutional Affairs to takethe lead in drawing up an action plan withthe aim of cutting down these delays. As partof this plan, we would envisage laying downstrict criteria to be met before experts areappointed, and maximising the amount ofwork that can be done before getting intocourt, for example through enforced parties’conferences. Specialist resources to provideassessments about prospects ofrehabilitation might also assist, and could bedelivered by consortia of Local Authorities.

3.3.12 One way of helping to implementquickly decisions to remove a child is‘parallel planning’. There are pilot schemessuch as the Coram Concurrent PlanningProject which use families who are ‘matched’to a specific child but who initially are askedto foster the child while enquiries are madeof the suitability of the birth family. Ifrehabilitation is not possible then the caringfamily are then able to adopt the child.

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4.1 Local Democratic Control of Health and Social Care

4.1.1 The Liberal Democrat vision of socialcare is much more than the fire fighting thatSocial Services Departments engage in today.If the people centred approach outlined in1.1 is to be realised it requires a ‘wholesociety approach’ which fosters and supportscommunities in which individuals with careneeds can best live independently. LocalGovernment has a crucial communityleadership role to play in promoting thehealth and well being of those who live andwork in an area. This role would bestrengthened by our plans to give localauthorities a power of general competence,introduce a more representative and fairelectoral system and greater financialautonomy from Whitehall set out in PolicyPaper 30 Re-Inventing Local Government(1999).

4.1.2 Building on the work Councils arealready undertaking in preparing localCommunity Plans we would require thehealth and social care impact of the plan tobe assessed. We would expect Councils to usetheir community planning process to ensurethat health and well-being promoting actionswere integral to the work of the localauthority and other local agencies. Theeconomic regeneration function of localauthorities will also be crucial in building thekind of cohesive communities which willoffer a setting in which those with careneeds can live independently. Land useplanning can be employed to promoteaccessibility of vital services and ensure thedesign of the overall physical environment isconducive to independent living for thosewith disabilities.

4.1.3 A significant institutional barrier tothis kind of integrated working is the false

division between health and other localservices which come under Local Authoritycontrol. We therefore propose to transfer thecommissioning role of Primary Care Trusts toelected Local Government at the same tier associal services. The radical change of runningthese services through a pooled budget atthis level will end the artificial divisionbetween clients identified to have ‘Health’rather than ‘Social’ care needs, facilitating a‘seamless service’ and more rapid progress onthe comprehensive introduction of a singleassessment process for clients.

4.1.4 The transfer of healthcommissioning functions to local authoritieswill allow a transition to a democraticallyaccountable process with the minimum offurther structural upheaval within the NHS. Itwill facilitate the further necessary processof devolution of decision making to the mostappropriate local level. Devolution withinsome geographically dispersed and diverseauthorities (such as County Councils) maymean there are several area committeescontrolling the Health and Social Carebudget. There is a need to radicallystrengthen involvement of clients, carers andvoluntary organisations within the newcommissioning arrangements. Theestablishment of care forums withrepresentation from all stakeholder groupswould be one way of ensuring the views of awide cross-section of those with specialistknowledge and expertise could be utilised.We would review and strengthen statutoryrights of consultation on existing services aswell as detailed involvement with regard toany new developments.

4.1.5 Giving political accountability overhealth commissioning to local authoritiesdoes not of course mean that councillors willdirectly take decisions on the medical care ofindividuals, any more than the existingpolitical accountability of Social ServicesDepartments means that councillors directly

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Governance, Organisation and Resources

take decisions over individual childprotection issues. Professional decisions willremain for professionals. We believe that theexisting culture of local government is ingeneral more sensitive to dealing withvoluntary and user groups, and this will be apositive influence on the culture of thehealth service in a more integrated system.It is also likely that greater integration ofcommissioning may lead to more rationalresources allocation, for example as betweenprimary and secondary care.

4.1.6 The Government has recentlyproposed piloting Children’s Trusts to jointlycommission health and social care servicesfor children. We welcome this as a way topromote integrated care in the short term.However, ultimately Children’s Trusts shouldbe embraced within the wider programme ofintegrated health and social carecommissioning we advocate through localgovernment.

4.1.7 The case for the integration ofhealth and social service commissioningholds true at a regional, as well as a local,level. Local services are at the heart ofcommunity and primary care; but localservices cannot provide for the whole rangeof specialist health and social care needs.Local authorities would not provide everyservice locally, but make arrangementswhereby each one can be providedappropriately, which may include purchasingservices at some distance. Just as somespecialist medical services need to beprovided across a wide geographical area andover a larger population, more specialistsocial care, such as some types of long stayspecialist accomodation or specialist needseducation, should be commissionedregionally. As part of our programme forRegional Devolution in England, we wouldestablish Regional Health and Social ServicesAuthorities drawing together those functionsof Strategic Health Authorities not devolvedto local government and those functions ofthe Whitehall Department of Health whichcan be regionalised. The RHSSA would be

under the democratic control of electedRegional Governments where the populationsof those Regions so chose in a referendum.Until elected Regional Government comesinto being we would establish RHSSAs asjoint boards comprising councillorsappointed by each local authority in theregion. RHSSAs would also provide anexcellent forum for cross-district informationexchange and joint planning.

4.1.8 Such radical decentralisation doesnot mean that there is no place for agreednational minimum standards and a system ofindependent audit and inspection to ensurethat they are met. Our plans forstrengthening and integrating the inspectionfunctions of CHAI and CSCI are detailed insection 3.1.5. The setting of nationalminimum standards for services should befaciliated by Central Government but agreedby local and regional government (asproposed in Policy Paper 53 Quality,Innovation, Choice).

4.2 Resources

4.2.1 Clearly the resource squeeze onsocial services has been acute, with manycouncil Social Services Departmentsoverspent on budgets. Reforms to the wayservices are commissioned and deliveredalong the lines we have advocated canachieve improved value for money. Forexample, it was recently discovered inCheadle that local health, education andsocial services departments were allproviding services for Autism sufferers, butwithout any co-ordination or knowledge ofwhat the others were doing. Greaterintegration of services will allow morerational use of resources and the eliminationof duplication. However, given the scale ofthe problem efficiency savings alone areunlikely to provide a complete solution.

4.2.2 Our proposed changes to localgovernment finance with the abolition of theunfair system of Council Tax and itsreplacement by Local Income Tax, with rate

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varying powers for local and regionalgovernment, and the return of local controlover business rates, will strengthen local taxbases and allow authorities to alterexpenditure in line with local needs andvoter preferences. The council tax collectionsystem costs around half a billion pounds ayear across English local government, andscrapping it will allow us plough back thesavings into local services. The reduction inthe massive bureaucracy which has grown upin the current Health and Social Careorganisations to negotiate the divisionbetween them will also free up resourceswithin the unified budget for additional frontline services.

4.2.3 A further way to make additionalfunds available for social care is byreallocating money set aside by theDepartment of Health to pay for the LabourGovernment’s “bed-blocking fines”. Insteadof effectively taking this money from theNHS budget and putting it on one side, wewould direct it straight to local authorities topay for investment in capacity improvementsuch as intermediate care.

4.2.4 However, in addition to thesemeasures we think the whole issue of socialcare funding needs a comprehensive review.We would therefore initiate an exerciseequivalent to the Wanless review of healthservice funding (as Wanless himselfrecommended). This would include in itsremit how public policy can help to achieve‘compression of morbidity’ (a reduction in thelength of the period of poor anddeteriorating health most people experiencetowards the end of life).

4.3 Charges for Social Care

4.3.1 Liberal Democrats are committed toimplementing the Majority Report of theSutherland Royal Commission, includingfunding personal care costs for those needinglong term care (subject to a needs

assessment). This commitment would befunded from progressive taxation. LiberalDemocrats have already delivered on thispolicy in government in Scotland.

4.3.2 Local authorities in Englandcurrently raise around £215 million per yearfrom charges for non-residential careservices. Although councils have discretionin charging, in practice most Councils chargefor the majority of non-residential careservices to balance their books. However,charges can deter access, create the need forcollection arrangements which in themselveshave costs, and overall raise relatively littlein comparison with the total level of socialcare budgets. While our proposals forabolishing charges for personal care wouldgo someway to ending non-residentialcharges there would still be charges for suchthings as domestic help. We would like to bein a position to abolish them, we believethat the future of such charges should beconsidered in the ‘Wanless’ - type review ofsocial care funding proposed in 4.2 above.

4.3.3 There is mounting evidence frominquiries by the Health Service Ombudsmanthat local authorities are means testing andcharging people when the NHS should meetthe full cost of the person’s care. Thejudgment of the Court of Appeal in the 1999Coughlan case ruled that where a person’sprimary need for accommodation is a healthneed, then the patient’s care funding is theresponsibility of the NHS and not the localauthority. The Department of Health hasfailed to provide clear guidance to the NHSon its legal duties. We would establish anindependent case review and compensationscheme and ensure that clear guidance wasissued and complied with.

4.4 Staff Training, Recruitment and Retention

4.4.1 There are some 1.2 million people inthe social care workforce. Most of the

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workforce is in the private and voluntarysectors. For example Social ServicesDepartments do not employ 60% of qualifiedsocial workers. Recruitment and retention areserious issues right across the workforce.The delivery of the agenda mapped out inthis policy paper hinges on the quality andcommitment of that workforce.

4.4.2 There is little systematic collectionof workforce information. What is knownfrom survey work by the Local GovernmentAssociation (LGA) is that nearly two thirds ofSocial Services Departments have difficultyin recruiting social workers and almost halfcannot find enough home care staff. Thereare critical shortages of child protectionstaff. The position is particularly severe inLondon and the South East.

4.4.3 The King’s Fund Report FutureImperfect? reported similar recruitmentdifficulties across the public, voluntary andprivate sectors. The recruitment difficultieswere having a direct effect on the qualityand cost of services as employers becomeincreasingly dependent on agency staff. Lowpay, low status and competition for socialcare staff has led to concerns that careproviders have little choice but to fillvacancies with people with high numeracyand literary training needs.

4.4.4 It is clear that low pay is asignificant factor in the recruitment andstatus problem. The local governmentfinance reforms indicated above and theadditional scope for extra pay allowances inhigh cost areas supported in Quality,Innovation, Choice will allow a start to bemade on tackling this problem.

4.4.5 The LGA Report Care to Stay? alsoidentifies a link between management andstaff shortages. Where there has been a lackof effective planning this has led to a cycleof heavy workloads, low morale, long hoursand high staff turnover. What is required is ahuman resources strategy and co-ordinatedapproach to workforce planning across health

and social care. It will aim to raise standards,boost morale and status, draw talent intosocial care and enable more rational andeffective planning and management. Thisstrategy will need to have both a nationalcomponent and scope for adaptation to meetlocal needs.

4.4.6 The human resources strategy willhave to establish a three-year or equivalentprofessional qualification as the basis for aprofessional career in personal socialservices. It will require appropriatemanagement training to develop thenecessary skills in those with managementresponsibilities. A clear career path withinsocial care will have to be mapped out whichboth has routes into management and scopefor senior practitioner status for those whowish to develop their careers while stillworking directly with clients. Combiningthese changes with a strong publicinformation campaign to publicise theimportance and emotional rewards of socialwork should both boost status and help solverecruitment and retention problems.

4.4.7 The strategy should also encourageentry to social care work from a diverse rangeof people. Social care could be made anattractive ‘second career’ option for thosereturning to work after a long period devotedto family responsibilities. Greaterencouragement should be given to thosewith physical or learning disabilities to workwithin the social care setting.

4.4.8 It will also have to ensure thatproviders are supported in developing theirstaff. In key shortage areas the strategycould target resources for the development ofhome-grown staff and special remunerativemeasures to attract and retain staff. Thehomegrown scheme would enable social careemployers to select and support appropriateand suitable known staff in obtainingqualified status. This would be delivered byinhouse schemes accredited by local suitableacademic institutions. Such schemes couldattract those who would not have gone on to

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traditional social work training. We shouldalso be encouraging greater freedom ofmovement between ‘health’ care, ‘social’ care,and other types of hands-on care roles.Developing NVQ training jointly with healthpartners would help to develop transferableskills.

4.4.9 The human resources strategy wouldalso address the need to develop commontraining of all staff involved in childprotection work. This would form part of awider drive to develop the ethos and practiceof multi-agency working in the delivery ofhealth, housing and social care.

4.4.10 An important feature of workforceplanning will be ensuring qualified socialworkers are able to concentrate on the

professional work they are trained for and donot get bogged down in routineadministration and paperwork. Intelligentuse of IT systems should be promoted toensure time spent on necessaryadministrative tasks is kept to a minimum.

4.4.11 At a national level the twin aims ofreassuring the public that the needs ofvulnerable children and adults are beingproperly safeguarded and that the status ofall social care workers is being raised can beadvanced by accelerating the registrationprogramme of the GSCC.

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This paper has been approved for debate by the Federal Conference by the Federal PolicyCommittee under the terms of Article 5.4 of the Federal Constitution. Within the policy-makingprocedure of the Liberal Democrats, the Federal Party determines the policy of the Party in thoseareas which might reasonably be expected to fall within the remit of the federal institutions inthe context of a federal United Kingdom. The Party in England, the Scottish Liberal Democrats,the Welsh Liberal Democrats and the Northern Ireland Local Party determine the policy of theParty on all other issues, except that any or all of them may confer this power upon the FederalParty in any specified area or areas. If approved by Conference, this paper will form the policyof the Federal Party, except in appropriate areas where any national party policy would takeprecedence.

Many of the policy papers published by the Liberal Democrats imply modifications to existinggovernment public expenditure priorities. We recognise that it may not be possible to achieveall these proposals in the lifetime of one Parliament. We intend to publish a costingsprogramme, setting out our priorities across all policy areas, closer to the next general election.

Working Group on Social Care

Dr Ian Mack (Chair) Richard MillsJeremy Ambache Douglas TaylorBaroness Barker Ralph TaylorPaul Burstow MPPatsy Calton MP Staff:Terry GilbertDavid Hart Christian MoonSue Last Emily PowellSandra Lawman Richard StokoeCllr Robin Martlew

Note: Membership of the Working Group should not be taken to indicate that every membernecessarily agrees with every statement or every proposal in this Paper.

Comments on the paper are welcome and should be addressed to:Policy Unit, Liberal Democrats, 4 Cowley Street, London SW1P 3NB

ISBN: 1 85187 704 5 © August 2003

Further copies of this paper may be obtained, price £5 from:Liberal Democrat Image, 11 High Street, Aldershot, Hampshire, GU 11 1BHTel: 01252 408 282 Email: libdemimage@ldimage.demon.co.ukPrinted by Contract Printing, 1 St James Road, St James Industrial Estate, Corby, NorthantsNN18 8AL. Cover design by Helen Belcher.

This document has been prepared using 100% recycled paper.

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