“Our dominant reaction to today’s Budget announcement is relief, but we are disappointed that the investment in social care wasn’t more and that at £650m (plus £45m for Disabled Facilities Grant), it is somewhere between a third and half of the amount the experts say is needed to fill existing gaps in services.”
“Due to lack of funding, next year was shaping up to be truly perilous for the delivery of social care so it is very good news that this extra money has been found, but at £650m it won’t be enough to plug current gaps, let alone bring back the care homes and home care packages we’ve lost over the last decade or so – all at a time when demand has been rising. Unfortunately, despite this additional money the 1.4 million older people with some level of unmet need for care will have to continue to ‘make do’ and those older and disabled people who are lucky enough to be receiving a service are unlikely to see any improvement in 2019.
“This announcement also continues the pattern whereby year on year, governments allow social care to teeter on the brink, only to bail it out with an emergency hand out – just enough to prevent total national collapse but no more. The problem is that this approach gives neither staff nor providers much encouragement to stay and so they continue to drift away, storing up even greater problems for the future.
“Nothing could better demonstrate the need for a bold and ambitious Social Care Green Paper, fit for meeting the challenge of saving social care for this and future generations, with much also resting on the outcome of next year’s Spending Review. “
A new survey by the Care and Support Alliance (CSA) has found that more than a quarter (29%) of disabled 18 – 64-year-olds who rely on council funding have had their care cut over the last year.[1]
Yet respondents to this online survey often reported that there had been no change in their needs, or even a worsening of their condition, so it seems disabled people’s legal rights to care are widely being breached. In the most worrying cases, the health, safety and wellbeing of these people was being jeopardised as a result.
The Care Act is absolutely clear that the amount of care people receive should be based on an objective assessment of their needs, and that councils have a duty to ensure that anyone whose needs fit the ‘substantial’ criterion are met. However, an estimated £6.3bn has been taken out of adult social care in real terms since 2010[2] and overall council budgets were cut by 49% in real terms over the same period because of the Government’s policy of austerity.[3] Meanwhile, need has steadily increased because of a rise in the numbers of older people and disabled people, creating an ever bigger gap between the demand for and supply of care. It would not be surprising therefore if cash strapped councils had been forced down a path of restricting the care they provide – but any such move would be in clear breach of the law and in defiance of disabled people’s rights.
People who are entitled to receive council funded care have very considerable needs and require help with everyday basics the rest of us take for granted like getting dressed, eating and getting out of the house. Those whose care is funded by the council will have been assessed as not being able to pay for all or some of their care, so will also be living on a very low income. Failure to receive all the care you need in this situation can have a devastating impact.
The CSA research undertaken this year also revealed that regardless of how their care is funded, too many are going without even the most basic care. Nearly half of respondents to the survey told us that because of a lack of care they have experienced not being able to get out of the house (48%) and not being able to work (46%), or have seen their health deteriorate (49%). In addition, nearly a quarter (24%) told us they are unable to move around their homes safely because of not having the social care they need.
The alliance of over 80 organisations and charities is urging the Government to address the chronic underfunding of social care in the Budget on October 29th. Experts say that at least £2.5bn is needed to protect the social care system from the risk of further catastrophic decline in the next financial year (2019/2020)[4], and to resource councils to deliver their duties under the Care Act.[5]
The Government recently pledged £240m to ensure that people who need care do not stay longer than necessary in hospital this winter. While this investment is welcome, it is only a stop-gap that does not address the chronic and systemic shortage of funding for care in local areas.
Social care user Rachel Looby, 31, from Harrogate, needed medical help after the amount of social care she received was cut (further details below). She said:
“When my hours were cut it was a stressful time for me. I took the wrong medication and ended up in hospital, and this made me feel like my health had not been considered at all. Being in hospital left me feeling anxious and upset and I worried if something else might happen once I got home.”
Julie Sharp, 32, from Rotherham, has Triple X syndrome, a genetic condition which affects her neurological and endocrine systems, impacting her balance and coordination (further details below).
“Last year, I had my care cut from 42hrs to 0. I had been using the care, for amongst other things, to help with meals. Without any care I tried cooking for myself but couldn’t follow the recipe and ended up with such bad food poisoning I was in hospital for five days. Severe dehydration, with my conditions could have been fatal.
“I have continued to fight this year for my care, and many consultants have written to social services on my behalf, only now it seems I might be getting funding again but through direct payments where I have to be an employer, which is more than I can understand. No one listens, I can’t cope with this.”
“Care package hasn’t changed, my income hasn’t changed, but council now only fund 1/4 of costs for carer as they don’t count mortgage or costs of running a car as living expenses.”
“It’s complicated as I care for my wife and I also have MS as well. The hours that my wife had for carers to come in and help was cut last year. Which had put more of a strain on me, and some days I really really struggle.”
“Without telling me verbally or writing to me after my last assessment various services were cut including my laundry service, my free telephone rental service and my home bound library service is currently under threat. Meanwhile, I have been financially assessed without my being asked any questions or showing any bank statements or evidence and my contribution to the help that I get has been increased.”
Mark Lever, Chief Executive of the National Autistic Society and co-Chair of the Care and Support Alliance, said:
“It is scandalous that the rights of disabled people are being denied and that they are going without the care they need. As a result, some are being placed at risk and, more generally, disabled people’s opportunities to live full and productive lives are being seriously undermined. This is a false economy for our society and disastrous for the individuals concerned.
“Evidence of the law being breached is widespread and compelling, and the cuts to council budgets since 2010 have been of such a scale that it would be little surprise if care is now being ‘rationed’, even though this should be impossible according to the Care Act.
“The Government must ensure that at least £2.5bn goes into the social care system in 2019/20 and announce this in the Budget. In addition, the social care Green Paper to be published later this year must contain proposals that give disabled people real confidence that our care system will be placed on a much firmer financial foundation over the next few years.”
“We have seen an upwards trend in calls about social care and safe guarding issues linked to the worsening cuts. When Mencap challenges decisions, they are frequently reversed. Local authorities are making unlawful decisions because there is not enough money in the system.
“There is no point having a duty to provide care in the law but for councils to be powerless to provide it for budget reasons. The Government must provide an urgent injection of cash, at least £2.5bn and push on with urgent and sustainable reforms to social care. Unless this happens we are bound to see a continuing increase of neglect and safeguarding cases.”
Last year, 2017, the Care and Support Alliance conducted research which showed that the majority of social workers, and other professionals who undertake care assessments, felt expected by their managers to reduce the help on offer to people in need of social care. Social workers also revealed their experiences one said “We are being encouraged to write care plans that do not include any form of social interaction.”, another said “The view within the council is that only 20% of all those assessed should be receiving formalised care packages from the local authority and that 80% should only receive information and advice.”
The Association of Directors of Adult Social Services (ADASS) warned this year that 75% of directors said that reducing the number of people in receipt of care is important or very important for them to achieve necessary savings.[6] They warned: “This approach risks falling the wrong side of a fine line: if a reduction of those in receipt of care is an outcome of a strategy to develop asset-based, preventive approaches, this is a positive aspiration, but if it is about gatekeeping resources then it risks people in need being left without services, which would be unlawful and financially risky.”[7]
Since the survey was conducted, financial problems for councils have hit the headlines as several have come close to bankruptcy as a result of delivering the services they’ve been legally required to provide. Northamptonshire, East Sussex, Somerset are among a number of councils which have come close to financial collapse, which is even more worrying given that recent research by the County Council Network shows that Government imposed cuts will continue, with around a further £683 million estimated to hit local authorities in 2019/2020.[8]
The Care and Support Alliance (CSA) – is a coalition of more than 80 of the country’s leading charities (including Scope, MS Society, Mencap, National Autistic Society and Sense) – who are calling for a properly funded care system.
Social care is an essential life support system that people rely on for everyday tasks like washing, dressing, eating and managing in the home. It also enables people who can to work, volunteer and take part in society. It helps people get out and about and is meant to support them not just to live but to have a fulfilling life. Without social care, many people would be lonely and isolated, as well as at risk of crisis.
About the survey: CSA ran an online survey 24th January 18 to the 9th March 18.The survey was shared via CSA members and was completed by 3,915 self-selecting people who identified as having experience of adult social care in England.
Rachel, 31, from Harrogate is visually impaired, epileptic and has speech and processing difficulties.
For a long time, Rachel received 17 hours of social care a week. This involved help with basic tasks such as cleaning and cooking, as well as support with managing her money, medication and personal care.
However, although her needs had not become any less pronounced her support was reduced to just five hours per week. This meant she only had help with basic tasks. With no one to help her manage her medication Rachel missed doses and had a seizure. To make things worse, while recovering Rachel mistook her dog’s medication for her own and became very ill and had to be hospitalised.
These two incidents understandably knocked her confidence and she became demotivated and stopped taking her anti-depressant medication. This led to her becoming depressed and socially isolated, threatening to compound the difficulties she was facing. Social services stepped in again and returned her hours and now Rachel now has the care she needs to stay safe and well.
Julie studied music at Huddersfield University and wants to use her skills and experience with the care system to become an activities coordinator in a care home focusing on music therapy.
Her care has been cut several times over the years once when she left Huddersfield and returned to her birth town Rotherham, and also when she got married – despite her husband having high needs of care himself. Something that social services only recognised when Julie was rushed to hospital and they had to put in a care package for her husband. Despite still recovering and being in a wheelchair, the care package for her husband was immediately stopped on the day Julie returned home from hospital as the council presumed she could resume her caring role despite having high care needs herself.
*Cut 1: working-age adults (18 – 64) (445 people) whose case was fully funded, or partially funded by their local council – A third (29%) said over the last year their care had been cut despite their needs remaining the same or getting worse.
**Cut 2: working- age adults (18 -64) (1,247 people) who had experienced any of the following because of a lack of care…:
Nearly a third, 31% have been unable to maintain basics like washing, getting dressed or visiting the toilet.
As described by the Social Care Institute for Excellence (SCIE), the “national eligibility criteria set a minimum threshold for adult care and support and carer support. All local authorities must at a minimum meet needs at this level. The threshold is based on identifying how an individual’s needs affect their ability to achieve relevant desired outcomes, and whether as a consequence this has a significant impact on their wellbeing. The overall aim of adult care and support is to help meet their needs to achieve the outcomes that matter to them in their lives, which in turn promote their wellbeing”. [9]
Under the national eligibility criteria (Care Act 2014) local authorities have a legal responsibility to assess people who appear to have a need for social care and then apply the eligibility criteria to determine whether the local authority is required to meet those social care needs. Local authorities have some discretion over “how” to meet eligible needs, but not whether to meet such needs. [10]
The charging criteria determines how much a person must contribute towards the cost of meeting their care needs. Meanwhile, the needs eligibility criteria set out in the Care Act require local authorities to consider whether a person is unable to achieve two or more of the specified outcomes and whether failure to meet those outcomes has an impact on the person’s wellbeing. These are as follows:
Making use of necessary facilities or services in the local community, including public transport, and recreational facilities or services
If the inability to meet the outcome means that there is a significant impact on the person’s personal dignity; on their mental or physical health; or on their control over day to day life; then there is deemed to be an impact on a person’s wellbeing. As the Care and Support Alliance’s research shows, over a quarter of working-age disabled adults (29%) who responded to the survey and rely on local authority-funded or part-funded support have had their care packages cut even though their needs have stayed the same or have increased.[11] This indicates unlawful behaviour, as local authorities should continue to provide care to those who have two or more of the specified outcomes outlined above.
Disabled people are more than twice as likely to be unemployed as non-disabled people and over 3.4 million disabled people are in employment.[12]
A 10 percentage point rise in the employment rate amongst disabled adults would contribute an extra £12 billion to the Exchequer by 2030. [13]
After housing costs, the proportion of working age disabled people living in poverty (28 per cent) is higher than the proportion of working age non-disabled people (18 per cent). [15]
As of 2016, there were 63 million people between the ages of 18 and 64 in the UK.[16] Meanwhile, 19% of working-age adults in the UK have a disability. [17] An estimated 12million people.
When asked about which groups they were most concerned about in terms of financial pressures on adult social care budgets (relating to increasing need, complexity and demand), 32% Directors of Adult Social Services (48) were most concerned about the financial pressures relating to working-age adults.[18]
[9] Social Care Institute for Excellence, https://www.scie.org.uk/care-act-2014/assessment-and-eligibility/eligibility/definition.asp
[16] ONS, https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukpopulation/july2017
In response to the CQC State of Care report, released today, Caroline Abrahams, co-Chair of the Care and Support Alliance and Charity Director at Age UK said:
“It’s really unfair that the care you receive depends so much on where you happen to live and that so many older and disabled people are being forced to go without all the support they need to live safely and decently.”
“The crisis in social care is truly a national problem that requires a national solution. The Government must bring forward a big injection of funding for social care in the Budget, and publish a bold and ambitious Green Paper by the end of the year.”
Yesterday, Secretary of State for Health and Social Care, Matt Hancock, announced that the government will inject an emergency £240m into the social care system.
In his speech at Conservative party conference, he announced that the funds are intended to ease pressure on the NHS by allowing elderly people to be cared for at home, rather than in hospital.
We have been calling on Government to ensure immediate investment is made to avoid market collapse and keep the system afloat and believe this £240million falls for short of what is needed. We also need to see long term reform so that social care can be put on a sustainable footing for all those who need care – older people, disabled people and their carers.
Caroline Abrahams, Charity Director at Age UK and co-Chair of the Care and Support Alliance responded to the announcement:
“The extra funding announced for social care this winter is very welcome, but the fact this latest ‘bail out’ was needed at all shows just how precarious things are. In addition, there are hundreds of thousands of older people and disabled people who need social care and who are not coming out of hospital, who will not gain from this funding. So the need for a long term funding solution for social care remains as clear as ever & it is Government’s responsibility to come up with solid proposals in the Social Care Green Paper, due out later this year.”
Care Minister Caroline Dinenage MP has confirmed that the social care Green Paper will look at the needs of working age disabled adults, rather than addressing these in a parallel process.
The Care and Support Alliance has been campaigning for this and so we are delighted with this news. Previously, the Government’s position was that the Green Paper would have a focus on older people.
The Minister was speaking at a CSA breakfast event with CEOs from our member organisations. In her speech, the Minister agreed that while the Green Paper would need to come up with proposals for the long term sustainability of the care system, there were significant pressures now.
On the long term funding solution, she talked about the need for some ‘risk pooling’, but stressed that there would be a full consultation on any proposals.
– Greater sustainability for all, including people who are born with a disability, people who develop a disability in adulthood and older people
The Green Paper is expected to published this year. The CSA has developed ‘7 tests’ for the Green Paper and we’ll be looking to make sure that it meets our tests.
The CSA will also continue to make the case to Government ahead of the budget, that immediate funding to the social care system is urgently needed.
With a funding gap expected of £1.5bn 20/21 and at least 1.4m people currently not getting the care they need becau… https://t.co/yOO3Sz51Y3, Nov 12