Comprehensive spending review: little for social care

The months of rumours, leaks and speculation are over; the Comprehensive Spending Review has finally been announced. As expected, for social care, it does not make for fun reading.

Here are some of my immediate thoughts, based on Chancellor George Osborne’s speech and a (very) swift look at the spending review document. While the review obviously affects everyone in some way, I’m going to try to focus on the impact it could have on people with mental health issues and/or learning disabilities.

Firstly, it should be noted that there is very little geared specifically to people with learning disabilities and/or mental health issues. For instance, specific mentions of ‘learning disability’ (or disabilities) does not get one mention and ‘mental health’ only 2. I didn’t expect there to be; today is the day for grand statements, with the detail to come at a later date.

In terms of what was said, while Osborne promised an extra £2 billion for social care in the next five years, including £1 billion to aid joint working between health and social care, he mentioned that this would help older people – no mention of adults with disabilities.

Also, BBC health reporter Nick Triggle worries this could be more or less cancelled out by the increasing demand of the aging population.

Meanwhile, benefit reform will ensure that it “always pay to work”, according to Osborne. Benefits are to be capped at no more than the average net wage from 2013 – which will work out to about £500 per week for couple/lone parent household and £350 per week for single adult households – although people receiving Disability Living Allowance are exempt from this.

However, this may well hit people on incapacity benefit/Employment and Support Allowance and other benefits, especially those who are moved onto Jobseeker’s Allowance from ESA. The focus of the welfare reform is evidently on people getting jobs, with benefits cut to make it more of an incentive to work.

There is also a new 12-month time limit proposed for the one million people on ESA in the Work Related Activity Group to find work or face having their benefits cut.

But surely this will be dependent on the jobs being out there for people to take? Many people on ESA would like to take up jobs – part or full-time – but with many businesses not looking to take on employees, and the public sector set to shed 490,000 jobs, there are precious few available and competition for them will be fierce.

The reforms to housing benefit will also hit many people with learning disabilities and/or mental health issues, especially those living in London and the southeast, where property prices are generally higher than in the rest of the UK.

Potentially, the adverse impact of money worries on people with mental health issues or learning disabilities could be immense, as could the upheaval of having to move, if they now cannot afford the rent on their homes. For someone to have to move away from an area they know – including a network of informal support – to somewhere new could have a disastrous effect on a person.

Not all bad news

But the CSR wasn’t all bad for social care; there were a couple of positive notes from the Chancellor.

Firstly, personal budgets are to be extended to people with long-term health conditions, children with disabilities and special educational needs and adult social care. The commitment to personalisation is welcome and, for some people, personal budgets have made a tangible positive difference to their lives. Giving more people the option to do this is a good thing. Whether their budget will be enough to do this is another matter.

Likewise, the commitment to increase talking therapies for people with mental health issues is also to be welcomed.

The government is also going to take forward proposals to invest nationally in mental health liaison services at police stations and courts to intervene at an early stage, diverting mentally ill offenders away from the justice system and into treatment. However, it does carry the caveat ‘subject to business case approval’.

Nevertheless, this is a good move. Far too many people with mental health problems get stuck in the justice system and opportunities for them to access treatment are often lost.

Conclusion

From an initial assessment, people with learning disabilities and/or mental health issues do not fare well out of the CSR, especially in terms of welfare and housing reform. However, I don’t think anyone – regardless of who they are – fares well out of this review.

But there are some crumbs of comfort, especially with expanding personal budgets and talking therapies, although they are probably outweighed by the cuts.

However, to paraphrase Winston Churchill, this is not the end, it is not the beginning of the end, it is the end of the beginning. Next month, government departments will set out business plans to outline how they will implement cuts. This is where the real detailed information about cuts will come at a local level, and we will all find out which departments, services, projects, charities etc will retain funding, be closed, or face hard times.

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.

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.

Reflections on the Budget’s impact on social care

As usual, Tuesday’s Budget was a mixed bag; some gains, some losses for the majority of people, including those in social care. Here is a brief summary of what I have spotted.

Firstly, the downsides; public sector pay has been frozen for 2 years, except for those earning less than £21,000 per year. As many people in social care work in the public sector, this could have an impact on service users down the line.

For instance, it could demotivate workers, but some may decide to leave the sector entirely if they see the chance of better pay in the private sector – however, losing experienced staff is something that can be ill-afforded.

Also, the government will introduce a medical assessment for Disability Living Allowance from 2013 for new and existing claimants. Interestingly, the wording in the Budget says that this measure is to “ensure support is targeted on those with the highest medical need”.

I assume this will be some form of capacity for work assessment, which is the prevailing trend in disability benefits. It also seems to indicate that the criteria for eligibility may be raised. This could see some claimants moved onto other benefits that do not pay as much, or off them entirely.

Also, and a little oddly, the document also says that the medical assessment will “ensure payments are only made for as long as a claimant needs them”. As DLA is paid to people with a disability – generally an ongoing thing that doesn’t get better – this makes me wonder if the government really understand what it is and what it is for.

DLA has never been a form of unemployment benefit; it is there to help people with disabilities – physical or mental – pay for items they need to live, such as care services, which the general population do not need. To take this away could make life very difficult for some disabled people.

Elsewhere, VAT will rise to 20% from January 2011, which is a move that will hit everyone in the pocket, but for people on benefits or low incomes, the effect could be magnified.

Also, capping Housing Benefit at £280 a week for a one-bedroom property and £400 a week for a four-bedroom family home could also adversely impact on service users and carers, especially in London and the south of England.

On the plus side, from April 2011, disabled people who require an extra room to support a resident carer will be able to claim Housing Benefit. This again supports the government’s ongoing commitment to the personalisation agenda.

Also, the changes to tax thresholds could see some people on low incomes – which often include carers – taken out of the tax system.

Likewise, the move to link pensions with earnings from April 2011, meaning that it is guaranteed to rise in line with earnings, prices or 2.5%, whichever is the greater, will help older people.  

Chancellor George Osborne added that proposals on welfare reform will be announced by October this year, before the government announces its comprehensive spending review (CSR), which will set out the plans for public expenditure for the next 3 years. It is good to see that – finally – there may be some movement on this much-needed measure.

So there are plusses and minuses to this Budget – possibly more of the latter than the former. However, benefit cuts have not come directly, which had been rumoured, but other measures will impact adversely nonetheless.

But there is also still much that is still to be decided; local authority budgets, which will be announced in the CSR, and that could yet have more impact on social care.