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.

Cuts – a personal tale

A couple of weeks ago, I had one of those deeply depressing moments that will generally punctuate a career in social care.

I had to go and tell a woman, who cares for her mother with enormous patience and dignity, that we could not increase their personal budget although her mother’s care needs had grown.

I suppose I went to my manager in a relaxed almost casual way and explained how the needs of the older woman had changed and to ensure her well-being, she needed additional time.

I was told, with a degree of equal sadness and regret that there would be no increase. If we were to provide what I felt was a necessary increase in care, the time had to be taken from the the hours already allocated.

She did, to her credit, try to have a discussion about this with her own manager but there was no budging on budgets. Despite the change in various situations, there would be no extra money. In fact, she added, the plan really needed to be cut.

It had been my first personal budget implemented. The council, in an attempt to encourage and prod us to implement these personal budgets had promised us and by extension, the service users and carers we work with, that no-one would be disadvantaged by moving to a personal budget so even if the RAS (resource allocation system – the way that figures are attached to needs through the personal budgets  system) did not ‘deliver’ enough money to provide an equivalent package of care that had been delivered under the ‘old’ system – it would not be reduced (and here’s the key) at least, not initially.

Now this particular service user and her daughter had what was a high package of care. It had costed much  more than the ‘RAS’ had spat out.

After making the promises, after the move to personal budgets is no longer an optional roll out of volunteers – the cuts are coming.  There is no longer the carrot to offer of ‘equivalent packages of care’ because we now offer everyone as a matter of course a personal budget and those who were not receiving them are being transferred over to the new system regardless – they don’t have to be self-managed, of course, but they have to exist.

So I visited the family and we looked at ways of shifting around hours.

The hours that were cut were the respite hours.

I suppose it was inevitable.

Family carers are invisible. The work they do is not costed. Of course the daughter was sacrificing her own needs for a few hours respite to her mother’s needs for additional personal care.

This is what the cuts mean to one family.

I had to tell them and negotiate with them about what to cut from their own package of care.

Not the Prime Minister. Not the Millionaires in the cabinet. Not any elected politician or Council Chief Executive. No councillor had to sit in that room with me and look the service user and carer in the face and ask them what they would prefer to give up from their package of care.

I’ve known this family for many years. I have a good understanding what is at stake for them and how much these cuts are hurting. I also know they won’t complain or grumble or shout from the rooftops.

They are not going to be going on any rallies or demonstrations against the cuts – not least because the respite hours have been cut.

We who can, have to demonstrate and shout and scream on their behalf.

And you know, as I know and I say this with a heavy heart – they’ll be much more of this to come.

National Care Service?

The Secretary of State for Health, Andy Burnham, wrote a piece in the Guardian today about his vision for a ‘National Care Service’

‘ providing personal care and support to adults on the basis of need and free at the point of use, will ensure that an ageing society remains a decent and fair society.’

[picapp align=”none” wrap=”false” link=”term=andy+burnham&iid=6631589″ src=”2/9/d/3/Labour_MPs_v_4e33.jpg?adImageId=11876209&imageId=6631589″ width=”356″ height=”594″ /]

Andy Burnham and Ed Balls..

It’s hard to argue against that as a positive. Everyone wants good care and noone wants a price attached to it. All well and good so far.

He focuses on the disparity in the current system which places a burden on those who have property and savings and there is no doubt that there the current system is not ‘fair’ although the way that ‘fair’ can be interpreted is wonderfully flexible.

As for me, the rhetoric is pleasant sounding and hard to argue against. The fight will be in the details and don’t get me wrong, I’d love a system like this for all run on the basis of the National Health Service – but there is a real price to pay and trying to hide behind that fact or ignore the necessity for payment will just build unrealistic expectations.

People have different ideas about ‘fairness’ and ‘equity’. Personally, I think there is more of an obligation to help those who have the least resources to pay for the care that they need. I think if there were more focus on the money and the way the funding is divided, more money could be saved through properly thought through preventative services although there seems to be a tendency to veer from crisis to emergency at present and only providing care for the highest defined needs buys into this system – when a more substantial base of care at lower or ‘moderate’ needs may well prevent a more expensive longer term role for formal care.

On one element I do agree with him though, that the system that is churned out should not be voluntary – as the Tories ‘optional insurance’ suggests – if there is an inherent fairness, it needs to be universal. I know I’d happily pay a premium or increased tax if it were to produce a good quality system of equitable care for older adults and those with disabilities.

But there are more statements to be made and more talking to be done. Until the rhetoric morphs into concrete plans – which I have to say, I’m very much looking to – it’s a matter of waiting and seeing – and playing at politics until the election guides us to the way it might be taken forward.

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What Price Care?

Today the Institute for Public Policy Research publishes a study about adult social care on the cusp of the publication of a new Green Paper next month.

As they claim, the study

seeks to generate public debate about the future of social care; and consider how the social contract between the state, organisations, communities, families and individuals may need to fundamentally change to ensure that the future of social care is based on principles of fairness and sustainability.

Quite a substantial task!

It does make interesting reading though – especially as the gap between expectations which have possibly been raised to unrealistic heights by a free health care system and realities which are that the costs of social care in a society which is ageing can only increase – possibly exponentially.

What is clear is that no-one wants to pay for services. No-one wants to have to sell a property in order to fund care services. No-one wants family members to be obliged to pay for care services. No-one wants higher taxation levels to pay for care services. But everyone wants high quality care services that are not means-tested and are, like health care, free at the point of delivery.

So looking back to the study, the main points raised were that

  1. Low awareness and uncertainty: confusion about the nature of social care services

There was shown to be confusion on where the barrier is drawn between health care and social care. One only has to see the balance that is drawn by continuing care funding to see how difficult it is to judge at times. It is also something that is rarely going to be seen to be  equitable.

There was a general wide understanding of the most obvious social care provisions like directly provided home care, residential care and day care but this tapers off when provisions like support for those who are homeless or support for substance misuse services or even direct payments for carers are considered.

– Misconceptions about social care funding

    When it came to asking about how social care is currently funded there was a large proportion of people who just didn’t know that the services were means-tested. Unsurprisingly, the younger the age of the respondent, the less likely they were to know about how funding was implemented!

    Which leads to the third ‘heading’

    – Lack of preparation and planning for care needs

      The vast majority of people have made no plans to fund future care needs and unsurprisingly, the younger the respondent, the less likely they were to have made plans – or as in the older age groups – feel that they wouldn’t be able to make plans in any case.

      – Reluctance towards greater family responsibility for funding and providing care

        This heading is an interesting one and one that is a model in other countries but here in the UK, there is seemingly strong resistance to any kind of obligation to fund older family member’s care with only 4% of respondents feeling that there should be an obligation on children to pay for their parents care. 14% would support a system based on means-testing to fund parents’ care however 52% believe that is fundamentally wrong to make any expectations of children to pay for their parents’ care.

        Interestingly this resistance to pay increases with age. Perhaps because of closer experiences with the caring role and the need for social care provision.

        Also, there was a preferred role for professional ‘paid’ carers providing social care as opposed to family or friends, either voluntarily or in a paid capacity, providing that support.

        Although these figures are significantly varied when related to Minority Ethnic families where there is a higher willingness to take up the costs of care for older relatives and a greater desire for that care to be provided by family members.

        – Views on the principles for future care and support for a more collective, universal system

          When asked about possible models, by far the most popular seems to be a free, universal system of care available to all and funded through taxation on a strictly need basis. I have to say I’m not surprised by this although I wonder if it would change if a proposed level of taxation had been mooted.

          – Space for change: a strong desire for more information and debate on the future of social care

            With information comes understanding and only 7% of respondents claimed to feel well-informed about the current ways and means that social care is funded, against 69% who feel they are uninformed and 11% who are somewhat informed but would like to know more.

            image mickeymox at Flickr

            In all I think it’s a study that possibly can link in to the Green Paper proposals – not because there is anything particularly new but because it reiterates the point that there is vast confusion about the current system and will continue to be into the future. People don’t like to think about getting old or needed care until these issues are sometimes quite literally, staring them in the face.

            Personally, I can only see some kind of mixed pattern of care with some kind of means testing and some kind of base free entitlement for the most critical needs, possibly with the additional of a type of insurance. The free universal pattern would be wonderful  but is not economically viable.

            It will be interesting to see what the Green Paper comes up with.