1. Who Cares? The Future of Adult Care and Support in Northern Ireland - Discussion Document

2. Process of Reform The Department of Health, Social Services and Public Safety has decided to reform care and support provision. The consultation on the discussion document Who Cares? The Future of Adult Care and Support in Northern Ireland is the first stage in a 3 stage process. It is intended to raise awareness of the challenges that the care and support system is facing. The responses to the consultation will help inform the development of proposals for change (stage 2), which will then be followed by a final document setting out the agreed away forward for care and support in NI (stage 3).

3. CONTEXT

4. What is care and support? Care and Support system Help with Housing Benefits Adult Social Care The activities, services and relationships that help us to live an independent, healthy, active and inclusive life. Involves a wide range of services provided across government. These services include adult social care which is the responsibility of the Department of Health, Social Services and Public Safety (DHSSPS), and benefits and help with housing which is the responsibility of the Department for Social Development (DSD).

5. Types of care and support Domiciliary Care (care in the home) Residential Care Nursing Home Care Respite Care Meals on Wheels Day Care / Day Opportunities Advice, Advocacy, Counselling Social Work Adult Social Care Attendance Allowance (AA) Disability Living Allowance (DLA) Carers Allowance Benefits Housing Adaptations / Disabled Facilities Grants Supported Housing schemes Help with Housing

6. Who provides care and support? Statutory sector Private and Voluntary sectors 58% domiciliary care 77% residential care home packages 100% nursing home packages 42% domiciliary care 23% residential care home packages

7. NEED FOR CHANGE

8. Care and Support is facing a number of challenges: Lack of Understanding of System Changing Expectations Demographic Pressures Funding Why Does Care and Support Need to Change?

9. The Challenge Demographic Pressures Increasing Expectations Lack of understanding of how current system works means people dont plan for the future Increasing Demand But Funding cannot keep pace at time of austerity

10. VISION

11. Sustainability & Affordability Dignity and Respect Independence Quality Equity Equality and Diversity Human Rights Safeguarding Founding Principles

12. Vision Working across government and in partnership with service users, carers, providers and communities: - every person should be treated with dignity and respect, and should as far as possible be supported to lead the life they freely choose, safeguarded against harm from abuse, exploitation or neglect; - for all of us, care and support should recognise, foster and promote the preventative role we can all play as individuals in maintaining our own wellbeing and that of those around us; - for people with a care need, care and support should be personalised to individual need, providing the right support at the right time in the right place, with a focus on early intervention to protect and restore independence wherever possible.

13. Issues to Consider Does the vision reflect what you want from care and support? If not, what else should it reflect? How can people be supported to have greater choice and control over how their care and support needs are met? Should care and support continue to be provided by a combination of the statutory, private and voluntary sectors?

14. BALANCE OF RESPONSIBILITY

15. Who contributes to the care and support system? Care and Support Government provides funding for care and support and, in some cases, directly provides care and support services Members of communities often act as unpaid carers and volunteers to provide additional support through activities such as befriending Individuals take responsibility for some aspects of their own wellbeing – for example, through a healthy diet and exercise – and often contribute to the cost of their own care and support services

16. Contributions to Care and Support Government determines where money is spent and who should contribute financially to cost of care People who use services may contribute financially to cost of their care Carers look after relatives and friends without payment £811m spent on adult social care £947m on disability benefits Over £100m contributed by people who use services Carers NI estimate value of support provided by carers at £4.4bn

17. Charging for care and support Some services such as personal care provided through domiciliary care are free Some services such as meals on wheels require a flat rate contribution Some services such as residential and nursing home care are means tested, with people having to pay up to the full cost of their care.

18. Fairness and Sustainability Fairness: How do we ensure a fair balance between people who use services, taxpayers and government? Sustainability: How do we ensure sufficient funding to meet increasing demand?

19. Issues to Consider Do you think the current balance is fair? If not, how should we change the role of government, people who use services, and carers and the wider community? Should people be required to make means tested contributions to all services? Should government funding continue to be targeted at those least able to afford support? Should additional funding for care and support be redirected from other areas, e.g. NHS, education, economic investment?

20. How to get involved? Consultation closes 15 March 2013; Respond via questionnaires at end of main document, public information booklet or through online questionnaire; Check website http://www.dhsspsni.gov.uk/index/hss/reform- cas.htm for further information.