Memorandum by Scope (SC 51)
1. ABOUT SCOPE
1.1 Scope is a major disability organisation
whose aim is that disabled people achieve equality and enjoy full
human rights. We provide a range of transition, residential care,
domiciliary care and empowerment in the community services to
disabled people. Many of the disabled people we support have complex
needs. We welcome the chance to respond to this consultation as
social care is an integral and essential part of our stakeholders'
1.2 The changing demographics of Britain
mean that demand for social care provision will inevitably increase,
which will put significant strain on resources. As well as the
challenges brought by an aging population,
advances in technology mean that more young people with complex
needs are living for longer into their adulthood (it is estimated
that between 2002 and 2029, the older, disabled population will
increase by 40%).
1.3 There are currently almost two million
people receiving social care in England and this may rise by approximately
1.7 million by 2029.
For many disabled people effective and timely social care is the
difference between engagement and isolation, independence and
dependency. Social care and support is essential for many disabled
people to lead full and rewarding lives, however previous proposals
on social care reform in England have not fully considered the
lives of disabled people,
nor meaningfully addressed the substantial barrier that disabled
people still face in accessing appropriate, effective and timely
social care and support.
1.4 We have welcomed a number of key aspects
of the Government's Green Paper;
in particular the proposals for greater consistency of care and
support through a single assessment, joined-up working, a greater
emphasis on personalisation and information, advice and advocacy.
However we remain disappointed that a number of substantive barriers
to fair access to social care have not been sufficiently resolved.
We have outlined our outstanding concerns in this document.
2.1 Whilst the proposals in the Green Paper
take some important steps towards social care reform, there is
still a lack of detail on the practicalities of reform and a lack
of consideration of disabled people; particularly those of working
age. We still have outstanding concerns about the restrictions
and inconsistencies of eligibility criteria, which are exacerbated
by the limitation on portability posed by the retention of Ordinary
2.2 Whilst the proposals do not explicitly
state the submergence of DLA and AA in the general social care
funding pot, the Government needs to give both reassurance and
commitment to those three million disabled people who would automatically
be worse off if such a direction were taken.
Finally, information, advice and advocacy services need to be
effectively resourced in order to ensure that disabled people
and their families can take full advantage of the personalisation
agenda. Brokerage in particular could be an effective way of stimulating
and shaping a personalised market.
3.1 The absence of an ability to move your
support package from one authority to another without your level
of support being reduced (portability) remains a significant barrier
for disabled people. We have welcomed proposals from the Green
which have aimed to resolve this by suggesting a national needs
assessment which can be transferred from one authority to another
and an entitlement to the same proportion of care and support
costs paid for wherever one lives in England. Whilst this will
be a step towards resolving the issue of portability, it does
not remove the core of the problem: ordinary residence rules.
Ordinary residence rules govern where a person is considered to
be resident and who is responsible for funding their support package.
It is estimated that over 500 people are caught up in ordinary
residence disputes at any one time and that nearly 20,000 people
could be adversely affected in the longer term.
Until these rules are addressed, local authorities will continue
to dispute funding responsibilities, and disabled people's freedom
of movement will continue to be restricted. The case study below
demonstrates how ordinary residence is preventing independent
4. CASE STUDYSTUART
4.1 Stuart is 30 years of age and has a
learning disability. He is funded "out of area" and
shares a flat with three other people. He works at a garden centre
and bakery and has a Saturday job in a café. Stuart has
a good social life, he knows his way around his local community,
and has made major strides in developing his confidence and independence.
Stuart now wants to move into a place of his
own. He has found a flat, close to where he is currently living.
This is ideal, since it will enable him to maintain his existing
friendships and networks and he knows his way around the local
area. Stuart will claim housing benefit but will need additional
funding from the local authority for his personal support.
4.2 However, Stuart has now learned that
his move may not be possible. His placing authority has told him
that he will now become an ordinary resident in the authority
where he wishes to live, and no longer eligible for funding by
them. The authority he wishes to live in say that they will not
fund his care until he has been resident in his own flat, claiming
housing benefit, for six months. So Stuart is caught up in a Catch-22
situation; he can't move into his flat and claim housing benefit
until his support package has been agreed, and he can't have a
support package until he has been living in his flat for six months.
Whilst the two authorities are in dispute, neither is prepared
to carry out an assessment of the support he will require in his
4.3 Because of this, Stuart doesn't know
how much support he will receive if the new arrangements are agreed.
He needs this information now if he is to make informed choices.
The fear is that he will be assessed as needing less support than
he needs and have his service levels cut just when he is feeling
most vulnerable. Also there is no way back. It will be very hard
for Stuart to reverse the move if for some reason it doesn't work
out. Even if his previous home is still in operation, the placement
is likely to have been filled. The funding arrangements are not
flexible enough to allow him to change his mind. This increases
the worry for Stuart and his family at a time of major change.
Stuart and his family are very upset by this. Stuart was looking
forward to this new step in his life. He has found an ideal place
to live and just needs support to enable him to do so.
4.4 Stuart's case is just one of the hundreds
of cases that third sector organisations, like Scope, deal with
every year. As his case illustrates, Ordinary Residence rules
need to be abolished to allow genuine freedom of movement. We
are, therefore, disappointed that the recent ordinary residence
was seeking views on the guidance rather than the principle itself:
"[this consultation]I is not seeking general
comments on whether the concept of Ordinary residence is the most
effective way of determining which local authority is responsible
for the provision of social care. Nor is it seeking views on whether
social care packages should be transferable from one local authority
4.5 From our subsequent correspondence with
the Department of Health, we believe they may be seeking legal
clarifications to the rules because of the substantial opposition
to the rule. We would greatly encourage any substantive reform
or removal of these rules and would be happy to offer any further
clarification, advice or recommendations on this matter.
5.1 We are disappointed that the proposed
changes in eligibility
do not address the fact that eligibility criteria is too strict,
leaving many disabled people in need of care receiving none. The
problem is that councils are still able to interpret the eligibility
criteria according to their level of resources, leading to a "rationing
of services". With 75% of councils now only providing care
to people with "substantial" or "critical"
needs we are seeing a rise in the number of people who do not
qualify for care and support services.
The rigid nature of Fair Access to Care Services (FACS) which
is used to determine eligibility for social care also makes it
extremely difficult to realise the model of self-directed support
suggested by the personalisation agenda. We realize there is currently
a consultation on revising the eligibility criteria and hope that
it goes some way to addressing this area of concern.
5.2 A national care service proposed by
the Green Paper would go some way towards eliminating this inconsistency
but it would depend how much discretion the local authorities
would continue to have. All local authorities should use the eligibility
criteria in a consistent way because this will ensure people receive
the care they need while enjoying greater opportunities to work
and travel in the local area. Increased social care will lesson
isolation and alleviate the burden on the NHS. Social Return on
Investment (SROI) is a useful framework within which to explore
potential savings and map how early intervention can bring long-term
benefits. For example, New Economics Foundation's research has
demonstrated that savings can be achieved to the local and wider
public sector through early intervention in mental health.
5.3 As a transitionary arrangement, the
councils which only provide social care in the top two bands (substantial
and critical) need to provide an infrastructure for signposting
to information, advice and advocacy organisations. This could
include a training brief for front-line professionals such as
GPs and social workers so they can tell people where to find other
means of support.
6.1 The current concerns around eligibility
could be further exacerbated by any proposal to remove important
benefits, such as Disability Living Allowance (DLA) and Attendance
Allowance (AA), as some disabled people will be left with no benefits
and no social care despite requiring it. There are currently 2.87
million people receiving these benefits who are not receiving
social care. If benefits such as AA and DLA were to be submerged
into general social care funding, almost three million people
would suffer, as would their families. These benefits provide
vital support to disabled people. Many disabled people have told
us that they rely on AA and DLA to meet the additional costs of
living with an impairment or long-term health condition.
6.2 We believe that scrapping AA and/or
DLA would have a very negative impact on many disabled and older
people's quality of life. They are the only disability related
benefits which are not means-tested. A recent Select Committee
report revealed that 29% of pensioners in households with one
or more disabled adults who were not in receipt of disability
benefits lived in poverty; in households where disability benefits
were claimed, the figure was 11%.
7.1 We are encouraged by continued direction
towards personalisation in social care and the proposals in the
recent Green Paper to ensure that personal budgets will be available
to all who want them. Devolved budgets can enhance the co-production
of support services and ensure that disabled people contribute
to making key decisions about their packages of support from the
very start. However, the provision of information, advice and
advocacy will be vital to ensuring the personalization agenda
is successful. Whilst we want choice and control to be central
to social care provision, we recognize that the choice needs to
be informed for effective control to be realized.
7.2 Inadequate support to manage devolved
budgets, levels of funding that are not adequate to buy the services
people require, and a lack of suitable services or staff in the
local area all prevent disabled people exercising genuine choice
and control over their lives. Some local authorities have also
chosen to limit what disabled people can spend their direct payments
or personal / individual budget on. We believe that this goes
against the ethos of independent living which demonstrates that
disabled people are best placed to decide what support they need
and who should provide it.
7.3 The funding and sustainability of effective
and timely information, advice and advocacy services will be crucial
to the meaningful realisation of the personalisation agenda. Importantly,
there needs to be more collaboration between government and financial
services to ensure that disabled people can access quality independent
advice and appropriate financial services to enjoy the full benefits
of a personalised budget.
7.4 In addition to appropriate advice services,
the market will need to be further stimulated to create innovative,
personalised services solutions that enable disabled people to
have choice and control over their care and support. Research
has suggested that an area of weakness within the civil service
is developing innovative delivery models.
Whilst Putting People First
and the current Green Paper on social care reform contain high
levels of innovation, they could go further in stimulating the
personalised market marketplace. Below we have outlined three
ways in which Scope has responded to the personalisation agenda
and the increasing demand for these services by disabled people.
8. SCOPE INC
8.1 Increasingly, personalisation is effective
support in the individual's own community. Scope Inclusion (Scope
Inc) is a popular and well-respected articulation of this model
because it offers opportunities for every aspect of an individual's
lifesupport at home, respite through a sitting service,
as well as leisure and community support.
The support provided by Scope Inc is based entirely around their
needseither in their family home or in a variety of social
or community settings. The staff encourage disabled children and
young adults to be as independent as possible. They offer outreach
support, so that disabled children and young adults can take part
in stimulating activities. They also assist with the development
of new skills. They help disabled children and young adults to
fully and equally participate in their favourite leisure activities
and outings, alongside their non-disabled peers. So this could
be things like swimming, bowling, going to the gym.
8.2 Involving a range of activities is important
in ensuring that disabled people can participate in the same range
of activities that non-disabled people can. For example, staff
from Rutland House (our local specialist education establishment),
part of Scope Inc, work in inter-disciplinary teams because this
enables a more personalized service. Rutland's broad aims include
"to facilitate the holistic development of all pupils/students"
and holistic multi-agency working will enable better use of personalized
services. The North West Scope Inclusion Team offers a service
of "includers" to help realize a vision of independence
and inclusion. They work from person-centred plans to provide
support in the most appropriate way, which maximises each person's
appropriate level of control over their own lives.
9. CASE STUDYBEN
9.1 Ben is 23 years old, has complex needs
and has lived in Scope's Orchard Manor Transition Service for
three years. This Transition Service is specially designed for
young people aged 18-25 with the most complex care support and
learning needsthose with combined physical and learning
difficulties and additional sensory impairments. As Ben has neared
the end of his time at Orchard Manor, he has worked with the Transition
Coordinator and other staff to present his views on his life to
his family and his Local Authority and to inform decision making
regarding his future. Initially, it appeared that the placements
likely to be available to Ben would be six to eight bed care homes.
Ben would be able to have his own room and bathroom but would
need to spend considerable time with and share facilities with
other service users. This caused Ben anxiety. Scope agreed to
alter a ground floor flat on the Orchard Manor site for Ben to
use for a year after leaving the Transition Service. His Local
Authority agreed to fund him in his new flat so that he will be
able to make an informed decision about living in his own home
in the wider community. When the time comes, people who know Ben
well will support him to decide. Orchard Manor staff will help
Ben to engage a staff team to meet his needs and to put in place
an activity schedule to encourage his independence. Initially,
he will be able to attend the Day Service on site but gradually
will be encouraged to pursue his interests in the community.
9.2 The individual learning goals for young
people with complex needs are increasingly seen as too "small"
to attract funding for a college placement; while a care home
cannot provide the stimulation and developmental learning opportunities
that are vital if young people are to enjoy as much independence
as possible later in their lives. The goal of Orchard Manor is
to offer not only care, but to help young people develop as much
independence as they are able. This marks it out as a distinctive
service which could be used as a template for future transition
10.1 Brokerage is also an important issue
for the future of social care and in particular, ensuring successful
personalisation provision. Voluntary and community organisations
are well-placed to fulfil this brokerage function, given that
they often have distinctive knowledge of their client base and
their families as well as the local areas. Appropriate brokerage
also leads to market shaping meaning that people can take advantage
of choice which is both informed and varied.
10.2 For example, Scope's Suffolk Brokerage
acts as an interface between the consumer and provider in social
care. Scope is working in partnership with the Suffolk Aiming
High team to develop and deliver a brokerage model that can work
across Suffolk County Council's 18 community clusters. Scope is
responsible for matching the needs and aspirations of disabled
children and young people by developing the market and creating
a wide range of short break leisure and recreation opportunities.
For example, the brokerage arrangement will ensure that there
are sufficient short breaks across the range to meet potential
demand at all levels. Scope has a robust quality control mechanism
that will be applied across providers and activities to ensure
they are safe and accessible. Scope regularly consults with disabled
children and young people to ensure they are capturing up-to-date
information about existing activities and also respond to changing
need and interests. It has a collective understanding of all the
services in Suffolk and the area now has ten times more integrated
play activity than last year.
11. FURTHER AREAS
11.1 In order to fully understand the impact
of the proposals of the future of social care and support, we
recommend that the committee:
Investigate the technicalities of implementing
portable care packages as well as the benefits in radically reforming
or abolishing Ordinary Residence rules.
Investigate the ways in which the reform
of eligibility criteria for social care and support can ensure
better outcomes for disabled people as well and enabling a greater
social return on investment for the state and local agencies.
Scope Inc service, to explore the successful
personalisation of support services;
Suffolk Brokerage, to consider third
sector involvement in brokerage;
Orchard Manor, to investigate how personalisation
can work in the context of young people with complex needs undergoing
A local Disability Information Advice
Line (DIAL) group to explore the importance of timely and appropriate
information, advice and advocacy service to the success of personalisation.
1 ONS (2009) Mid-year Population Estimates and Population
Projections: http://www.statistics.gov.uk/cci/nugget.asp?ID=949 Back
Personal Social Services Research Unit (2005) Long-Term Care
Expenditure for Older People, Projections to 2022 for Great Britain:
Department of Health (2009) Shaping the Future of Care Together
For example Kings Fund (2006) Wanless Social Care Review :
Securing Good Care for Older People (taking a long-term view):
DH (2009) Shaping the Future of Care Together: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_102732.pdf Back
Approximately 2.9 million people are receiving these benefits
and are not receiving social care. Figure extrapolated from DWP
(2009) Quarterly Statistics Summary: http://www.dwp.gov.uk/docs/stats-summary-aug2009.pdf
Theyworkforyou.com, Phil Hope, Written answers
and statements, 23 April 2009 http://www.theyworkforyou.com/wms/?id=2009-04-23b.25WS.1
VODG (2007) No Place Like Home: Ordinary residence, discrimination
and disabled people: http://www.disabilities-trust.org.uk/images/VODG_REPORT_ORDINARY_RESIDENCE.pdf Back
DH (2009) Consultation on ordinary residence guidance, Directions
and cross-border arrangements: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_098424.pdf Back
DH (2009) Consultation on the revision of the Fair Access to
Care Services guidance to support councils to determine eligibility
for social care services: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_102436.pdf Back
LGA, (2009) Facing facts and Tomorrow's reality today, the
extra costs of care: http://www.lga.gov.uk/lga/aio/1546471 Back
New Economics Foundation (2007) Unintended Consequences: How
the efficiency agenda erodes local public services and a new public
benefit model to restore them: http://www.neweconomics.org/gen/z_sys_PublicationDetail.aspx?pid=248 Back
House of Commons, Work and Pensions Select Committee (2009) Tackling
Institute for Government (2009) The State of the Service: A
review of Whitehall's performance and prospects for improvement:
DH (2007) Putting People First: A shared vision and commitment
to the transformation of adult social care: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_081119.pdf Back
For more information see http://www.scope.org.uk/education/scope-inclusion-team.php Back