Paying for social care

There are an increasing number of local news reports coming through of cuts being made to social care provision and charges for it being put up. Unfortunately, this is going to be repeated across the UK in the coming months.

 In the past day or so, 2 stories have come across my radar, both of which detail aspects of social care cuts in local authority areas.

 These are just taken at random and happen to be the ones that appeared in my inbox. There have been others over the past few weeks and there will be more to come, these are just to illustrate my point.

 Firstly, www.getwokingham.co.uk reported that Wokingham Borough Council has confirmed that it will no longer offer free services to people with savings of more than £23,250 and will introduce a £16.30-a-day charge for day care services.

Meanwhile, Community Care carried a story about Derbyshire County Council’s plans to save about £4 million a year by ramping up its eligibility threshold for social care services.

I suspect that many more councils will follow suit as budget cuts really begin to bite. The oft-quoted figure of 25% savings having to be found still haunts managers and commissioners in local authorities who will have to make some very uncomfortable decisions in the coming months.

I don’t wish to be the harbinger of doom, but, well, I’m going to be; these cuts could get deeper too. The comprehensive spending review, which sets local authority spending budgets for the next 3 years, is in October, and with cutting the UK’s deficit at the top of the government’s priority list, there are likely to be more cuts to come.

While many politicians claim that cuts won’t affect frontline services, it seems to me to be political flannel. Cuts of that magnitude will inevitably affect frontline services, as the 2 reports above show.

Currently 72% of council have their eligibility criteria set at ‘substantial’. Meanwhile, 24% will cater for people with ‘moderate’ needs and only 1% provide services for people with ‘critical’ needs, according to the Local Government Association and the Association of Directors of Adults Social Services.

I reckon that the percentage of councils catering only for ‘substantial’ or ‘critical’ needs will rise in the next year, which will mean that increasing numbers of people with moderate needs will be left out of the care system, unless they can pay for it themselves.

The government has talked about a focus on early intervention and prevention – which is to be applauded – and will help to keep people independent for longer. There is also a focus on those with the highest needs, as there should be.

But this leaves an enormous hole in the middle of people with moderate to quite complex needs who, unless they are lucky enough to live in an area that isn’t scrabbling around for every penny it can find, won’t be getting any services.

To me, there are inevitable knock-ons from this. For instance, without any care services, more people will end up with higher – and more expensive – needs faster than if they had got support earlier. It also puts more of a strain on carers, many of whom undertake the role without any financial support, or just for the Carers Allowance, which is still only £53.90 a week.

Not only this but services such as day care and meals on wheels, which are often vital lifelines, will also be cut back on.

I apologise if this makes for grim reading – I take no pleasure in writing it – but I can only see hard times ahead for everyone associated with social care. I doubt I’m saying anything revelatory, either.

But, to end on a positive note, if there is one thing the sector is good at, it is being resourceful. Social services, charities, third sector organisations and carers will always find ways to provide services that make a difference. This won’t stop because of local authority cuts.

DLA changes worry majority of claimants

When the coalition released its emergency Budget in June, the introduction of medical assessments for all Disability Living Allowance (DLA) claimants from 2013-14, with the aim of only paying the benefit for as long as the person needs it, caused much consternation among claimants, their families and disability groups.

Now, the extent of that dismay is becoming clearer. It seems that nearly all people who claim DLA are very or quite concerned about the changes to the benefit being introduced by the coalition government’s Budget, according to a survey by the Essex Coalition for Disabled People (ECDP).

More than half (57%) of respondents fear that their DLA may be taken away under the new assessment rules and 1 in 3 respondents thought it unlikely they would be able to work as a result of the changes.

Nearly 6 in 10 (58%) respondents said the changes were likely to have “a big impact” on their everyday lives, including not getting the support they need (67%) and a negative impact on their family (55%).

For many people receiving it, DLA makes up a significant proportion of their income and is not spent on luxuries, but everyday things that enable them to live their life as they choose, including having a job and, in some cases, paying the bills.

Without it, life would become tough very quickly – they will still need the equipment/services DLA enabled them to buy but have less money to do it with.

Even more so if they were to give up a job because of it, as one respondent quoted in the ECDP report said; “Without my DLA I would lose my adapted car, my independence and my job. DLA supports me to contribute because it enables me to work full time.”

In addition, many service users are also concerned about the closing of the Independent Living Fund to new service users until at least April 2011– something that was not widely flagged when it was announced in May – more than 6 in 10 are very concerned by the changes, particularly around not getting the level of care and support they need (64%) or not being able to live independently (62%).

While this survey was only of 141 people, 93% of which were of working age – and 12% of which had a learning disability and 11% a mental health condition – it nonetheless provides an interesting snapshot of the overwhelmingly negative feelings about the changes.

To bundle DLA and the ILF into the drive to get people off benefits and into work misses the point of them. There is a suspicion among some that the government views DLA as an unemployment benefit, which it isn’t. Also, DLA is not a “scroungers” benefit – the assessment people have to go through in order to receive it is already rigorous.

Some people, such as the example above, rely on DLA to be able to work; to take it from such people and force them back onto benefits seems wrong.

This is something the government should investigate with urgency. Any changes to DLA should not be about cost-cutting, but ensuring disabled people have the means to be able to live their life as they choose and have the same life chances as their able-bodied counterparts. Many people believe the current changes do the opposite and could be disastrous for many people.

The future for social care programmes?

Last Friday I blogged on the government’s axing of the Caring with Confidence programme, and how on an initial reading it seemed to make little sense. But comments since then from care services minister Paul Burstow have explained more about the decision – and given a hint as to future policy direction.

Burstow, as reported in Community Care has justified the move to end Caring with Confidence by saying: “We were not getting value for money from the delivery. Not enough carers had been through the programme, and there was no evidence that delivery would accelerate significantly.”

Whether that is accurate or not is a moot point. But this statement may tell us more about future policy direction when it comes to social care programmes: if they can demonstrate they are providing value for money, they will be safe, if not – watch out for the axe.

Now, once upon a time I was a business journalist, and I used to regularly interview entrepreneurs who would explain that a project or an arm of a business had been closed because it wasn’t providing value for money. Their priority was the bottom line and if it wasn’t contributing to it, and showed little sign of doing so in the future, then it would be axed, more often than not.

That’s fair enough in business – they exist to make profits – but in social care, it is a whole different ball game.

In social care, investment in a project may not provide demonstrable fiscal returns; it is often a lot more subtle than that. For instance, how do you quantify the value for money for someone taking part in a mental health project? It may aid their recovery and wellbeing but does it provide value for money? How do you judge? Is it whether they are able to get a job at the end of it and therefore can come off benefits and start paying tax?

It’s not an easy call to make; social care projects often provide intangible benefits to those that use them, and in these cases it is generally more important than any financial returns.

In fairness to Burstow, he has added (again according to Community Care) that the money from Caring with Confidence will be reinvested in other carers’ projects, including a training programme to raise GPs’ awareness of their role in supporting carers. He has also said that Caring with Confidence materials will be available free to carers’ centres that want to carry on the work.

Nevertheless, Caring with Confidence will not be the last project to bite the dust in the coming months. The government is making difficult decisions and with the cuts coming – said to be 25% of local authority budgets – it is inevitable that some social care programmes will be axed.

There are projects out there that are not doing what they were set up to do well enough and need to be weeded out, but there are many more that do and should be protected. Government and council leaders will need to examine each one very carefully and assess the benefits it gives to service users before deciding which should be cut and not just make a decision based on financial data.

Carers caring more but do the government?

An interesting juxtaposition of carers news over the past couple of days; firstly, the percentage of carers providing 50 hours or more care a week has more than doubled in the past 9 years; meanwhile, the government has axed the Caring with Confidence programme, a support package for carers worth £4.4 million a year.

New statistics from the NHS Information Centre reveal that 5 million adults in England – nearly 1 in 8 – act as a carer for a sick, elderly or disabled person, with more than a fifth providing care for more than 50 hours a week.

Today, 22% provide care for 50 hours or more, compared to 10% in 2000-01. Also, nearly half of carers (48%) provide 20 hours or more of care a week and 30% provide 35 hours or more.

These figures are based on 2 surveys of more than 37,000 carers; the Survey of Carers in households – 2009/10 England – Provisional Results, and Personal Social Services Survey of Adult Carers in England, 2009/10, so it’s fairly in-depth.

So with this in mind, it seems odd that the government has chosen to close the contract for the Caring with Confidence programme – a scheme designed to improve support for carers – in September, rather than March 2011, as was originally planned.

Care services minister Paul Burstow’s justification for cutting Caring for Confidence is that the money used in the scheme could be “spent smarter” elsewhere. He didn’t elaborate on how, other than to say that he plans to offer more support to carers’ organisations and for carers’ training.

However, given that supporting carers and giving them training is – was – Caring with Confidence’s raison d’etre, the decision makes even less sense, especially as it was coming to the end of its government funding early next year and, anecdotally, was making a positive difference to carers’ lives.

It seems like the government is trying to make quick savings to cut the financial deficit with this decision, and it flies in the face of its manifesto commitment to support carers.

Hopefully Burstow makes good on his words and this is not a sign of things to come for carers, otherwise the Personal Social Services Survey of Adult Carers survey’s statistic that 17% found their quality of life was either “bad, very bad or so bad it could not be worse”, could increase in years to come.

Incapacity benefits claimants worried by threat of cuts

These are nervous times for incapacity benefits claimants; with more rigorous testing coming for Incapacity Benefit and Disability Living Allowance, there is also the threat of more cuts to come later in the year.

Earlier this week, Chancellor George Osborne hinted that benefits which the government had not given specific commitments to protect would be part of a summer spending review aimed at cutting the deficit – although exactly what form this may take has not been elaborated on and work and pensions secretary Iain Duncan Smith has since tried to play down reports of cuts.

Nevertheless, it all amounts to a worrying time for disabled people. There have been several blogs in the past week by people who fear for their future or are angry at the nature of the changes, such as Emmanuel Smith in The Guardian and Dawn Willis.

Already Incapacity Benefit – and its successor Employment Support Allowance – has been in the firing line for some time, with new claimants having to go through more stringent checks with the work capability assessment since before the election. This is set to be extended to all claimants next year.

The government reckons that about one in 5 people on Incapacity Benefit – about 500,000 – are fit for work.

Some people – the much talked about “benefit scroungers” – who do play the system that will be found out by this, which is good.

But the vast majority of claimants are legitimate – 500,000 erroneous claimants seems high to me – and the Citizens Advice Bureau reported in March that the work capability assessment has found seriously ill and disabled people fit for work, including people with Multiple Sclerosis and severe mental illness.

There are several potential negative effects of taking people off Incapacity Benefit and onto Jobseeker’s Allowance. For instance, not only will income be reduced – and many disabled people are not well off to begin with – but, for people with mental health problems especially, the stress could harm their recovery.

The targeting of DLA is also serious; the new assessment seems designed to get people off it.

Indeed, there is a feeling among some commentators that the government has misinterpreted what DLA is. The Guardian’s Anne Wollenberg pointed to the government’s state of the nation report, which noted that “…around 2.2 million people, including 1.1 million people of working age, have been claiming disability living allowance for over 5 years”.

As Anne says, DLA is not and never has been an unemployment benefit; it is there to support people with the extra costs associated with disability – usually a long-term condition – such as wheelchairs and care services.

For many claimants, DLA is essential to their quality of life and if they were moved off it, life would become very tough very quickly – they will still need the equipment/services DLA enabled them to buy but have less money to do it with.

All these measures are wrapped up in a drive to get people off benefits and into work. While this is a laudable aim, there are problems. For instance, the UK is just coming out of one of the longest recessions of recent times and jobs are scarce, with 2.9 million unemployed and another 1.3 million set to lose theirs due to the measures in the recent Budget, according to news reports today.

The struggle to get work is often magnified for people with disabilities. Even though there is anti-discrimination legislation, I would be willing to bet that many employers would still choose an able-bodied person over someone with disabilities – although few would admit as much and may do it unconsciously.

I could go on. But it is clear is that life could get very tough for some people with disabilities or mental illness in the coming months and years if the government goes ahead with its plans.

Postscript: The government has now announced an independent review of the methods used to assess incapacity benefits claimants’  fitness to work and will report back by the end of the year.

How will the Budget affect social care?

Tomorrow is probably the most crucial day for the UK since the general election; the emergency Budget is delivered.

This has been widely trailed for weeks, and we all know that cuts are coming and will be deep. Just how deep will be revealed tomorrow – and there are a lot of worried people out there, for many reasons.

For example, it is anticipated that the cuts will herald many job losses in the public sector –the Adam Smith Institute, a think tank, claimed that more than 250,000 employees could be cut without affecting frontline services.

But will the Budget effect services in social care? Yes, is the simple answer, because the Budget will affect every department of the public sector.

However, there have been few specifics given away so far – although we know that the grant for implementing the personalisation agenda in adult social care will be protected.

Elsewhere, there may be an announcement about provision for more respite care for carers, which would be warmly welcomed.

As for anything else, it is back to guesswork again. So here goes…

The London School of Economics and University of Kent, commissioned by Age UK, reckons the social care budget could be cut by £900 million over the next 2 years. That would inevitably mean cuts, and it could well be that local authorities ramp up the eligibility criteria for social care once again. This would take some people out of the system and as a result could seriously adversely impact on their – and their carers’ – lives and possibly hasten their move to more complex services or residential care.

Elsewhere, welfare benefits will be looked at, and any rise is unlikely at best. There is also the threat of changes to Incapacity Benefit and more stringent testing for eligibility, which could mean that some people are moved onto the (lower rate) Jobseeker’s Allowance who have little chance of gaining work.

There is also a lingering threat of a rise in VAT, which would hit everyone.

However, before the election at the Age UK conference, the Conservatives and Liberals said that social care funding levels would be maintained at least. But since then both have had a better look at the UK’s books and this hasn’t been reiterated since the coalition was formed – or if it has, I haven’t seen it; please correct me if I’m wrong.

So, tomorrow’s Budget could be painful for social care in terms of job losses for those employed in the sector, cuts to services and benefits. What effect this will have remains to be seen, but those involved in providing care will keep on going because they always do – that is the one certainty at this time.

Would increasing NHS spending cut social care services?

Interesting stuff from shadow health secretary Andy Burnham today, as reported in the Guardian, who claims that increasing NHS spending could adversely affect social care provision.

Burnham objects to the government’s commitment to increase NHS spending in real terms year on year; “If they persist with this councils will tighten their eligibility criteria even further for social care. There will be barely nothing left in some parts of the country, and individuals will be digging ever deeper into their own pockets for social care support,” the Guardian reports him as saying.

As a cynical journo, my instant reaction is this is just a way of scoring a few cheap political points before the emergency Budget next Tuesday. And it probably is – but he does make a couple of salient points nevertheless.

It has struck me as odd that the only department with a guarantee of an increase in spending – amid swingeing cuts for everyone else – is health, especially at a time when the NHS is performing relatively well – if you take meeting the majority of targets as ‘well’. It smacked of a sop to the electorate – increasing health spending is always a vote winner.

Also, while there is nothing to say that the increase in NHS spending will come from the social care budget, there is nevertheless an element of robbing Peter to pay Paul with the Conservative commitment too – its reasonable to assume that increases in one department will mean that others gets cut. There are no spending commitments for social care (that I know of), so cuts in this area would seem inevitable.

Burnham also notes that putting the NHS in a stronger financial position to social care would make joint working – the current prevailing trend – harder to achieve.

Also, cutting social care could increase the burden on the NHS if more people end up in hospital due to falls etc due to struggling without care services they need because they cannot afford them. They could stay there longer if there is not the social care provision – meals on wheels, housing, care services etc – to support them in the community on release.

But whatever happens in next week’s Budget, it would seem the future for social care is an austere one; at a local level, there are already news stories of cutbacks in services, or charges for them increasing. To pick one example at random, here is a story from the online version of the Northampton Chronicle & Echo about county council proposals – currently out to public consultation – to raise £600,000 by increasing the cost of social care services.

Northampton County Council justifies this plan by saying that without the increase in charges, services would have to be cut.

This is a situation repeated across the country. It would seem that social care providers and service users are going to have to do more with less. How the government – and local authorities – will deal with this will be interesting to see. All should become clear in the coming weeks.

What happened to social care in election debate?

After 3 weeks out of the country – I was one of those caught up in the volcanic ash crisis – I’m getting back up to speed with what’s been happening in social care and where the main parties stand on it before the election.

There was precious little mention of social care or older people in last night’s TV debate – well, the bit I watched before jet-lag caught up with me – but I haven’t seen much else about it in the news. I’m told there was not much talk about it while I was away either.

Considering that social care was supposed to be one of the main debating points in this election, everyone seems to have gone quiet on it since Labour announced its White Paper on the future of social care and plans for a National Care Service.

But while we know about Labour’s plans, you have to look hard to find the Conservative and Liberal Democrat policies on older people – social care as a category isn’t there, disappointingly.

More disappointing is the lack of concrete policies. For instance, the Conservatives pledge to introduce a ‘home protection scheme’ to ensure people don’t have to sell their homes to pay for care, but don’t say how it would work, or how it would be funded.

They do however advocate the extension of direct payments and individual budgets to give people more choice and control over their care. While this is a continuation of an existing policy, it does hint that if the Tories win, they may not make fundamental changes to the personalisation agenda.

Meanwhile, the Lib Dems say they would undertake a review of social care. It’s difficult not to be sarcastic about that pledge – hasn’t the sector had enough of those in recent years?

More promisingly, they talk about re-establishing the link between the basic state pension and earnings.

There has also been little mention of the future of social work, although there are fears among some social workers that cuts to frontline services may be made; there have been assurances that teachers, doctors and nurses will not be axed, but no such declarations made for social work.

So, the future of social care, one of the bigger issues facing the UK, has once again been swept under the carpet. In a way it is not surprising, because there are no easy answers or snappy soundbites and some of the solutions may not be vote-winners. But it should have been a key part of the debate because this will affect everyone in the UK at some point.