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The Failing Local Authority Care System
DPAC has analysed a number of recent reports on care funding cuts and added to that research made through Freedom Of Information ( FOI) requests to 20 of the main English local authorities to try to provide an overview of what is happening with care funding and where the personalisation agenda has reached and failed to do what it was originally intended to do which was to facilitate independent living and greater choice and control for disabled people.
We feel this is important as the government seem to be basing their reasoning for closing the Independent Living Fund totally from 2015 on the notion that the personalisation agenda is alive and well which anyone who uses, or has tried to use, local authority services will know is not the case.
The main thrust behind United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) and the personalisation agenda should be service improvement and not cost reduction, however with the aim for a 100% take up target for personal budgets by 2013 personal budgets are likely to become a cost cutting tool rather than a way of giving choice and control to disabled people.
A Think Local Act Personal (TLAP) report  found that only 30% of all people eligible for social care now receive a personal budget – half of those are aged over 65 years.
This was borne out by results from an ADASS survey of 132 English councils with a response rate of 86% which found that the total amount allocated in Personal budgets was £1.5 billion and that less than £1 in every £7 was spent by councils directly on care and support services.
One-fifth of personal budgets are for less than £1,000 per year, 33% for between £1-5,000, 22% for 5-10,000 and only 24% are over £10,000.
Most of the increases in the numbers of Personal Budgets between 2010 and 2011 were in managed budgets with no significant increase in Direct Payments to individuals to manage themselves. This is most likely to be due to the complexity of having to manage Direct Payments without adequate independent support to do so.
At least 19 councils were delivering personal budgets to less then one-fifth of eligible users.
While this survey shows about 1 million people were eligible for personal budgets only one-third got them.
This failure to roll out personal budgets and make them adequate to meet the needs of disabled people is reinforced by figures from those councils we surveyed; from adult care budgets two councils spent over 20% of the total budget on overheads, the highest amount being 24% of total budget. The lowest figures for spending on overheads was 10%.This compares very unfavourably with the overhead costs of Independent Living Fund (ILF) which are only 2% of their total budget.
The number of people in receipt of a Direct Payment or Individual Budget was as low as 7% and 9% in two local authorities and the highest figure was 34%. Most councils were unable to tell us what their spend on Individual Budgets were or extrapolate spending on DPs and IBs from overall spending on community services.
Most of the councils surveyed still spent much larger amounts of money on residential care services although the eligibility criteria for these have been massively tightened and far fewer older disabled people in particular are able to access residential care placements, even if they want to. The lowest percentage spend on residential care was 20% but in most cases this accounted for around 40-45% of total spending. In Trafford and Sandwell that figure rose to a staggering 83% and 63% of total adult care budgets.
Impact of Central Government Funding Cuts to Local Authorities
A second survey from the Learning Disability Coalition surveyed 152 local authorities of which 61 responded.(40%)
|90% said they had less funding than last year|
|20% were making cuts|
|57% have increased charges or raised eligibility criteria or were holding consultations on these|
.Of People with a learning difficulty or their families surveyed
|20% had their hours of care reduced|
|33% were told the council were increasing eligibility criteria|
|27% faced increased charges|
|21% received both local authority and ILF funding.|
A budgetary survey by the Association of Directors of Adult Social services (ADASS) found that in total Adult Social Services teams are cutting £890 million out of the social care budget between April 2012 and March 2913. When combined with last year’s figures the total cut from social care funding by local authorities is £189 billions of cuts.
This is in spite of demand for services increasing by 3% a year from older and disabled adults.
The Demos Report ‘Coping with Cuts’ found that councils are making cuts to disabled people’s services without any knowledge of the number of disabled people or needs of people in their areas. There are no satisfactory impact assessments being made at local level which can be fed back to national level for any real and informed decisions to be made. The way cuts have been implemented varies between local authorities and there is no consistency in how services are being reduced to save money from local authority budgets.
From our FOI responses we found a similarly surprising and worrying lack of information was collected by councils on care funding and most worryingly none of those surveyed had any information available about what impact the closure of ILF funding from March 2010 meant for any new service users. None kept any details of whether disabled people with high support needs were having funding made up by local authorities. Again this means that there is no data to be fed back to central government on which they can base any decisions about the future of the Independent Living Fund.
Bradford council said only that “ILF allowed more support than the council is able to provide” and Birmingham “The council does not make up any difference in funding, (where people would have previously been able to apply for ILF funding) however we would seek to offer equipment, adaptations and support for daily living …”
The response offered byNorthamptonwas even more baffling
“If a funding stream such as the ILF is no longer available then the local authority would need to consider whether that need is an eligible need and if it is would fund support in the most cost effective way. In the first instance the local authority would try to support the customer to find ways of meeting this need themselves or through other networks in line with the County Council’s core purpose of helping then to help themselves. Where an eligible need is determined, this may or may not be the same level of funding, however it is likely to be similar to ensure need is met.”
The Demos report also found that funding for care and support services are not ring-fenced by councils in any way and so what is cut, how and when is entirely up for grabs with no real information available to either officers or councillors of what this means in real life for disabled people and their families.
They also found that local authorities are not systematically collecting data on the effects of the cuts resulting in disabled people being left with significantly reduced quality of life . Our FOIs showed that all councils surveyed had experienced large reductions in their adult care budgets. This is in spite of Maria Miller claiming that an extra £7.2 billion has been made available for social care funding.Liverpool for example had a gross reduction in their budget of £36,514,345 in 2010-2011 with a further reduction of £3,231,188 in 2011-12.Wolverhampton lost £5.6 million in 2010-2011 and £3.4 million in 2011-2012 from a total budget of only £69.8 million which is overall more than a 10% cut.
From our FOI requests we found that only one council Bradford still funded moderate needs according to Fairer Access to Care (FACS) criteria. Two of those surveyed Northamptonand East Riding did not even fund Critical and substantial but had categories called greater substantial restricting what support needs they fund even further. Birmingham had of course tried and failed to remove care funding from over 4,000 disabled people with substantial needs in 2011 but were prevented from doing this by a successful legal challenge. This tightening of eligibility criteria is supported by the budgetary report from ADASS which found that 83% of councils now fund only substantial and critical needs an increase of 6% since 2011-12 and 2% only fund critical. Those figures however ignore councils where they have introduced eg. greater substantial criteria.
There is no data or evidence collected on the cumulative effect of cuts to disabled people’s families in spite of many using multiple services which are all being cut at the same time eg increases in charging for day centres, play schemes, Individual budgets and eligibility criteria.
A recent poll by Community Care found that 48% of social workers felt personal budgets were set at too low a monetary value to achieve personalisation.
Many councils were found to employ a deflator eg Salford andShropshireused a 25% deflator. This makes the value of a personal budget 25% less than the value of services people had previously received from the council directly.
Other local councils deflated by using costs from the bottom end of local market prices.
Overall one-fifth of councils adopted some form of reduction to the Resource Allocation System (RAS).
Another Survey report by the Red Cross says that the health of elderly people is being put at risk by “dangerous and short-sighted” cuts in home-based care services.
The charity said the cuts were a false economy creating growing pressure on the NHS, and called for a rethink in the way social care is organised. It said elderly people faced increased levels of isolation.
Almost nine in 10 GPs among 200 surveyed for the Red Cross said elderly and vulnerable patients were being put at risk by a lack of social care support, and 80% of the 2,200 members of the public polled said standards were being driven down.
The charity released an economic analysis of its own home-based low-level care services by the New Economics Foundation think tank, which it said showed that a preventive approach to health and social care could save the NHS up to £10,000 per patient thanks to avoided hospital and residential care admissions.
Sir Nick Young, chief executive of the British Red Cross, said: “We all know budgets are tight but cuts and under-investment to lower-level home-based care which jeopardise patients’ wellbeing and dignity must be challenged.
“The practical and emotional support these services offer often makes the difference between coping or not, between independence or desperation, and between remaining healthy for as long as possible or rapidly deteriorating into crisis.
Some examples of local authority failures to meet care needs.
Wirral Council’s department of adult social services “deliberately” and “unlawfully” delayed arranging care packages for service users to manage costs.
Community Care reported allegations last year from a whistleblower that the council was operating a policy of delaying care packages for four weeks unless line managers had issued a waiver. At the time, the council said that this was not the case, but that documentation supplied to practitioners could have been “misinterpreted as meaning that care packages should take 20 days to process fully”.
However, Green has now said that minutes of a meeting had been unearthed that “prove a decision was taken not to implement care packages immediately but to delay for four weeks”.
There’s yet more bad news in the Wirral News today which seems to be about personal budgets being allocated to service users without funding being in place for them. Apparently, this had placed learning disabled personal budget holders at risk of being sued for breach of contract by support providers if they were not paid. So now the council has had to find this money – some £630,000 – to stave off this possibility.
Newcastle city council – introduction of caps on high-cost care packages
The council’s budget papers contain a proposal to introduce a cap on high cost care packages.From the budget:
“We plan to put in place a funding panel that will authorise all high cost care packages to new and existing users. Packages costing more than £500 per week will be reassessed with a maximum upper limit of spending on care packages to meet each person’s individual needs. We will implement this over the next two years. The upper limits principle is already applied to services for older people.”
1. The council have recently removed all funding for recipients of ‘moderate’ banding care packages – 66 people have already had their service taken away
2. The council are currently reassessing all recipients of social care services across the city. This will allow downgrading – i.e from substantial to moderate – taking more people out of the system.
3. Closure of day-centres by non-referral (stated by carers who have tried to access a day-centre)
4. Non- completion ofLime Courtafter 2 years (still no design and contractors)
5. Non-development of Speke and Lancaster day centre ‘hubs’.
6. Privatisation of Beresford House - Beresford House is used for respite and residential clients, it is going over to the private sector; tenders have been submitted to the council.
Tuesday, 15 May 2012-Nottingham
A National disgrace – disabled isolationism in the community !
A disabled man living in Nottinghamfeels the state has created a ‘prison’ for him at home.
Trevor Marshall had been attending Rushcliffe Resource Centre three times a week, at a cost of £12. Those cost are now £207 a week, making him a prisoner in his own home – isolated & forgotten.
There are currently 1,924 people using care services provided by Nottingham City Council – those using care services have now been forced to pay the full cost. It is now expected to save it £900,000 a year, it was introduced to comply with Government guidelines.
The council has reviewed the way social care users pay for their services. The council has demanded 1,986 disabled people pay a financial contribution for care; and 1,924 were forced to pay the full cost.
June 2012 Halifax
COUNCIL chiefs have ordered an external investigation after a disabled woman was left without care and lying in her own urine and faeces.
Janis Milner, 33, of Stainland, suffers from spinal problems and is often bedbound.
Her care was suddenly withdrawn for several days after what appears to be a breakdown in communication.
Miss Milner did have carers calling three times daily.
She was told care was stopped because she hadn’t responded to phone calls but claims no messages where left on her mobile and her home phone hasn’t worked in recent weeks.
A disabled woman from Lisson Grove says she was told to “cut her hair” to save her carer time when she raised concerns about her home care hours being cut.
Mary Garland, ofCapland Street, had her home care hours reduced from 19 per week to 10.5 when Westminster Council changed its eligibility criteria.
The 49-year-old, who suffers from rheumatoid arthritis and Crohn’s disease, said she asked her social care manager how there would be time for her home carer to help her dress and wash as well as clean, tidy and perform other home duties.
She said the manager recommended she would be “better off cutting her hair”.
When Ms Garland asked what would happen if her condition worsened, she was shocked to hear the manager reveal she would have to go into residential care.
“When I asked about how they would have time to wash my hair it was suggested that I would be better off cutting my hair.
“That may be practical but I don’t want to have to cut it off.”
She said the reduction in hours of home carer visits has affected many aspects of her life.
“I don’t feel like a person anymore, I just feel like a number.”
Westminster Council said it was unable to comment on the specifics of the case but adult health boss Cllr Rachael Robathan said: “We are focused on protecting frontline services for those most in need, and strive to support disabled and older people at home for as long as possible before considering options for residential care.”
November 2011 Hucknall
COUNCILLORS have approved plans to change services for vulnerable and elderly residents of Hucknall and the rest of Ashfield — as part of a bid to cope with the fallout of £10 million spending cuts.
Notts County Council has rubberstamped proposals to reduce its Supporting People grant from £22.5 million to £12.5 million over the next three years.
The cash helps elderly and disadvantaged people, such as the disabled and residents with mental-health problems, live independently in their own homes.
But the budget has been reduced as part of the council’s drive to balance its books.
November 2011Isle of Wight
The judge ruled that the council had failed to comply with its own internal guidance on its new policy for assessing eligibility for adult social care.
The ruling would prevent the council “from cutting services to some of the most vulnerable disabled people” and would provide “comfort and peace of mind” to thousands of residents.
Rook said: “This landmark victory sends out a very clear message to all councils inEnglandandWales.
“If a council seeks to make cuts to its budget for adult social care, it cannot do so by only meeting certain needs designed to keep someone safe, but neglecting their overall quality of life.
The first claimant, JM, aged 32, has severe autism and a brain injury suffered at birth. The court heard that he lives with his retired parents, who devote themselves to his care, and he struggles to communicate with anyone else. He needs support with all areas of his life throughout the day.
The second claimant, 31-year-old NT, also has autism and a learning difficulty. He is currently living in residential accommodation provided by the council during the week, but returns home to his mother every weekend.
The court heard that he is highly vulnerable and anxious and has communication difficulties. His mother launched legal action because she feared the council’s new policy could potentially have a “devastating” effect on NT’s quality of life.
The council said it was facing a reduction of £21m in central government funding, representing a £33m budget gap taking into account inflation and increased need.
It added that 80% of those savings had to be made by the end of 2012-13. The savings anticipated through changes to the council’s community care eligibility criteria, plus charging, amounted to £2.5m.
October 2011 Manchester
Manchester City Council’s plans to cut spending on adult social care by a total of £39.5 million over two years through increased charges, with about 75 per cent of disabled people likely to pay more for their care.
Liz Bruce, the council’s director of adult services, said: “We’ve carried out detailed consultations, and have looked at every option to try our very best to mitigate the impact of the cuts – and ensure that our policies are the fairest we could draw up in these difficult times.
CARERS have united against council plans to close day centres and force vulnerable adults to find their own care.
Lincolnshire County Council is currently consulting on the way it provides adult social care in an attempt to cut costs.
October 2011- Croydon
Funding for carers will be cut, a new five-year Croydon Council strategy reveals.
At a cabinet meeting on Monday, October 10, Croydon Council cabinet member for health and adult social care Margaret Mead put forward the new strategy, which will see the budget for providing for carers cut by 10 per cent from next financial year.
This is on top of a 50 per cent cut in funding provided by South West NHS Trust Croydon in April, slicing almost £100,000 from the borough’s budget.
Increases in care charges and other fees will net the city council an extra £400,000 over 15 months.
The largest increase is for home care services, which will increase from £9.15 per hour to £11.25.
Councillor Rory Palmer, lead member for adult services, said: “Let no-one be in any doubt that this is as a direct result of Government cuts. We don’t want to do this, but we have to.”About 500 of the 2,000 people using home care services would end up paying more.
Plans to cut a severely disabled man’s care package by 70% were reviewed following a legal challenge, resulting in a cut of 14%. But, many others with complex needs face potentially catastrophic cuts because of the failure of resource allocation systems and council funding panels to adequately account for their needs, says Polly Sweeney, the solicitor who brought the case.
Serious questions about the adequacy and appropriateness of using resource allocation systems (RAS) to assess people with complex needs are raised by the case of Tarik Zavadil, a 27-year-old man with profound learning disabilities and epilepsy, cerebral palsy, who is unable to speak and registered blind. His case also highlights the importance of family carers such as Tarik’s mother,Lorraine, within the assessment process, and what can happen when their skills and experience are ignored.
Taxpayer’s care bill to double by 2030
The LGA analysis is based on primary research carried out by the Economics and Social Care Research Unit – 30 May 2012
The cost of care for the country’s rapidly-ageing population is set to almost double in a generation unless Government urgently introduces reform, local government leaders have warned.
New analysis by the Local Government Association (LGA) shows there would be an average additional annual bill of £79 million for every council responsible for providing adult services or a further £230 for every man, women and child in the country.
The figures have prompted fears that, without Government action, councils will be left unable to provide anything except for care and waste services.
Councils, which are facing a 28 per cent funding cut from Government, already allocate more than 40 per cent of their budgets to fund care services for around three per cent of the population.
The growing financial care crisis is attributed to the combined pressures of a rapidly-aging population, growing demand, escalating service costs and a £1 billion reduction in councils’ social care budgets, which have been compounded by further recent Government funding cuts.
But alongside reform, Government must also address the significant shortfall in funding
The LGA represents more than 370 councils acrossEnglandandWales.
Councils with social care responsibilities (CASSRs) allocate more than 40 per cent of their budgets to fund care services. Spend on adult social care represents 30 per cent across the whole of local government.