Inclusion London’s evidence for the select committee’s inquiry into the impact of the comprehensive spending review on health and social care

January 2016

1. Introduction

Inclusion London

1.1 Inclusion London is a London-wide user-led organisation which promotes equality for London’s Deaf and Disabled people and provides capacity-building support for over 90 Deaf and Disabled people’s organisations in Londonand through these organisations our reach extends to over 70,000 Disabled Londoners.

1.2Disabled People

  • In 2012/13 there were approximately 12.2 millionDisabled adults and children in the UK, a rise from 10.8 million in 2002/03. The estimated percentage of the population who were disabled remained relatively constant over time at around 19 per cent.[1]
  • There are approximately 1.2 million Disabled people living in London.[2]

1.3 Inclusion London welcomes the opportunity to provide evidence for the select committee’s inquiry into the impactof the comprehensive spending review on health and social care.

1.4 Inclusion London’s response mainly focuses on how the government has responded to the crisis in care and support through the Comprehensive Spending Review 2015. We also comment on government plans for joint work and health units.

2. Inclusion London’s evidence

Article 19 UNCRPD

2.1According to Article 19 of theUN Convention on the Rights of Persons with Disabilities[3], Disabled people have the right to ‘independent living and being included in the community’. This includes the right to:

‘access a range of in-home, residential and other community support services, including personal assistance necessary to support living andinclusion in thecommunity, and to prevent isolation or segregation from the community’;

The, ‘opportunity to choose their place of residence and where and with whom they live on an equal basis with others and are not obliged to live in a particular living arrangement’;

2.2 We are looking to central government to provide sufficient funding for social care and support to ensure that this right is fully upheld.

2.3What is independent living?

Inclusion London believes that independent living for Deaf and Disabled people is having the same opportunities, choices and rights as other citizens; being able to work, live in your own home with people you choose to live with; being able to go out and participate in cultural activities, public life and sport and having the chance tobe a parent and have a social life.

Context of the Comprehensive Spending Review

Under funding of care and support since 2010

2.4Disabled people’s organisations[4], charities working for older people,[5] the ADASS[6] and other organisations[7]have all been warning central government, with an increasing sense of urgency, of a crisis in care and support due tochronic underfunding. This crisis has been caused to a large extent to by ongoing cuts to local authority budgets by central government since 2010. Anational survey of 600 of Disabled adults between the ages of 18 and 64 was conducted in the summer of 2012, it showed how disabled people were already being failed by the care system:

  • nearly half (47 percent) say the are withdrawing from society because the services they receive do not enable them to take part in community life[8].
  • over one third (34 percent) being unable to work or take part in volunteering or training activities after losing support services[9].

2.5 The survey was published in Scope’s ‘Other Care Crisis’ report which showed a£1.2 billion funding gap in social care support for disabled people under age of 65.[10] While for older people, Age UK ‘Care in Crisis 2012’ report revealed that England was £500 million a year short of ‘even maintaining the inadequate levels of provision in place when the Coalition came to power.[11]

2.6Disabled London residents had also experienced cuts in their funding in 2012. More than one Disabled person had to use legal means to prevent their care being cut despite there being, ‘...absolutely no change in my disability or its effect on my day to day life’.

2.7 In May 2013, afterthree years of austerity £2.68 billion savings were made by adult social care and the President of ADASS[12] said,

“… without additional investment from that already planned, an already bleak outlook becomes even bleaker."[13]

2.8 In June 2013, in response to pressure in June 2013 the government promised £3.8 billion for care and support, saying it would ‘help older and vulnerable people to stay healthy and remain at home…’and‘improve adult social care’[14]. However,this funding was delayed.[15]

2.9By June 2015 the ADASS reporteda total of £4.6 billion budget reductions for adult social care. The president of ADASS said the Chancellor needed to provide a settlement for “..the growing funding gap for social care” otherwise:-

“…the safety and wellbeing of growing numbers of people, often with more complex needs, who rely on social care being put at grave risk.”[16] The president also highlighted that there would be increased pressure on the NHS and more care providers exiting the market.

2.10As a result of the funding reductionsDisabled people’s care and support has been cut to a minimal clean and feed model of care, so in many areas Disabled people only receive support get up, dress, eat and go to bed, or do not receive any support at all because their needs are assessed as ‘low’ or ‘moderate’. If Disabled people do not receive enough support employment or voluntary work is jeopardised, independent living and participation in the community is lost.We give arecent example below where independent living and inclusion in the community is being lost and isolation from the community resulting:

Case 1

“Aged 44 year old male who has brain tumours, which had left him with significant physical impairments – he is a wheelchair user. He had been receiving 72.5 hours to meet his needs including ILF funding. Following his re-assessment his package was cut to 38 hours per week. The reason given for the decision was that the Independent Living Fund had finished. This left the person in a position where his hours would be taken up with his personal care and subsistence needs.

As a person who has many interests and is very involved in the community it has left him isolated at home and unable to maintain his quality of living.”

Inclusion London’s comments and evidence on the Comprehensive Spending Review

Prevention??

2.11According to the Comprehensive Spending Review (CSR) 2015local authorities will be given more powers to take preventative action.[17] This would be welcome as care and support provided at early stage canprevent an escalation of needs and the need for more expensive NHS services. Many Councils used to provide care for those with ‘moderate’ or ‘low’ needs i.e. an early stage. However, this provision was scrapped, initially because of cuts in local authority’s care budgets and then the national eligibility criteria was set at ‘substantial,’ as a result over 100,000 Disabled working age adults are likely to have missed out on essential care.[18]The example below shows how support to manage medication and a small amount of financial assistance in the community could prevent repeated hospital admissions and also the risk of eviction and homelessness:

Case 2

The following referral was made by a Social Services Care Manager to a Deaf and Disabled people’s organisation (DDPO):

“I wish to make a referral to you because:

  • Client has been referred to Community Mental Health Team for memory problems and has low mood.
  • Client is not managing diabetes well in terms of both medication and refusing to change her diet. Appears to have had hospital admissions because of this.
  • The client’s Welfare Benefit ESA has dropped by £50 a week and she has refused vital life-saving equipment i.e. A key Safe & A Personal Alarm / Falls ‘pendant (should she suffer a Hypoglycaemic episode), She is aware of the risks & benefits but of a personal alarm & Key Safe but says she cannot afford this equipment (Care - Link £8.68 a week + Telecare £2.90 a week).

Can you kindly assess her financially to support her income & sustain her tenancy & wellbeing in the client’s best interest.”

The DDPO replied:

“We are not able to help as this is not a service we or any other service in the borough is now funded to provide”.

2.12 Local Deaf and Disabled People’s Organisations (DDPOs) in London have informed us that without support to apply for welfare benefits and any associated appeals people with learning difficulties and mental health support needs fall behind with rental payments, putting them at risk of eviction and without enough money to pay for food and fuel. A DDPO informed us that

“People with schizophrenia and severe mental health problems often come to us for support at a crisis point, when they have had no income for some time, and are on the point of eviction”.

However, there is a gap in care provision, which does not provide support to read correspondence, as the case example below illustrates:

Case 3

Billy[19] lives in his own flat in the community. He receives a Direct Payment from the Council for Personal Assistance with basic personal care. This is not sufficient to cover support with for example reading and responding to his mail and his PAs say it is not in their job description to do this. Billy has a learning difficulty which means he cannot read and write. He was in receipt of a lifetime DLA award. He is concerned about how he will know when the letter comes calling him up for reassessment for Personal Independence Payment or how he will complete the form.

2.13Assistance to read correspondence is needed.

2.14 Also wequery whether any meaningful preventative action to be taken by local authorities because of the lack of funding from central government.

Social care precept

2.15The government, has introduced a new optional‘social care precept’, which enables local authoritiesto raise council tax in their area by up to 2% above the existing threshold, the funds raised from this can only be spent on social care and support.[20]

Inclusion London’s comment

2.16There is no compulsion on Councils to impose the ‘social care precept’. A two per cent rise in Council tax may not be acceptable to many residents, so elected politicians could be wary using this option so it is possible that some local authorities will not increase funding for social care.

Some boroughs have already taken the decision not to raise council tax: A spokeswoman for Merton’s Labour group said that the Labour group “intends to keep its promise to residents to freeze council tax” and would not take advantage of the two per cent increase option. Cllr Stephen Alambritis, leader of the council, said in a statement: “I promised residents a four year council tax freeze and if there’s one thing you can say about me I keep my promises”.[21]

Also, according to the Kings Fund the Council rise will only bring in £800 million a year rather than the £2bn the Chancellor predicted.[22]

2.17We also are concerned that low income areas where demand for social care is greater will struggle to raise enough funds through the precept, while more affluent areas with fewer demands will be able to raise greater funds. This will create a post code lottery of funding and the quality and quantity of care and support could suffer in the areas of greatest need.

A devolution revolution?

2.18The government is proposing a huge change – phasing out the local government grant from central government.[23] In return local government will be able to keep 100% of the rates they collect from local business to fund local services by the end of parliament. However, councils are being given the power to cut business rates and government will require more ‘efficiency savings’.[24] The government quotes Office of Budget Responsibility (OBR) which says that council tax and business rates are forecast to grow in cash terms by £6.3 billion by 2019-20.[25]

Inclusion London’s comment

2.19We strongly oppose the phasing out of the local government grant so funding for social care and support is dependent on the vagaries of revenue raised from business rates and an optional 2% rise in Council tax.

2.20We suggest that the OBR’s forecast of growth in cash terms of business rates are very optimistic, revenues can fall as well as rise. Mark Carney, governor of the bank of England said on 19 January 2016, said, “The world is weaker and UK growth has slowed” and spoke of “the slowdown in wage growth” “slower potential growth”.[26]

2.21It is quite possible that the revenues from business rates fall rather than rise. Councils may also choose to cut business rates, reducing the funds available for services. The Chancellor said that business rates revenues can be used to fund ‘local services’ but he has not stipulated that it has to be spent solely on social care, so it is possible the funds could be spent mending holes in the roads.

2.22Funding from business rates, which can fluctuate according to the economic climate and an optional 2% rise in Council Tax is not a sound basis on which to fund vital care and support. We believe that cash from central government is a more secure way to fund social care and support so that Disabled people’s independent living and participation in the community is placed on a firm footing.

Better Care Fund

2.23The Spending Review does provide local government with funds for social care from 2017, ‘rising to £1.5 billion by 2019-20’, to be included in the Better Care Fund (BCF).[27]

Inclusion London Comment

2.24 The £1.5 billion for BCF is welcome, but £3.8bn promised in the June 2013 and then withheld and the £6bn for the implementation of the Care Act has been delayed.[28] Also the funding does not start till 2017 and it is not clear how care and support will be funded in the interim.[29] In response to the CSR, the ADASS president said,“We don’t believe that the funding for the next couple of years will anywhere near meet the costs of the national living wage and the increasing demand for social care”.[30]

2.25 Inclusion London believes the Chancellor has missed a vital opportunity to solve the crisis in care by providing more funding from central government so the level of social care and support facilitates Disabled people’s independent living and participation in the community. Without additional cash from central government social care is likely to stay at a basic clean and feed model, which only allows Disabled people and older people to get up, eat, wash and go to bed. Dignity and the ability to participate in any activity outside the home is being sacrificed to the government’s ambition to bring down the deficit. Disabled people whose support was previously funding by the Independent Living Fund, (ILF) which closed in June 2015 are now reliant on social care funded by the local authority, as result care and support is been cut to clean and feed model and inclusion in the community is being lost as case studies below show:

Case 4

“Aged 45 year old male with Cerebral Palsy spastic quadriplegia. He had been in receipt of 24 hour a day care for a number of years. Following the assessment it was reduced by 14 hours and a quarter a day to ten hours and three quarter hours. However, the package provided was so small that it would not allow carers to receive minimum wage. It would have left a severely disabled person in an extremely vulnerable position as he would be left at home without any support at all. Following an appeal, he was re-assessed and it was accepted that he had 24/7 care needs.”

Case 5

“My son was originally allocated 80 hours per week following his accident in 1987, which allowed for a care package consisting of 10 hours per dayMonday - Sundayand 2 evenings per week at 5 hours per evening. This only reduced over the past couple of years, due to the lack of suitable and available Carers to provide support to Barry.

.. on the 10th June(2015) the assessor stated that the current 59 hours per week can no longer be justified and that they would no longer be able to fund this, just enough hours to provide care and support to Barry in the morning, to get him up, provide his personal care and to assist with his breakfast, then to provide time to help at lunchtime, for his evening meal and later to put him to bed. …. the total of hours available for my son's care and support from a recent total of 59 hours to just 41 hours.

.....which will result in Barry becoming disillusioned and frustrated at not being able to go out into his local community as normal, which he will then take out on me, as his Mother… he has 'severe' challenging behaviour and can regularly be both physically and verbally aggressive to everyone around him (but especially me!)

Barry can also place himself in great danger when left unsupervised for any length of time, especially at home as he isn't fully able to assess situations of possible risk……