Eligibility, Birmingham and Cuts

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While awaiting the details of the court judgement, there was an important ruling yesterday that Birmingham Council’s attempt to limit eligibility to social care services to those who have ‘critical’ care needs is unlawful.

Drawing out some of the definitions to what this actually means and could mean requires a look at the details of those who brought the case to court.

There were four defendents which the BBC explains include

a 65-year-old woman with severe learning difficulties who receives 24-hour care in a home paid for by the council

25-year-old man with a rare genetic disorder and severe learning disabilities who receives overnight respite care, also funded by the council

30-year-old deaf, autistic man with severe learning disabilities who is prone to self-harm. His specialist day care would also have gone under the plans

and

a 36-year-old woman with severe learning difficulties whose day care centre will close and who is also set to lose respite care

It’s useful to go back to the definitions of what ‘critical’ and ‘substantial’ needs are to understand fully the implications of councils moving the eligibility criteria from one stage to the next.

Critical needs exist where –

• life is, or will be, threatened; and/or
• significant health problems have developed or will develop; and/or
• there is, or will be, little or no choice and control over vital aspects of the immediate environment; and/or
• serious abuse or neglect has occurred or will occur; and/or
• there is, or will be, an inability to carry out vital personal care or domestic routines; and/or
• vital involvement in work, education or learning cannot or will not be sustained; and/or
• vital social support systems and relationships cannot or will not be sustained; and/or
• vital family and other social roles and responsibilities cannot or will not be undertaken

Whereas Substantial needs (those that Birmingham are stating they are no longer able to meet) exist where –

• there is, or will be, only partial choice and control over the immediate environment; and/or
• abuse or neglect has occurred or will occur; and/or
• there is, or will be, an inability to carry out the majority of personal care or domestic routines;
and/or
• involvement in many aspects of work, education or learning cannot or will not be sustained;
and/or
• the majority of social support systems and relationships cannot or will not be sustained; and/or
• the majority of family and other social roles and responsibilities cannot or will not be undertaken

A couple of things to be noted here. A differentiation is made between ‘abuse’ and ‘serious abuse’ so that one will be covered and the other won’t. What kind of ‘legal’ test would there be to determine when abuse counts as ‘serious’ or not? Can we see children in similar cirumstances being subject to a differentiation of level of care available depending on whether abuse is ‘serious’ or ‘not serious’? And who is doing the judging? Well, I can answer that last question. It is the social worker involved as I am asked as a matter of course to ‘band’ people according to these criteria.

The obvious glaring point is the lack of thought of any kind of preventative work that sticking so closely to the criteria will create. Where is the hope of creating those very creative personal budgets when only the very bare minimum of essential needs are being met.

I can’t claim anything other than relief that Birmingham case was challenged in court. These criteria and these levels of need look at people as lists of what they cannot do. That goes against everything that we know and the ways in which we practice by looking at strengths and looking at people as individuals. However, the reason the criteria were brought in in the first place was to end some of the ‘postcode lottery’ of care provisions and to bring consistency to who was offered what nationally. Of course, the problem remained that interpretations of these criteria vary so the consistency which is objected by ticking boxes (the only way the officials seem to know to apply it) depends, as mentioned previously on the social worker who is doing the ‘judging’.

Back to this case though, it was brought under the Disability Discrimination Act and hopefully the judgement will be available soon. Hopefully too, local authorities around the country will be leafing through it and realising that the wholesale and slapdash cuts that they are imposing are not legal.

As for the government of millionaires, none of them will be reliant on social care support from the council. They can buy in any support that they might potentially need and cannot understand the distress of those who are totally reliant on the availability of services.  They cannot understand the implication of their gung-ho ideological cuts and the thought of Cameron, Clegg and Osborne claiming ‘We’re all in this together’ sticks painfully in the throat.

Although I fully expect Birmingham to challenge this ruling, I hope that the case is held and that some of the trigger happy cutting is stopped and the very real effect of the cuts agenda is shouted out more loudly and more clearly – not just for those of us who are personally losing services but to raise our voices with those who cannot always shout so loudly.

That is what social justice is about and that is what social working is about.

Eligibility

I have been subject to a complaint which was raised to the local MP. This is not particularly unusual after a period of time working in social services. We are quite used to councillors’ letters and MPs’ letters.. once we even had a letter from the MEP!.

Still, these letters assigned with the portcullis of power still retain a special place in our ‘priority’ box for the day.

It was a mixed feeling when I saw the letter which had been left on my desk by my manager. In some ways, I was cheered as I had suggested to the service user that he should speak to his MP if he was not happy with the service provision or that he should make a formal complaint to the council. He had obviously taken himself off to the MP and raised his issues, which I felt was a great sign of his determination and self-advocacy skills.

My heart sank a little when I read the contents of the letter. He had raised a complaint about me, personally. Of course, that hadn’t been exactly my intent when I explained to him in detail about the scope of eligibility criteria and why he couldn’t receive the services that he felt he needed.

I discussed this with my manager as they have to respond to the director on my behalf – as that was who the letter was addressed to. I had, coincidently, an arranged appointment with the said service user later the same day so fortunately didn’t need to rearrange very much.

I decided not to raise the letter specifically with him but to address some of the content with him. However, he had received a copy himself and he passed it to me to read. I explained that I had seen it and we went through the details. He explained with a grin on his face, that perhaps some of the content might have been miscommunicated and that it was the service rather than the individual that had been the focus of his ire. I didn’t really have much doubt about that as we have a fairly stable relationship built up but it eased my ego somewhat. Not to say there’s anything wrong with people making complaints about me, it’s just the natural self-critical human response kicks in at times.

There were a few things I could action but the meat of the problem was that he felt he needed more services than the local authority had provided according to the criteria and his needs.

I explained this again. We looked at some voluntary services that he has accessed and some that simply don’t exist anymore or have been reduced to place him out of the scope of their bounds.

We’d  been through the Self-Assessment Questionnaire probably in more detail than I had been with anyone else I work with because he actively engaged with the process and had a fairly solid understanding of the linking of answers with money available but I couldn’t see any way to tweak the answers to give a higher band of need that wasn’t there. That isn’t to say that there wasn’t a need and that his life would not be enriched by more services. It would be. This is the sharper end of resource allocation.

The job isn’t all about helping people and making the world a better place. Sometimes it is about trying to defend resource allocation policies at the ‘sharp’ end to the individuals whose lives are changed by a policy decision taken very far away from them.

It made me ponder the role that we play and will increasingly play as these criteria are being tightened further. I read in Community Care yesterday that Birmingham Council is proposing that services will be restricted to critical needs only under the Fair Access to Care Services quoted on the Department of Health website. It’s worth considering them to understand the implications that this will have for expectations of care services in the future.

Critical

These are the most serious and extreme circumstances. There may be a risk to life and/or where even the basic essential tasks cannot be carried out. Personal care, domestic and family life are all at risk. This may be an immediate problem or one very likely to occur without urgent intervention. A number of these factors may exist together.

A case will fall into the critical band when one or more of the following occur:

· Life is, or will be threatened; and/or

· Significant health problems have developed or will develop; and/or

· There is, or will be, little or no choice and control over vital aspects of the immediate environment; and/or

· Serious abuse or neglect has occurred or will occur; and/or

· There is, or will be, an inability to carry out vital personal care or domestic routines; and/or

· Vital involvement in work, education, or learning cannot or will not be sustained; and/or

· Vital social support systems and relationships cannot or will not be sustained; and/or

· Vital family and other social roles and responsibilities cannot or will not be undertaken.

Of course, there is some degree of interpretation involved, as there always is – but for example, ‘substantial’, the next ‘grade’ down refers to abuse and neglect has occured or will occur but to reach the ‘critical’ threshold, it has to be ‘serious’. For me, that triggers a lot of alerts about the nature of the role of personal budgets and the types of support that can be provided.

Services will only be provided to those who have no other means of meeting these roles. I worry that this will lead to a greater burden being placed on family members to continue to provide support until they drop because as long as the functions are being carried out, they can’t be replaced by statutory services. There is no scope for helping someone to do things for themselves and there seems to be little scope for reducing dependency which might happen further down the list of ‘criteria’.

The personalisation ‘dream’ of life-enhancing care packages which allow for more flexible leisure interests to be pursued is even further away than it was a year ago.

This is my fear about the wonderful idea of ‘big society’ that the government promote.  It can ring very hollow for those on whom we rely and for those that do not have the networks, community and families to rally around them. From my angle, I see voluntary services pulling back due to fears of cuts rather than extending out to the people who may benefit but for whom the state will no longer reach out to.

I can see increasing letters of complaint as the perception of what adults might expect from statutory social care is increasingly separated from the reality of provision.

It isn’t helped by the rhetoric of transformative personal budgets which are far reaching. There will be no money to be exceptionally creative anymore. Yes, it is possible to choose carers – quite rightly, but there will only be provision for the very barest life or death needs to be met. None of this ‘going out shopping together’ – that takes too much time. None of this ‘going to the football match’ – that costs too much money.

And so, as I batted off one complaint, probably unsuccessfully, replying via my manager that the work and the package had been provided according to our borough’s eligibility criteria, I have no doubt there will be many more. Indeed, I hope that there are so the people who hold the political power see the effects of the cuts as they are happening. I might recommend MP’s surgeries to more people now.