Social Care - Health Committee Contents


Memorandum by Scope (SC 51)

SOCIAL CARE

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' lives.

  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[1], 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%)[2].

  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[3]. 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[4], 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[5]; 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.  EXECUTIVE SUMMARY

  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 Residence rules.

  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[6]. 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.  PORTABILITY AND ORDINARY RESIDENCE

  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 Paper[7] 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[8]. 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 living:

4.  CASE STUDY—STUART

  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 new life.

  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.[9]

  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 consultation[10] 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 to another."

  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.  ELIGIBILITY CRITERIA

  5.1  We are disappointed that the proposed changes in eligibility[11] 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[12]. 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[13].

  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.  RETAINING DISABILITY LIVING ALLOWANCE AND ATTENDANCE ALLOWANCE

  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%[14].

7.  PERSONALISATION

  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[15]. Whilst Putting People First[16] 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 life—support at home, respite through a sitting service, as well as leisure and community support[17]. The support provided by Scope Inc is based entirely around their needs—either 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 STUDY—BEN

  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 needs—those 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 services.

10.  BROKERAGE

  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 FOR EXPLORATION

  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.

    — Visit either:

    — 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 transition;

    — 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.

October 2009







1   ONS (2009) Mid-year Population Estimates and Population Projections: http://www.statistics.gov.uk/cci/nugget.asp?ID=949 Back

2   Personal Social Services Research Unit (2005) Long-Term Care Expenditure for Older People, Projections to 2022 for Great Britain: http://www.pssru.ac.uk/pdf/dp%202252.pdf Back

3   Department of Health (2009) Shaping the Future of Care Together
http://careandsupport.direct.gov.uk/wp-content/uploads/2009/07/2009-08-18-shaping-the-future-of-care-together-large-print.pdf  
Back

4   For example Kings Fund (2006) Wanless Social Care Review : Securing Good Care for Older People (taking a long-term view): http://www.kingsfund.org.uk/document.rm?id=6307 Back

5   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

6   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  
Back

7   ibid Back

8   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

9   ibid Back

10   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

11   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

12   LGA, (2009) Facing facts and Tomorrow's reality today, the extra costs of care: http://www.lga.gov.uk/lga/aio/1546471 Back

13   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

14   House of Commons, Work and Pensions Select Committee (2009) Tackling Pension Poverty
http://www.publications.parliament.uk/pa/cm200809/cmselect/cmworpen/411/411i.pdf : 
Back

15   Institute for Government (2009) The State of the Service: A review of Whitehall's performance and prospects for improvement: http://www.instituteforgovernment.org.uk/content/77/transformational-change Back

16   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

17   For more information see http://www.scope.org.uk/education/scope-inclusion-team.php Back


 
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