Memorandum by Mencap (PEX 22)
Mencap is the UK's leading learning disability
charity, working with people with a learning disability, their
families and carers. We want a world where people with a learning
disability are valued equally, listened to and included. We want
everyone to have the opportunity to achieve the things they want
from life.
EXECUTIVE SUMMARY
Mencap's response mainly focuses on the issues
relating to social care.
The current social care system is under funded
and fails to meet the needs of many people with a learning disability.
With a growing demand on services, due to increased numbers of
people with a learning disability, this is set to get worse in
the future.
Local authorities are facing growing pressures
from increasing demand on services as well as a drive for efficiency
savings and cuts and together these are having a direct impact
on social service departments.
In comparison to the NHS, social care services
are often seen as less significant and receive less funding.
When done properly joined up work by NHS and
social services can make a positive difference to people with
a learning disability.
However the Department of Health must ensure
all bodies understand and fulfil their roles and that there are
adequate funds to provide the services, in particular for people
with a learning disability who have the most complex needs.
RESPONSE
1. Growing demand
Increasing numbers of people with a learning disability
Evidence shows that people with a learning disability
are living longer and that more people with profound and multiple
learning disabilities are surviving into adulthood.[44]
This demographic change is a result of:
— decreasing mortality among people with
a learning disability, especially in older age ranges and among
children with severe and complex needs;
— the impact of changes in fertility over
the past two decades in the general population;
— the aging of the "baby boomers",
among which there appears to be an increased incidence of learning
disabilities[45]
These changes will have a significant impact
on the future of health and social care services as there will
be larger numbers of older people with a learning disability and
more people with complex needs who will require care and support.
This in turn has meant that the demand on adult
social care services, by people with a learning disability, is
increasing (the number of people with learning disabilities requiring
social care will increase by at least 3-5% annually on average
over the next five years).
PREPARING FOR
THE DEMAND
Although evidence is showing increasing demand,
local authorities have a poor understanding about the numbers
of people who require services in their area. Strategic planning
of health and social care services is also inadequate. Urgent
research needs to be undertaken by the Department of Health to
track future demand for health and social care so that funding
can be determined.
Without evidence of this likely future demand
for services, any improvements to the care and support system
will quickly be dissipated by ever-increasing demands and inadequate
funding to meet them.
2. Funding
2.1 National spend on learning disability
Mencap is aware that the proportional spend
of adult social care funding on learning disability has increased
from 17% to 23% in recent years.[46]
However, despite this increase, in 2009 71% of Mencap local groups
reported cuts to social services in their area and 82% reported
that, where people were receiving individual budgets, there was
not enough local funding to meet their needs.
Last year a Department of Health report found
that local authorities spent over half of their adult social care
budget for learning disability on residential and nursing care
for a relatively small number of people.
In addition, local authorities that spent a
higher share of their adult social care budget on care tended
to spend more overall but achieve worse results than local authorities
with a lower use of residential and nursing care.[47]
This shows that existing funding is not being spent wisely.
This discrepancy between spend and the experience
of people on the ground needs to be explored as a matter of urgency.
Mencap also calls on the Department of Health to commission accurate
research on how existing money is being spent, both at the national
and local level.
2.2 Pressures on local authorities
Without an increase in investment in social
care from the government, given the increase in the number of
people with learning disability (especially those with profound
and multiple learning disabilities) there will be significant
budgetary pressures on local authorities.
Social care is already in crisis and local authorities
are unable to meet the growing demand on social care services.
84% of councils who responded to the Learning Disability Coalition
survey described the funding situation for learning disability
services in their area as difficult. Many are already either making
efficiency savings or are having to cut services.
As a result of budgetary pressures, local authorities
are tightening eligibility criteria with more local authorities
preparing to join the 73% of councils[48]
who only provide care and support services for people with critical
or substantial needs.
2.3 Efficiency savings
Mencap understands the rationale for Councils
implementing efficiency savings; however we believe the current
expectations of saving levels are unrealistic and overly optimistic.
According to the Local Government Association[49]
local authorities were already, under the previous Government,
facing a demanding 3% efficiency requirement, rising to 4%;
"It is difficult to see how local Government
could meet the cost of this proposal from existing plans for efficiency
savings, without the lifting of other existing burdens."[50]
In recognition of potential cuts to social care
services for people with a learning disability, Mencap calls on
the Government to ensure that no individual found eligible for
care and support will face reduced levels of care and support
allocated from a Community Care Assessment.
2.4 Future commitment to social care
Social care service budgets are not ringfenced
and are therefore subject to increasing cuts by local authorities.
Mencap are concerned that pressure to cut spending could have
serious consequences for people with a learning disability and
urges the DH to consider these concerns.
Over £100 billion is spent on the NHS each
year, while social care receives around £16 billion. Mencap
believes that the Department of Health should give social care
services a similar level of importance as the NHS- as social care
has traditionally been the poor relation.
In the last Comprehensive Spending Review, the
NHS received 4% extra funding per annum (in real terms), yet local
government spending (which includes social care) only had 1%.
In addition, social care funding should be ringfenced and allocated
separately, and be on a comparable basis to the NHS.
3. NHS and social care
3.1 Joint working
Mencap know the real difference that can be
made to the lives of people with a learning disability when the
NHS and social care work together, particularly for people who
require complex packages of care.
When done well, joint work has the potential
to reduce high costs packages of care in the future, as shown
by the joined approach to health and social care in Herefordshire.
Herefordshire introduced a preventative care
service in 2008, which cost £400,000 in the first year and
£300,000 per year after this. Despite this it saves the county
an estimated £1.5m-£1.7m a year by reducing admissions
to residential and nursing homes.
Joint working should include commissioning,
services and planning. To this end, Mencap welcomed the Government's
Health White Paper which maintaining the commitment to Joint Strategic
Needs Assessments.
Mencap also believes that a more integrated
and joined up approach would allow all agencies commissioning
and planning to have a greater understanding of the numbers of
people who require services in their area and so establish a clear
picture as to the true demand on services.
3.2 Financial and administrative barriers
Mencap urges the Department of Health to remove
the financial and administrative barriers which can reduce the
benefits of a joined up approach.
Joint working will only work well when both
agencies have the funds to provide the services. The system must
be adequately funded for it to meet the needs of people with a
learning disability.
The Department of Health must be clear as to
what is expected from the NHS and social services in respect of
joint working. In particular the Department of Health must be
clear as to the role of the NHS. As said by the NHS Chief Executive,
Sir David Nicholson, during a recent speech to the NHS Confederation,
the relations between social care and the NHS are critical. All
partners at the local level should be involved in the development
and implementation of the joined-up services, to ensure that the
joint services meet the need of the local demand.
October 2010
44 Estimating the future needs for adult social care
services for people with a learning disability, 2008, Eric Emerson
and Chris Hatton. Back
45
Ibid. Back
46
P 22, Use of Resources in Adult Social Care, Department
of Health, 2009. Back
47
P 43, Use of Resources in Adult Social Care, Department
of Health, 2009. Back
48
Cutting the cake fairly: CSCI review of eligibility criteria
for social care; 2008, Commission for Social Care Inspection. Back
49
Local Government Association, Personal Care at Home Briefing,
14 December 2009. Back
50
P 3 Ibid. Back
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