APPENDIX 9
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.
ACCESS TO
HOME CARE
AND OTHER
SOCIAL SERVICES
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.
FUTURE ACCESS
TO HOME
CARE AND
OTHER SOCIAL
SERVICES
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.
LEONARD CHESHIRE
SUGGESTS THAT:
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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