Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by the Leonard Cheshire Foundation (DD 16)

  Leonard Cheshire is the UK's leading voluntary sector provider of social care support services for disabled people. We support 19,000 disabled people in the UK, offering flexible services to meet a wide range of needs. This includes access to rehabilitation and home care services.

  We warmly welcome the timing of this inquiry, as the Care Standards Act 2000, due to be implemented from April 2002, means that the further financial pressures to implement the new care standards will be placed on already stretched social services budgets. This will have "knock on" effects in that the flexibility of local authority social services departments (LASSD's) to meet the needs of people due for discharge from NHS facilities will be further limited.


  Continued under-funding of personal social services means that attempts to place the NHS on a firm financial footing will continue to be unresolved. Based on responses from our service managers throughout the country, it is clear that many people who are using NHS facilities/resources do so inappropriately—their needs would be better best met by social care services. This limits the ability of the NHS to treat those who have medical, as opposed to social care needs. Some examples are listed below:

    —  The manager of a Leonard Cheshire care home in Hampshire has cited two examples of individuals in Health Authority long stay accommodation. The cost of this accommodation works out at more per week than the equivalent cost of the personal social services that Leonard Cheshire would be able to provide. The Local Authority Social Services Department has, however, been unable to find the funding for these two residents to move into social care settings.

    —  Another Leonard Cheshire service, based in Surrey, described the case of a disabled woman who occupied a hospital bed for over 4 months due to a delay in getting agreement by her LASSD to fund her social care arrangements with us.

  The Local Government Association's survey estimates that the funding shortfall between central government spending allocations and actual spend by Local Authority Social Services Departments will reach around £1.2 billion in 2001-02.

  This shortfall in personal social services funding means, as we make clear in our examples above, that many Local Authority Social Services Departments are unable to meet the assessed, often newly identified, needs of many people who have been or are in hospital. As a result, some people cannot be discharged back into the community.

  The lack of readily available social care services can also unwittingly predispose otherwise healthy younger disabled people to illness, possibly creating avoidable long term health problems that need NHS interventions. For instance, pressure sores can build up on some disabled people if they do spend long periods of the day in one position because they do not have access to regular social care support in their own home. Treating pressure sores is a distressing, lengthy and costly business—and in these instances, avoidable. Clearly, a lack of adequate social care services can create demands on an already stretched NHS.

  Another example of this arises from the limited provision of NHS physiotherapy and osteopathy services. A lack of regular physiotherapy can mean that disabled people's functional mobility is impaired further. This can create situations where an avoidable need for more expensive medical care is generated in the future. Leonard Cheshire often uses its voluntary income to provide these NHS services to avoid such problems but this practice is not widespread—people often simply go without these essential services and their disability is exacerbated as a result. In the field of osteopathy, a young person with severe arthritis could have severe mobility restrictions later on in life if he or she does not receive access to osteopathy services early on. Again, this can lead to expensive critical NHS interventions—which is again avoidable.


  The funding shortfall also has a negative effect on the capacity of the social care sector in that it reduces the availability of social services—even if they could be afforded.

    —  The residential care sector has lost a net 19,000 places since 1997—this rate of attrition is likely to accelerate with the implementation of the National Care Standards, as some providers opt to capitalise their business assets and stop providing services. This means that fewer services will be available to LASSD's, as and when funds become available.

    —  Difficulties in recruiting and retaining social care staff are well documented. This further reduces capacity and limits flexibility in the scale and nature of services available. The demand for more nurses arising from the National Care Standards will exacerbate the existing shortfall of qualified nurses for NHS establishments. While Leonard Cheshire warmly welcomes the new Care Standards, we estimate that for Leonard Cheshire alone, an extra 237 full time nursing posts will be required by 2007. This will be approximately a doubling of our present capacity.


  1.  A formal gearing between funding formulas for the NHS and personal social services is developed. This will allow both areas to be treated as equal, interdependent, partners.

  2.  Personal care is made free of charge for older and disabled people, alongside nursing care. We continue to believe that this will prove the most effective way of encouraging access to the right form of care package at the right time, consequently reducing the number of delayed discharges and avoidable admissions.

  3.  Formal distinctions between health and social care budgets and administrations are ended, meaning that a funding package can follow the service user;

  4.  Powers are given to the new Care Trusts to prioritise solutions to delayed discharges;

  5.  Guaranteed long term funding is planned for intermediate care facilities.

  Fiona Street, Director of Services, Leonard Cheshire

  John Knight, Head of External Policy, Leonard Cheshire

  Rob Banks, Parliamentary Officer, Leonard Cheshire

21 January 2002

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