The Supported Living and Ageing Well Strategy (SLAWS) is designed to help adults of all ages that have ongoing care and support needs. This includes, but is not limited to, adults with physical impairments, mental health conditions, learning disabilities, dementia and conditions associated with ageing.
Under the chairmanship of Deputy Harwood, the Policy Council formed a cross-departmental Working Party at the end of 2013 comprising representatives of the Housing, Health and Social Services, Social Security and Treasury and Resources boards. The Working Party considered what would be needed to develop care and support services in a sustainable way for the future and, following a public consultation in July 2015 (follow this link), produced a Research Report with 29 recommendations to take this work forward. This was been appended to a Policy Letter from the Policy Council (follow this link), which was debated and approved by the States in February 2016.
The February debate was intended to be the beginning of ongoing, long-term change to bring about:
- Person-centred care with more choice and independence for the individual
- Joined-up services - service providers working together, not separately
- Effective and consistent support for carers
- Greater involvement in decision-making for those accessing care and their carers
- Greater inclusion in the community for those who need care
- A change of culture - including addressing issues such as ageism and loneliness in a co-ordinated and practical way
The Strategy also sets out ways by which the funding of services for people with ongoing care and support needs can be made more sustainable.
Frequently Asked Questions
What is SLAWS?
- SLAWS stands for 'The Supported Living and Ageing Well Strategy'. This Strategy has been jointly developed by the Policy Council, Housing, Health and Social Services, Social Security and Treasury and Resources Departments.
Who is the Strategy for?
- The Strategy is of relevance to everyone who pays tax or social security contributions, as they fund health and social care services. Paying for these services represents a very significant part of public sector expenditure and these costs are predicted to rise as more people live longer in both Guernsey and Alderney .
- The Strategy is for all adults in both islands not only those who have current ongoing care and support needs but all of us who may need this support in future. This includes - but is not limited to - people with physical impairments, people with dementia, people with autism and communication difficulties, people with learning disabilities, people with mental health conditions, and people with conditions associated with ageing.
I know what healthcare is but what is social care?
- Not everyone who needs 'care and support' requires healthcare - services provided by doctors, nurses, and other health professionals. The Strategy emphasises that for many people what they need is 'social care' - this covers any kind of support that a person needs to live their daily life. This can include help with shopping, help getting out of bed, transport to medical appointments, getting dressed, preparing food or just needing someone to talk to. Social care may be received in a residential home; in a supported housing setting such as the extra care housing schemes at La Nouvelle Maraitaine and Le Grand Courtil; or in any family home.
What issues is the Strategy seeking to address?
- The Strategy aims to begin to address what care and support services are needed, who should provide them and how they should be paid for. It is time for us to take a holistic and in depth view of all of these issues as a whole.
Why are these issues being looked at now?
- There is concern that with more people living longer we will no longer be able to afford to provide or fund the existing range of services, based on current funding arrangements.
- But it's not all about money. We know that while we're well-served by nursing and residential homes, we don't have as many supported housing options. We also know that many Islanders don't want to move to receive care and support but to receive it where they live; however, our social care services in the community do not currently always allow that choice to be exercised.
- We also know that when someone develops care and support needs, they and their family can have great difficulty finding out relevant information and navigating their way through the complex health and social care system.
- The Strategy is designed to highlight these and other issues, and to set an agenda for change.
Alderney has different issues than Guernsey: has this been taken into account?
- Yes. It is acknowledged that the services available to Alderney residents differ in various respects from Guernsey. The report recommends that further research is undertaken to understand the specific needs and requirements of Alderney, so that the Strategy can be adapted if necessary.
What is being proposed?
- The proposals, which will go before the States in February 2016, set out a plan of work which will lead to significant change, in particular within the social care sector.
- The changes proposed will take time to deliver, but the Health and Social Services Department is already working on a number of initiatives designed to improve the experiences of service users.
Why does the States need to agree this plan of work?
- The proposals being put forward should lead to significant change in how services are delivered and how they are paid for. The States as a whole needs to commit to make these changes which will need to be prioritised, funded and resourced.
What are the key changes proposed?
- It is intended that the February debate be the beginning of ongoing, long-term change to bring about:
- Person-centred care with more choice and independence for the individual
- Joined-up services - service providers working together, not separately
- Effective and consistent support for carers
- Greater involvement in decision-making for those accessing care and their carers
- Greater inclusion in the community for those who need care
- A change of culture - including addressing issues such as ageism and loneliness in a co-ordinated and practical way
- The Strategy also sets out ways by which the funding of services can be made more sustainable.
What does 'sustainable' mean?
- We are expecting there to be 3 times as many people over the age of 85 within the next 50 years, which could see the cost of providing care and support quadruple. This is because older people are more likely to have care and support needs and to have complex or multiple conditions (e.g. diabetes and a stroke, or dementia and a heart condition) which require more expensive care and support.
- At the moment health and social care services are funded from a combination of income tax and social security contributions (to the Long-term Care Insurance Fund). The Strategy identifies the implications for the States and for people if these costs are left to grow unchecked, and puts forward suggestions to change the funding arrangements and to deliver services in different ways to address these cost pressures.
- Changes must be made if we are to manage to provide for the predicted numbers of older people. Doing nothing is not an option.
- Whilst efforts will be made to make sure that the services that the States of Guernsey provide meet the needs of the community, the increase in costs which is forecast is simply too large to provide the same level of service with the resources we currently have.
Do the third and private sectors have a role here?
- Yes. The States will work with the private and third sectors (voluntary and charitable organisations) to look at how new services can be developed and existing services can be provided differently, which may have a positive impact on future cost forecasts.
Will I be required to pay more social security contributions?
- The States agreed to implement a Long-term Care Insurance Scheme in February 2001, to assist people with the costs of care and accommodation in private sector residential and nursing homes. At that point it was noted that:
- The contribution rate of 1.4%, arrived at through consultation with the Government Actuary's Department, is estimated to be sufficient to remain at that percentage rate for 15 years. (Billet d'État III, 2001, para 8.)
- 15 years later there is need to review this contribution rate to ensure that the Long-term Care Insurance Fund is able to assist people who require care and support in residential and nursing homes in the coming decades.
- The Strategy puts forward various suggestions regarding what services should be funded from the Scheme, and who should pay for care and accommodation - individuals or the States.
- These suggestions will be the subject of future reports to the States but, in the short term, the States have agreed that, as a first step to making the Fund sustainable in the future, the contribution rate should be increased by 0.5% from January 2017.
I live in a care home - will the Strategy mean that I will have to pay more towards the cost of my care?
- Care home fees are set by the nursing or residential home in which a person lives and will be regularly reviewed by the home concerned. Individuals can be helped to meet these fees through long-term care benefits, paid for from the Long-term Care Insurance Fund.
- Care home fees cover the cost of care but they also cover the cost of accommodation, food, utilities and other living costs. The Strategy suggests that one way of making the Long-term Care Insurance Fund more sustainable would be for care costs to be paid by the States, but to require the individual, where they can afford to, to pay for their accommodation and living costs.
- There is no plan to apply this in the immediate future but if the suggestion is taken up, a further report will be brought to the States with the details of the proposed changes.
I've heard I'll have to sell my house to pay for my care, is this true?
- There are no proposals requiring individuals entering care homes to sell their properties to pay for their care at this stage. There are many different options that are being considered including this one. It is important that all of the options and how they work together are considered in more depth so that everybody can get the support that they need.
