Why Bradford should continue to care
A joint response to the consultation by Bradford Council on the proposed changes to the Fair Access to Care Services Criteria
David Ward Member of Parliament for Bradford East Liberal Democrat Group on Bradford Council
1. Introduction 2. What are moderate and substantial needs? 3. Demographic Pressures 4. Pressures on Local Government Funding 5. The Proposals 6. Who will be affected by the proposals 7. The financial benefits of intervention and early prevention 8. National changes to FACS and Social Care 9. Bradford Cares 10. Conclusion
3 4 5 7 8 15 19 23 26 28
Unlike the NHS, social care is not free at the point of use and never has been. To receive funding and support, a person must be deemed to have a high enough level of need to warrant support. In England, local authorities use a framework called Prioritising Need and the Fair Access to Care Services (FACS) criteria to determine whether or not an individual’s need is eligible for support from a council. The FACS criteria are based on assessing the risk to the individual of not receiving support and are defined across four bands of eligibility: ‘low’, ‘moderate’, ‘substantial’ and ‘critical.’ The band at which a person’s need is assessed determines whether or not they will be entitled to paid care and support from the Council. At present, Councils have discretion to set eligibility for care and support at any one of these different FACS levels, taking account of their resources, local expectations and costs. The threshold which is set by the Council is key because it is a statement of where the Council accepts a legal duty to provide care and support services. Recent research suggests that the funding pressures on councils coupled with the discretion they have to set eligibility has led to councils using eligibility thresholds to try to manage numbers coming into the care system, rather than focusing on determining levels of support1. This is exactly what Bradford Council is proposing to do. They are proposing to change the Fair Access to Care Services (FACS) eligibility criteria from ‘moderate’ to ‘substantial’ thereby reducing the number of people eligible to receive paid care and support from the Council saving money in the process. Budgetary pressures are the sole rationale for introducing these proposals. A consultation on these proposals opened in early May and will finish on 4th August. This paper is our submission to the consultation in which we urge the Council to retain the existing criteria. In response to a summer survey of 35,000 households in Bradford undertaken by David Ward in 2012, responses showed that there was very strong support for keeping the level of FACS at ‘moderate’ in Bradford with 97% of respondents opposing any increase to ‘substantial’. This paper outlines why we believe Bradford Council’s proposals are wrong; we do not believe the proposed change will save any money either in the short or long term but will have devastating health and wellbeing implications for over 2,000 vulnerable people across Bradford. We are not oblivious to the stringent financial circumstances faced by the Council but our argument is that retaining the existing FACS criteria will, over-time, save millions of pounds for the Council and the NHS. Bradford has so far resisted the national trend away from using ‘moderate’ needs and this is something we should be proud of as it sends out a clear message about the way that we treat some of the most vulnerable people in our community – in a phrase, it shows that ‘Bradford Cares’.
Scope et al (2013) The other care crisis: Making social care funding work for disabled adults in England
What are moderate and substantial needs?
To understand the types of services that the Council are proposing to stop, it is really important that we understand what these actually are. Bradford Council currently provides paid care and support services to those people that have been assessed as having ‘moderate’ care and support needs. ‘moderate’ needs are: MODERATE - There is, or will be, an inability to carry out several personal care or domestic routines - Involvement in several aspects of work, education or learning cannot/will not be sustained - Several social support systems and relationships cannot or will not be sustained - Several family and other social roles and responsibilities cannot or will not be undertaken - Engagement with formal support networks are at some risk of not being maintained - Ability to access some community facilities is limited2. Put simply, ‘moderate’ care needs means that people need some help either on a daily or regular basis, to get up, wash, get dressed, clean the house, help with work, education or domestic paperwork and help to get out of the house and socialise with other people. Bradford Council are proposing to stop giving paid care and support to people that need such basic help to live healthy and independent lives. As part of their proposals, they will increase eligibility to ‘substantial’ which is when: SUBSTANTIAL - There is, or will be, only partial choice and control over the immediate environment - Abuse or neglect has occurred or will occur - There is/will be, an inability to carry out the majority of personal care or domestic routines - Involvement in many aspects of work, education or learning cannot/will not be sustained. - The majority of social support systems and relationships cannot or will not be sustained - The majority of family, social roles and responsibilities cannot or will not be undertaken - Engagement with vital formal support systems are at risk of not being maintained - Some risk of harm to self or others, or potential current risk exists - Ability to access a range of essential community facilities is limited - There is, or will be, an inability to carry out essential tasks of daily living3. As this clearly demonstrates, the severity of a person’s condition needs to be fa r worse for a person to be assessed as having ‘substantial’ needs rather than at the current ‘moderate’ needs. This means that in an area which sets eligibility at ‘substantial’ a person’s disabilities or conditions have to significantly deteriorate for people to be eligible for care. The level a Council sets its eligibility criteria is so important because it is the ‘gateway’ into the adult social care system. It’s the point at which a person is formally captured in the care system and where they continue to receive the care and support essential to ensuring that they are able to live fully independent lives.
Social Care Institute for Excellence http://www.scie.org.uk/publications/guides/guide33/introduction/whatis.asp Ibid.
Bradford Council asserts that the budgetary effects of future demographic pressures is one of its key reasons for increasing the FACS eligibility threshold and reducing the availability of care and support services for those that need it. In the budget 2013/14 the Council state that the largest cost pressures on Adult Social Care comes from demographic growth and they have therefore allocated £1.7m to Adult Social Care to deal with the increasing demand. Nationally, there are ten million people in the UK over 65 years old. The latest projections state that there will be 5.5million more older people by 2030 and the number will nearly double to around 19 million by 2050. Within this total, the number of very old people grows even faster. There are currently 3 million people aged more than 80 years and this is projected to almost double by 2030, and reach 8 million by 2050 4. In 2011 through the National Census, The Office of National Statistics (ONS) estimated that Bradford District had a population of 522,452. By 2033, the population is forecast to reach approximately 640,000, an increase of around 25%5. However, what is significant is that the number of older people in Bradford is disproportionally increasing relative to the population as a whole. Bradford’s Joint Strategic Needs Assessment states that by 2030, there will be an 83% increase in those aged over 85. That’s 9,000 more old and frail people living in Bradford 6. People aged over 85 are the biggest consumers of care services and this increase is therefore likely to lead to a significant rise in demand for care and support services. The Office of National Statistics (ONS) states that there will be a 6.2% growth in the number of older people within the Bradford district in the next three years alone including increased numbers with higher needs related to dementia and other serious illness requiring care. In addition the number of working age adults with severe learning disabilities, autistic spectrum disorders and serious physical disabilities is expected to rise by around 5% by 2021. Over the same time, the number of people aged under 65 with disabilities is expected to grow by 32%. In addition, the Council also faces rising numbers of adults with dementia. In Bradford there are currently estimated to be 5500 people living with dementia, however only 52% of these are currently diagnosed. It is fair to say that as people’s life expectancy is increasing, includi ng for those with complex needs, there will be more demand for care and support services which will act as an inflationary pull and increase budgetary pressures on the Council. More people will be requiring social care over a longer period. In Bradford the Council forecast is that there will be an additional 1,000 service users by 2015. As a result of demographic pressures Bradford Council’s spending on care services has increased in recent years from £94.8m in 09/10, £109.4m in 12/13, £111.3m in 13/14 and is
Womens Royal Voluntary Service (2012) Loneliness amongst older people and the impact of family connections. Bradford Metropolitan District Council and Airedale, Bradford and Leeds NHS (2012) Joint Strategic Needs Assessment 2012 6 Ibid.
projected to increase further to be £114.4m in 14/15, £126.7m in 2020 and £144.8m in 20307. Due to future budgetary pressures, the Council states that this is a reason to change, but we do not accept this view. If there are more people that need our help to live independent and happy lives then the Council needs to prioritise Adult Social Care budgets more. Instead of showing that it cares about the welfare of its vulnerable residents, the Council is tackling the issue of Adult Social Care from completely the wrong perspective and putting other priorities before the care of disabled and elderly people. The Council should be putting its vulnerable members first and coming up with new and innovative ways of delivering services to the people that most need it. The Council is correct in stating it will have to face further budgetary pressures, primarily caused by demographic changes but a policy of reducing support to all but the most needy is not only morally wrong it is a false economy and will only lead to higher costs in the future.
Bradford Council (2013) Report to January Executive Committee - Breakdown of clients with a community based service by FACS banding 2010-11
Pressures on Local Government Funding
The Local Government Financial Settlement published on the 10th December 2010 required Bradford to make budget savings over 4 years of 28%. 30% of Council spending is on adult social care. The Chancellor’s Autumn Statement in December 2012 required a further 2% cut to council funding for 2014/15 and June’s Comprehensive Spending Review demanded a further 10% cut in Local Government funding in 2015/2016. Since the start of the austerity programme in 2010, £2.68 billion, that’s 20% of net spending, has been saved by local authorities on Adult Social Care 8. A large proportion of this has been achieved through efficiency savings, better procurement, better ways of working and in a minority of cases increasing charging. In Bradford, the Council’s Adult and Community Services Department has reduced its expenditure over the last two years by £23m or 15%. The Council has reduced the Adult and Community Services budget by a further £7m this financial year in 2013/14. The Council estimates that 71% of the Adult Social Care budget is spent on the delivery of FACS eligible provision including assessment, planning support and reviewing. As this demonstrates, there have been large cuts to Local Government funding which has resulted in the need to cut Adult Social Care budgets. With the effect of future demographic pressures, the Council state that current service provision is unsustainable and therefore needs to change by managing demand for services by raising the FACS criteria. However, whilst the Government has cut Local Government funding as a whole, they have also provided huge sums of money to help protect Adult Social Care against the worst effects of the austerity programme. In 2010, the Government committed an extra £2.1bn of funding to local authorities to pay for Adult Social Care, £1bn of this will be a transfer from the NHS’ capital budget to local authorities for them to spend on Adult Social Care. This money was allocated so that Councils could protect services to vulnerable people. Regretfully in our opinion, this funding was not “ring-fenced” and therefore Councils could spend it on other priorities if it so wished. As part of this extra funding, Bradford Council will receive almost £30m between 2011 and 2015. Broken down this equates to £6.0m in 11/12, £6m in 12/13, £8.2m in 13/14 and £8.6m in 14/15. If the Council has received an extra £30m in funding from the Government to protect social care, why does the Council need to cut any services to vulnerable adults? According to the Association of Directors of Adult Social Services (ADASS) in their budget surveys in 2011, 2012, 2013 much of this extra money has or is being used to prevent cuts to services and to deal with demographic pressures9. Therefore, whilst there have been significant cuts to Local Government budgets as a whole, Adult Social Care has fared slightly better than most Council services.
Association of Directors of Adult Social Services (2013) ADASS Budget Survey 2013 , 6th May 2013, Social care funding “a bleak outlook is getting bleaker”. http://www.adass.org.uk/index.php?option=com_content&view=article&id=914:social-care-funding-bleak-outlookbleaker&catid=160:press-releases-2013&Itemid=489 9 Association of Directors of Adult Social Services - www.adass.org.uk
The Council is proposing to save money by raising the FACS threshold from ‘moderate` to ‘substantial’ to help prioritise budgets for those with the worst conditions and to help support further prevention and early intervention.
FACS Band Critical Substantial Moderate Low Total 18-64 34% 37% 26% 3% 65+ 2031 35% 2342 40% 1290 22% 119 2% 5783 Total 3045 3446 2079 210 8779 35% 39% 24% 2% Table 1
1014 1104 788 90 2996
How many people will this effect in Bradford? In a report to the Council’s Executive Committee in January 2013 seeking approval to commence a consultation on their proposals, the Council stated that in 2010/11, there were 2079 people assessed as having moderate needs. That’s over a quarte r (+25%) of service users in Bradford that would lose any paid care and support services from the Council from their figures in 2010/11. However, when asked for an up to date figure of the number of people that would lose their care packages, the Council stated that “This information is not available because it has not been recorded on our client database”. What they did say is that during the last 12 months out of the 3,400 assessments undertaken, approximately 300 (10%) were assessed at being at ‘moderate’ level with the other 3,100 being assessed at ‘critica` or ‘substantial’. The Council further confirmed that there are 8,500 people currently in receipt of services from the Adult Social Care department. Given that there are 8,500 people receiving services from the Council, and that 10% of people in the past year were assessed at ‘moderate’ level, the Council state that to get a number for the total number of people currently classified as having ‘moderate’ needs, then “we can assume that approx 10% of these have moderate needs”. This equates to 850 people who are currently assessed as having ‘moderate’ needs. This is the most accurate picture that the Council has. This is figure is extremely troubling for a number of reasons: 1. It is surprising that the Council do not have an accurate figure of the exact number of people that are classified within all four FACS criteria levels. 2. The Council do not know how many people will be affected by the changes and therefore it is impossible to determine how much money will be saved by changing the criteria. Given that the proposals are prima facie about how much money will be saved by the Council, if the Council do not have an accurate picture of how much money they will save, which presumably justifies taking care away from thousands of people, then this calls into question the fundamental justification of these proposals. 3. The Council confirmed that they aim to “maximise the number of people in r eceipt of a service whose needs are reassessed and reviewed annually ” and “in 2012/13,
Bradford Council (2013) Report to January Executive Committee - Breakdown of clients with a community based service by FACS banding 2010-11.
65% of service users were reassessed and reviewed ”. However, the Council stated that in the past year 12/13 they assessed 3,400 people. 3,400 is not 65% of 8,500 people and therefore the Council’s data is wrong and cannot be relied upon. 4. Assuming that the 850 current ‘moderate’ users figure from the Council is accurate which represents 10% of all people with care needs, this is a dramatic change from the figures in 2010/11 where there were 2079 people with ‘moderate’ needs which represents 25% of total users. If the total number of those with ‘moderate’ needs has reduced, surely this calls into question the Council’s predictions that there will be future demographic pressures on the Council’s budget, which according to them is making them have no choice but to make these difficult cuts to Adult Social Care in Bradford. 5. North Yorkshire County Council is also currently consulting on changing its FACS criteria but it had no problem in identifying the number of people that will be affected by the proposal. At present North Yorkshire County Council provides services to 10,000 people assessed as being at FACS ‘moderate’ and above. Of the 10,000 approximately 2,600 were last assessed at the ‘moderate’ level 11- that’s about 25% of service users classified at ‘moderate’ needs in a neighbouring County Council. This is similar to Bradford Council’s original 2011 figure of 2079 with ‘moderate’ needs rather than the current 850 that they are stating. Due to the large number of inaccuracies and anomalies outlined above, we cannot have any confidence in the data provided by Bradford Council. They are either not being forthcoming with the real impact of their proposals or they do not actually know the full impact of their proposals. Either way is extremely troubling and calls into real question the fundamental rationale and justification for these proposals. How much money will the Council save? In the Council’s Executive report of January 2013, its states that “although approximately 25% of service users have moderate needs, this does not represent 25% of Adult and Community Services budget spend, with the type of services utilised being less intensive and therefore not as costly as those required to meet the needs of critical or substantial service users. Sampling of individual package costs of people identified with moderate needs suggests the total cost of their care is approximately £7.8million per annum, or approximately 10%”12. Therefore, the Council is proposing to remove relatively low cost services from people that represent good value for money in terms of their preventative nature. What is significant however is that the Council are not proposing to save £7.8million a year, but only £1.57m a year. As it states in January’s paper “Adults and Community Services could potentially save on 2011/12 figures £1.57million on service users with Low and Moderate needs only”13. Recommendations in January’s report are that the proposed changes to the FACS eligibility criteria and any savings be part of the budget setting process for 2014/15. Therefore, the Council is estimating that they can save £1.57m from Adult
North Yorkshire County Council (2013) Item 3, Revenue Budget 2013/14 and Medium Term Financial Strategy – paper to the Executive on 24th July 2013. 12 Bradford Council (2013) Report to January Executive Committee, 15th January 2013, Fair Access to Care Services, page 5. 13 Ibid, Page 6.
Social Care and that these savings can be incorporated into next year’s Counc il budget 2014/15. What is not clear is how the Council has arrived at the £1.57m figure. If all people who would currently be classified with ‘moderate’ needs would no longer be eligible for care then surely the Council should be saving all of the £7.8million that it costs to deliver care to these people. There must be an answer – but it is not clear. If we accept the Council’s £1.57m figure to be saved using the 2010/11 figure of 2079 people classified as having ‘moderate’ needs, then the Council’s estimated current figure of 850 people with ‘moderate’ needs suggests that on current demand it would only be saving around £620,000 if the proposed change in the FACS criteria is implemented. In January’s FACS paper to the Executive, it states that “the real financial savings will come from managing demand” and “the predicted future costs of packages of care is currently estimated to increase by £6.6m in 2015 and £21m in 2021 and therefore this demand needs to be managed”14. Yet, these figures released by the Council include all care packages and they do not state how much of this increase can be attributed to ‘moderate’ needs and therefore potential savings in the future. But perhaps more importantly, if the Council is stating that there will be 1,000 more service users by 2015, which is in 2 years time, why has the current figure from the Council for those with ‘moderate’ needs decreased by 60% and the total number of care users identified by the Council in 2010/11 (8779 as shown in table 1) is roughly the same (8,500) as those that the Council are claiming are currently on their books. If as claimed, there are to be a 1,000 more demands on the Council’s care services, surely we should currently see a noticeable increase in all people eligible for care, but we do not. Again, it appears that the Council do not have an accurate understanding of the numbers involved nor of the basic financial information for how much they will be able to save now or in the future. Given that the proposed changes to the FACS eligibility criteria is solely based on financial rationale, these inaccuracies call into question the central purpose of their proposals and it cannot proceed with the current financial information provided. Additionally, what is further troubling about the Council’s financial rationale is that within January’s Executive paper it states that “it is unlikely that this (1.57m) can be saved in the first year of change due to the phasing of the changes, and it will be incremental dependent on the rate and outcome of reassessment”15. Therefore, by the Council’s very own admission, it is highly unlikely that there will be any savings in 14/15 and therefore no savings can be made within the next financial year, contrary to current budgetary plans. A report by the Audit Commission in 2008 revealed that when a large number of Councils changed their FACS criteria they did not tend to experience lower care costs in the short term and that any costs reductions took longer than a year to come to fruition16. Therefore, there is a strong indication that the Council will not save any money in changing the FACS criteria in the short term and therefore their assumption that these savings can be made in the next financial year (14/15) are unrealistic and over-stated.
Bradford Council (2013) Report to January Executive Committee, 15th January 2013, Fair Access to Care Services, Page 6. Ibid, Page 6. 16 Audit Commission (2008). The Effect of Fair Access to Care Services Bands on Expenditure and Service Provision.
In the Audit Commission’s analysis of the comparison between local authorities’ expenditure on social care, it states that overall, because there is normally a higher number of lower cost ‘moderate’ users in an area than more costly ‘substantial’ service users, then changing the thresholds from ‘moderate’ to ‘substantial’ has a relatively small effect on budgets and so the “tightening of FACS bands is not a particularly powerful weapon for controlling costs”17. A further study of local authorities, by the London School of Economics (LSE), concluded that restricting eligibility criteria may not generate the desired effect of reducing demand for care services. The LSE found that a process called “up-coding” can take place whereby care managers in areas of restricted eligibility are more likely to classify a user as needing a higher FACS rating than might be suitable18. This is more likely to take place in authorities with a ‘substantial’ threshold than in those areas with a more generous eligibility threshold. It states that “policy changes aiming at tightening eligibility criteria, for instance, might lead to shifts in the interpretation by frontline workers of the different FACS groups, and to a relaxation in the need circumstances required to meet the new heightened eligibility threshold19”. In essence, because the FACS criteria are more ‘restricted’ in an area that has set its eligibility at ‘substantial’, care managers in these areas are more likely to be more generous with the interpretation of the criteria and thus those with ‘moderate’ care needs are more likely to be classified as having ‘substantial’ needs. Therefore, increasing the FACS criteria does not necessarily reduce the demand for care services as anticipated. Therefore, Bradford Council cannot be sure that changing the FACS criteria will save them as much as they anticipate. There is a large question mark over how much money the Council actually will save from its proposal. It is seriously concerning that Bradford Council is proposing to cut services to over 2,000 vulnerable people in Bradford on the basis of affordability when they neither have an accurate understanding of how much they will save nor when these savings can be made.
North Yorkshire County Council As a point of comparison against the inaccurate information provided by Bradford Council, in a recent Executive paper, North Yorkshire County Council (NYCC) had no trouble in confirming their proposals to increase the FACS eligibility criteria from ‘moderate’ to ‘substantial’ would save them £1.4m a year by 2015-16, with 2,600 people currently being assessed as having ‘moderate’ needs. They state that £800k would be released in 2014-15, £600k in 2015-16, then £1.4m per annum from then on20. This accurate financial modelling is in complete contrast to the lack of information given by its neighbour, Bradford Council.
Audit Commission (2008). The Effect of Fair Access to Care Services Bands on Expenditure and Service Provision Fernández, José-Luis and Snell, Tom (2012) Survey of fair access to care services: (FACS) assessment criteria among local authorities in England. Discussion paper, 2825. PSSRU, London School of Economics and Political Science, London, UK. 19 Ibid. Page 53 20 North Yorkshire County Council (2013) Item 3, Revenue Budget 2013/14 and Medium Term Financial Strategy – paper to the Executive on 24th July 2013.
As noted by Bradford Council in their proposals, as part of the proposed cuts, all ‘moderate’ service users would need to be reassessed as Councils are obliged to consider the effect on people of withdrawing their care services, which may result in service users being assessed at a higher level such as ‘substantial’. North Yorkshire also recognises this and allocates additional funding to address these extra pressures of reassessing all of their 2,600 service users with ‘moderate’ needs. However, Bradford Council does not. As noted in NYCC’s July report, “Raising the eligibility threshold under FACS would require additional short-term staff capacity to undertake the required number of individual community care and financial reassessments”21 and thus NYCC will release £1.1m in order to support delivery of the savings proposals relating to the review of the FACS criteria. Given that Bradford does not budget for the extra workload needed to undertake a significant proportion of reassessments, it brings their financial assumptions into doubt. Prevention and Early Intervention In the January FACS Executive paper, Bradford Council recognises that in cutting services to ‘moderate’ users it will be necessary to continue to maintain a strong focus on prevention and early intervention. This is in fact forms part of the rationale in Option 1 as the preferred option set out in the Executive paper. The Council are proposing to keep services like telecare, meals on wheels, smart technology and equipment and make them available to those on ‘low` and ‘moderate’ needs but they do not allocate any further resources to these services to help with the logical increase in demand. No matter how much technology you give someone to assist their needs, it will not help them with basic everyday duties such as cleaning, getting dressed or getting out of the house. These proposals in no way properly compensate for the loss of care services and take no account of the psychological impact of increased levels of isolation and loneliness that may occur. The Council further states that “savings will need to be balanced against continued investment in voluntary sector support and other Council services which would meet low or moderate needs”22 and that “some of these savings could be used to put into voluntary organisations and other Council services to meet low and moderate level needs savings from the cuts to eligibility”23. The point in raising this is that at no point does the Council state how much money it will be providing or the savings that will be made available to the voluntary sector in order make up for cuts in Council services. In effect, the Council are simply proposing to save money by transferring the burden of care onto the voluntary sector without paying for it. Section 2 of the Care Bill currently going through the Houses of Parliament, will place a legal duty on local authorities to take steps to prevent, delay or reduce adults’ needs for care and
North Yorkshire County Council (2013) Item 3, Revenue Budget 2013/14 and Medium Term Financial Strategy – paper to the Executive on 24th July 2013. Page 5.37 22 Bradford Council (2013) Report to January Executive Committee, 15th January 2013, Fair Access to Care Services, Page 6. 23 Bradford Council (2013) Fair Access to Care Services Consultation Page www.bradford.gov.uk/bmdc/Consultations/fair_access_to_care_services
support24. A local authority must provide or arrange for the provision of services, facilities or resources, or take other steps, which it considers will contribute towards preventing or delaying the development of adults care needs and support & reduce the care needs for adults in its area. A local authority must also have regard to the importance of identifying adults in the authority’s area who have needs for care and support which are not being met by the local authority due to eligibility. Whilst these are welcome steps to help prevent the need for more formal care, what the legislation masks is that the local authority does not necessarily have to pay for these services, only ensure that such preventative services are available in their local area. Section 2(3b) of the Care Bill states that a local authority can charge for delivering such services but any charge can only cover their costs25. Therefore, whilst the Council state that they will use some of the savings from increasing the criteria to offset the damage done in cutting these services, in many cases the Council will be able to legitimately charge for the same services labelled “preventative services” that they have just been taken away from people. Such a development would not be in the best interests of the 2,000 vulnerable people in Bradford nor the many who would not be able to afford it and therefore get no care at all.
Right of Information Under the Care Bill, Section 4 will make it a legal obligation for Councils to provide and maintain a system for providing information to people in their area, whether they are getting formal care or not, regarding information and advice relating to care and support for adults and support for carers26. As part of their proposals to cut services, Bradford Council state that an adult with any level of need still has the right to a community care assessment, as do carers. If the person’s needs are not eligible, which in the future will be people with ‘moderate’ needs, Bradford Council will nonetheless still be under a duty to provide advice and information to these people about how to meet the needs they do have, and information about what might be available in the community, or from other sources, to support them. Whilst the provision of these services is welcome, such informational support is no way near enough for someone that needs regular help with feeding, getting dressed and various other delay tasks. The only information that the Council will provide to a person is what their needs are and which organisations can help them if they pay for these services. The Council will be simply transferring the cost burden from themselves onto vulnerable Bradfordians, who in many cases will not be able to afford the care that they need nor able to seek out their own care packages which are essential in order to try and live independent and healthy lives.
Care Bill (2013) http://services.parliament.uk/bills/2013-14/care.html - Section 2 Care Bill (2013) http://services.parliament.uk/bills/2013-14/care.html - Section 2(3b) 26 Care Bill (2013) http://services.parliament.uk/bills/2013-14/care.html - Section
As part of their consultation, Bradford Council is seeking views on the availability and suitability of current information and advice services in the area. At a recent meeting of the Bradford and District Disabled People’s Forum on 4th June held in response to the Council’s proposed cuts, most groups that attended thought that there was not enough information available for current and possible service users in Bradford. They thought that the information available was not accessible enough and that more funding needs to be made available for advice and information to be improved. In David Ward’s Social Care summer survey in 2012, access to information was an issue raised by nearly everyone contacted in the course of the research. Many people said that they found it difficult to access information and advice on care and support, particularly when they first tried to engage with the system. Several of the groups consulted expressed a strong preference for receiving information face to face. A number of respondents suggested that GPs could play a greater role in signposting services for care users. A recent study by the Joseph Rowntree Foundation27, focusing on the needs of ethnic minority communities, found that many find it difficult to access timely information about services in Bradford, often leading to participants not receiving services or benefits that they are entitled to. The Government has previously allocated £32million to local authorities to improve access to information and to set up a national online information tool covering both health and care. Given that there is a commitment by the Council to provide information, the proposed cuts will result in thousands of people needing to access informational services with consequential budgetary implications. If the level of information currently held is not comprehensive enough and there is a large increase in demand for information, then the Council will need a significant investment in its advice and informational services. However, the Council does not commit any new funding for these services. With no additional funding streams allocated to informational services, it makes it very questionable how the Council will realise this as part of the reduction in services without additional resources. In summary, the burden of future care costs has led the Council to propose to cut services to all people with ‘moderate’ needs and to replace service provision with information on where they can go to pay for the care that they need themselves. It is not known how many people this will affect, how much money the Council will save, if its cost projections are accurate or where extra resources for the increase in demand for preventative and informational services will be found. The basic premise of the Council’s proposals is based on financial arguments and they have fundamentally failed to justify their proposals on a financial cost savings basis. We do not accept the evidential base for the Council’s proposals.
Cattan, M & Giuntoli, G (2010) Care and support for older people and carers in Bradford: Their perspectives, aspirations and experiences.
Who will be affected by the proposals
As highlighted in the previous section, we do not have a definitive answer from the Council on how many people will be affected by the changes to the FACS criteria. North Yorkshire County Council states that it collects information on its Adult Social Care users “on a database in order to manage their care needs. This information includes client type, FACS level and equality profile”28. This is why they were able to model the number of people affected by their proposals and the cost savings resulting from this. Those with ‘moderate’ care needs require some help with the real basics in life such as getting out of bed safely and getting dressed, washing, cleaning the house, help with work, education or domestic paperwork and help to get out of the house and socialise with other people. This alone does not provide a clear picture of the types of people who will be affected by the policy change and it’s important to put a human face on the thousands of people who will have their services cut if the Council’s proposals go ahead.
Older People in Bradford The Council states that the largest group affected by the proposals will be older people. In the Equalities Impact Assessment report to the Council’s Executive Committee in January, it states that the highest number of people who will be affected by the proposals are those over 80 who are disproportionately represented as having ‘moderate` needs29. In the Council’s figures for 2010/11 in table 1, it states that 22% of over 65’s are classed as having moderate needs, which is just below 15% of the total number of people the Council provides care for. Four out of ten (36 %) respondents to a national survey stated that due to the withdrawal of funding for their support, they were not able to fulfil basic personal care tasks such as washing once a day, getting dressed, eating home-cooked food or getting out of the house30. If older people do not get the care and support that they need, their conditions deteriorate and it costs more in the long term to tackle their needs. At a recent meeting of the Bradford and District Disabled People’s Forum on 4 th June held in response to the proposals, feedback from older people at the meeting was that they thought that it is hard to access services now and difficult to get provision currently from the Council. Other than the obvious health and wellbeing effects on older people caused by the withdrawal of services and the inability to pay for their own care, perhaps the most damaging effect on holder people is loneliness. The Royal Voluntary Service states there are 342,000 people in Britain over 75 years of age who say they feel trapped in their own homes through lack of suitable transport and 9% of older people say that they feel that they have
North Yorkshire County Council (2013) Item 3, Revenue Budget 2013/14 and Medium Term Financial Strategy – paper to the Executive on 24th July 2013. Page 73. 29 Fair Access to Care Services - Report of the Interim Director of Adult and Community Services to the meeting of the Council Executive to be held on 15 January 2013. 30 Scope et al (2013) The other care crisis: Making social care funding work for disabled adults in England
lost their independence as they are unable to get out and about31. Nearly three-quarters of over 75s who live alone feel lonely and more worryingly, those that do live alone, are in contact with their children less often than those who live with a spouse32. According to a survey carried out by Age UK, on average around 10 per cent of people over65 believe that they are lonely or are very lonely33. Given the Office of National Statistics estimate of 79,41034 people aged over 65 living in Bradford, approximately 8,000 older people in the district are likely therefore to be lonely most of the time. 95% of respondents to David Ward’s summer social care survey in 2012 indicated that they believed loneliness to be a major health issue among older people in Bradford. Research suggests that loneliness can have severe long-term health effects. For example, a recent study found that loneliness can increase the risk of death amongst the over-65s by almost 10 per cent35. Loneliness is associated with a number of negative health outcomes including mortality, morbidity, depression and suicide. A 2008 study from the University of Chicago found that chronic loneliness is a health risk factor comparable to smoking or obesity and contributes to a suppressed immune system, high blood pressure and increased levels of stress36. The reason why ‘moderate’ care is so important in tackling loneliness is that for many people, their only social contact is with the services provided to them through having this need. Whether it’s through a visit by a carer or help with creating and maintaining social contacts, services provided through ‘moderate’ care helps combat loneliness with hugely positive wellbeing benefits. Older people living alone are significantly less likely to have visited a doctor as a result of a fall and are less likely to have interaction with someone that can notice any deterioration in their condition. If older people with ‘moderate’ needs are not provided with help and support then their condition will deteriorate, which is not only detrimental to that person’s health, but will also increase the probability of more expensive residential care, hospitalisation and in some cases premature death.
Working age people with physical or learning Disabilities in Bradford From the Council’s FACS data in table 1, it states that there are 788 people in Bradford between the ages of 16-64. These will be working-age disabled people who either have a physical, mental or learning condition. These people account for 9% of the total number of service users in Bradford. For disabled people with progressive conditions, being assessed as having ‘moderate’ needs and no longer being eligible for care will mean the significant deterioration of their
Womens Royal Voluntary Service (2012) Loneliness amongst older people and the impact of family connections. Ibid. 33 Victor, C. ‘Loneliness in older age: the UK perspective’ in Age UK Oxfordshire (2011) Safeguarding the Convoy: a call to action from the Campaign to End Loneliness 34 2011 Census – Population and Household Estimates for England and Wales, March 2011 35 http://health.universityofcalifornia.edu/2012/06/18/loneliness-linked-to-serious-health-problems-deathamong-elderly/ 36 Womens Royal Voluntary Service (2012) Loneliness amongst older people and the impact of family connections.
condition. This introduces a perversity into the social care system; where some disabled adults will have to wait until their conditions deteriorate before they are deemed as having ‘substantial’ needs and thus eligible for care. This is backed up with recent research by Scope which states that 41% of respondents to their survey said that they were unable to get out of the house due to inadequate social care and with 35% saying that they could not work due to lack of social care37. Care at the ‘moderate’ level enables and supports working age disabled people in employment. This makes them more self sustainable, increases wellbeing and is a financial stimulus to the local economy. Should more working-age disabled people not be eligible for care, then they may no longer be able to sustain work with wellbeing implications for those concerned and increased pressure on welfare budgets. Tim has a visual impairment. He has received support from the Council for several years, but his care package has been reduced. He has been told that if he still wants support with shopping, he will have to pay for it himself38. Setting the national eligibility threshold at ‘substantial’ would also badly affect those with physical and learning conditions as these conditions can fluctuate. These people’s conditions can vary between having different levels of need either ‘moderate’ or ‘substantial’. Some disabled people are assessed as having ‘moderate’ needs on a good day, but then lack the support they need to keep well or to help them cope during more difficult periods and thus have a higher level of need. Someone who has a stroke and leaves hospital may have ‘substantial’ needs at first. But through support and treatment, their condition gets slowly better until they only have ‘moderate’ needs. But because they live in an area that only provides support with ‘substantial’ needs, this important care and support is taken away and their condition deteriorates. The example of Matthew below illustrates this problem. Most of the time Matthew needs help with just one or two everyday tasks, and a little help with his work and family life. But Matthew has a fluctuating condition, and because of a reduction in the care and support services he receives, has been bedridden for weeks39. Regarding learning disabilities, the National Autistic Society said ‘substantial’ criteria for those who should receive social care completely "overlooks" autistic people who would not be recognised as needing support. Many people with autism already struggle to have their condition identified where fewer than half of English Councils have any system in place for diagnosis, and some can be particularly vulnerable to neglect and abuse 40. Furthermore, some people with high functioning autism or Asperger syndrome may only need some seemingly low levels of support, such as help with social skills and managing about the house (e.g. with bills and organising cleaning activities). Frequently, these types of need are not recognised by Councils as being ‘substantial’, yet without this help, this group
Scope et al (2013) The other care crisis: Making social care funding work for disabled adults in England Ibid. 39 Ibid. 40 Tracey McVeigh (2013) The Observer Newspaper, Autism Charity condemns new rules on eligibility for social care June 30th 2013. http://www.guardian.co.uk/society/2013/jun/29/autism-charity-eligibility-social-care
are at risk of developing more severe problems, such as social isolation and severe mental health problems. Sarah has a learning disability and lives independently. For several years, she enjoyed going to a local day centre once a week. The council has now stopped funding people with ‘moderate’ needs so Sarah is now stuck at home41. As stated earlier, what is even more worrying is that the number of people living with learning difficulties is increasing in Bradford and therefore there will be even more people in the future that do not receive any paid care and support services from the Council.
Scope et al (2013) The other care crisis: Making social care funding work for disabled adults in England
7. The financial benefits of intervention and early prevention What we and the Council do agree on are the benefits that intervention and early prevention can have on the welfare of people with needs. However, what we fundamentally disagree on is what we deem as intervention and early prevention and the amount of services that should be provided. In their review of social care for adults Emerson, Hatton and Robertson (2011), found that prevention is typically categorised into three levels: - Primary prevention which seeks to eliminate or reduce need by reducing the probability of it initially occurring. - Secondary prevention which seeks to eliminate or reduce need by intervening in the early stages of the development of the need in order to reduce the probability of it escalating. - Tertiary prevention which seeks to eliminate or reduce need by providing effective support to people who already experience such a need to prevent further disability or disadvantage and, as far as possible, to restore functioning42. In our view, providing support and care services at ‘moderate’ needs adheres to all three levels of prevention but particularly tertiary prevention where you are providing services to people who are already experiencing a need and to manage or prevent the deterioration of their conditions. This is because to be assessed as having ‘moderate’ needs, a person will already have to be presenting effects of a condition they are suffering from in the form of the deterioration in their health, wellbeing and functionalities. In effect, providing services at ‘moderate’ level needs is a very effective form of intervention and early prevention. As we will explain, delaying morbidity and the deterioration of conditions improves wellbeing outcomes for individuals but also saves money in the long run and justifying the resources used to pay for ‘moderate’ care needs. What happens when you don’t provide ‘moderate’ care? When a person does not get the care they require, their health needs are likely to escalate resulting in declining health and wellbeing. In many cases, if a person has a care need which needs to be addressed and they do not get paid care from the Council, the person will be in a worse financial position as they will either have to pay for the care that they need themselves or in the case of working age adults lose income from employment that they cannot undertake. In all cases, with deterioration in a person’s health, this results in increased costs to the state when they re-enter the care or health system with a higher level of need. A recent survey by the charity Scope found that two in five disabled people are failing to have their basic needs met, with almost four out of ten unable to eat, wash, dress or get out of the house, which has led to nearly half withdrawing from community life and one third
Emerson, Eric, Hatton, Chris Hatton & Robertson, Janet (2011) Prevention and Social Care for Adults with Learning Disabilities
being unable to work or take part in volunteering or training activities after losing their care package43. The Linkage Community Trust agreed with this assessment noting that people with lower levels of need ‘slip through the net’ and that they had seen increasing number s of people reaching crisis as a consequence44. Preventative support has to be tailored to the individual but whether it’s low level support like personal or home help, cooking or cleaning or whether it’s more social aspects such as helping to manage budgets or help communicating with family and friends, interventions of this kind can prevent people’s needs from unnecessarily escalating . Providing support at ‘moderate’ really can mean the difference between a person being able to live at home in their own community or having to go into residential care following a crisis. When giving evidence to an All Party Parliamentary Group investigation into social care reform, the NHS Confederation stated that they were not surprised that many councils have tightened eligibility criteria given cuts in local government finances but affirmed that “ when people’s needs are not met by the social care system, they turn to the NHS, which experiences the impact in the form of increased demand for emergency and unplanned work, and delays in discharging people from hospital ”45. Therefore, by reducing eligibility and pushing people out of the formal care system, councils are simply pushing the financial burden on addressing care needs from themselves onto the NHS. Furthermore, because there is a delay in people entering the care or NHS system, they do so at a higher level of need than they would been when assessed by the local authority originally and therefore the costs to the taxpayer in dealing with that person are increased. In effect, if eligibility is reduced from ‘moderate’ level needs, over 2,000 people in Bradford will be pushed out of the care and support system with the risk being that they re-enter it at a higher level of need and at a substantially higher cost.
Financial benefits of prevention and intervention It is very important to focus on the costs associated with the cuts to ‘moderate’ needs because as the Council is making an argument that ‘moderate’ needs are no longer affordable, it is important to demonstrate that this is a false economy and that it is actually cost-effective to invest in ‘moderate’ level needs. The British Red Cross delivers schemes across the country that provide people, following a crisis or admission to hospital, with practical and emotional support in order to improve that person’s wellbeing and increase resilience to be able to cope in the future46. The purpose behind these programmes is to reduce the likelihood of future avoidable readmissions to
Joint APPG Disability & Local Government Groups Inquiry (2013) Promoting Independence, Preventing Crisis: Making Social Care reform work for disabled adults 44 Ibid. 45 Ibid. Page 36 46 Deloitte (2012). The economic impact of care in the home services: A report commissioned by the British Red Cross, November 2012.
hospital and support their emotional wellbeing by helping them to live safely and with increased confidence in their own homes. Based on analysis by Deloitte of six of these schemes, Deloitte found that they were delivering substantial savings to health and social care commissioners. Savings per user from these schemes are estimated to range from £168 to £704 giving a rate of return between 40%-280%47. As a direct result of providing preventative care, savings are produced by preventing admission or readmission to hospital, reducing length of hospital stays and preventing or minimising the use of expensive domiciliary and residential care. The British Red Cross schemes were estimated to have the potential to save commissioners around £8m across these six schemes alone, which on average implies an overall return of 149%, that’s £1.50 back for every £1 spent on preventative care48. The analysis by Deloitte goes further stating that the savings they discovered can be categorised into savings by both the NHS and the local authority. The six schemes are estimated to cost health and social care commissioners approximately £5.4m but prevented the need for £13.4m of expenditure thus saving healthcare commissioners £3.2m, and social care commissioners £4.8m49. In another British Red Cross study they demonstrate further that savings can be realised from preventative care. In association with the New Economics Foundation, they conducted an independent economic analysis of the costs which could have been incurred by the state to treat and deliver care to five people, had preventative services not been used. They estimated that early care and preventative work delivered by the British Red Cross delivered savings of between £700 and £10,430 per person, which is a minimum return on investment in preventative care of over three and a half times the cost of the service, and in most cases significantly more50. The charity Scope has also completed significant modelling of the financial benefits to the NHS and councils of investing in preventative care and meeting ‘moderate’ needs. By analysing four different interventions, modelling by Deloitte for Scope estimates significant returns of up to 53% in any investment in providing ‘moderate’ needs with an average return greater than 30%51. In other words, for every £1 spent on care and support for people with ‘moderate’ level needs, an average of £1.30 will go back to the NHS, local and Central Government, and individuals themselves52. With cuts by local government in care and support services over the past ten years through increasing eligibility thresholds, the London School of Economics suggests that social care for disabled people alone is underfunded by at least £1.2 billion or 0.17% of public expenditure53. However, if we apply the Deloitte analysis to the potential cost savings in
Deloitte (2012) The economic impact of care in the home services: A report commissioned by the British Red Cross, November 2012. Ibid. 49 Ibid. 50 British Red Cross (2012) Taking Stock: Assessing the value of preventative Support 51 Scope et al (2013) Ending the other care crisis: Making the case for investment in preventative care and support for disabled adults 52 Ibid. 53 Scope et al (2013) The other care crisis: Making social care funding work for disabled adults in England
investing in ‘moderate’ needs to the tune of 1.2billion, then Scope suggests that closing this gap could lead to a ‘profit’ of £355m with a potential return of 39% to the NHS and local authorities54. If we extend such modelling on investing in ‘moderate’ care needs in Bradford and use the Council’s figure of £7.8m a year to deliver these services, then this is actually saving the Council and the NHS anywhere between 10.14m (130% return), £11.7m (150% return) or 27.3m (350%). The Council’s current proposals to stop preventative and ‘moderate’ services will cost more in the long run and could result, as a conservative estimate, in further costs of £2.34m to the Council and NHS. Therefore, the Council’s whole rationale for cutting services to save money is based upon a false premise and a faulty economic model.
Scope et al (2013) Ending the other care crisis: Making the case for investment in preventative care and support for disabled adults
8. National changes to FACS and Social Care
It is very important to set the Council’s proposed changes to the FACS eligibility criteria within the national context. Under Clause 13 of the Care Bill, it introduces a national minimum eligibility criterion55. The minimum threshold for people’s care and support needs will be a legal minimum guarantee of care which must be met by local authorities in all areas. Local authorities will not be able to restrict eligibility above this threshold and it will come into effect by April 2015. Councils will still have the opportunity to provide extra care and support to service users if they wish to do so but they will not legally be able to provide less care than the minimum that people will be legally entitled to. The rationale for making these changes is to stop the postcode lottery of care, where different authorities set different levels of eligibility for care. Because care eligibility is set locally, should a person move from one local authority to another, it is possible that their care needs will no longer be met once they move. This will ensure that people across the country can expect a certain legal minimum level of care wherever they are or wherever they move to. For those council’s that are currently providing care and support at a more restricted level then the proposed new national minimum, the Government will be providing funding that will support those Councils in providing a more generous social care system. The Department of Health estimates that the additional cost of local authorities meeting the national eligibility criteria is likely to be around £23 million 56. As part of these changes, the Department of Health will be implementing a completely new system of eligibility criteria, getting rid of the four different levels of assessed need ‘low, moderate, substantial and critical` and replacing it with one minimum level. Should your assessed needs meet this eligibility, then whatever your needs are, a suitable care package will be provided. The Department of Health states that their aim is to “ continue to improve the assessment framework so that it supports personalisation, prevents and reduces needs wherever possible, and helps people connect better with their communities ”57. In order to assist in implementing a new eligibility system and to help provide advice and support to the Government, the Department of Health has established a working group, the Care and Support Transformation Group, which will include the Department of Health and key members from the care and support sector. The draft national minimum eligibility threshold was published in June 2013 and is out to consultation until 29th November 2013. Following this initial consultation, a new version of the criteria will be published for public consultation from Spring 2014. Following this consultation, regulations to enact the new threshold will be laid before Parliament under
Care Bill (2013) http://services.parliament.uk/bills/2013-14/care.html - Clause 13 Department of Health (2013) Draft national minimum eligibility threshold for adult care and support: A discussion document 57 Ibid.
the affirmative procedure (which means that Parliament will debate and vote on the regulations) in autumn 2014, and will come into effect from April 2015. Whilst setting a new national minimum for eligibility and giving people peace of mind that wherever they live, they should legally be able to expect the same level of service, is certainly welcome, the national minimum counts for very little if the level at which is set is too high. As first announced in the Chancellor’s Comprehensive Spending R eview for 2013, the new national minimum eligibility criteria will be set at the equivalent of ‘substantial’ needs from 2015. The Government states that they are setting the new standard at ‘substantial’ because 87% of councils, as identified by The Association of Directors of Adult Social Services (ADASS), have set their eligibility for 2013/4 at ‘substantial` or above58. As highlighted in responses to David Ward’s summer care survey in 2012, there was concern that setting the national minimum at ‘substantial’ would lead to some local authorities levelling down and cutting services from ‘moderate’ to ‘substantial’. However, as confirmed by the Department of Health those local authorities who provide care and support to meet ‘moderate’ needs of which 12% do at present, will be free to decide to continue to do so59. What is striking however is that the Council are trying to change the eligibility criteria just shortly before the whole system will change. The Council will be spending hundreds of thousands of pounds to change their eligibility criteria only just before having to spend even more money changing their system again when the new FACS criteria becomes operational in 2015. Rather than having to face two changes in FACS criteria in subsequent years, surely it makes more sense to continue the current system of eligibility, thereby protecting thousands of people’s care services, until the Council will have to make some changes in 2015 when implementing the new FACS criteria. Funding for joined up health and social care As part of the Comprehensive Spending Review in June 2013, the Chancellor made another important announcement committing £3.8bn into a programme of integrated health and social care across the country. £2bn of this money will be from a direct transfer from the NHS to local authorities. The integrated budget will be overseen by local Health and Wellbeing Boards. The £3.8bn investment in more joined-up preventative care is expected to save £1bn alone. The fund will help to ensure that health and social care services work together to improve outcomes for local people by ensuring better information sharing, intervening early so that older and disabled people can stay healthy and independent at home, which will help avoid unnecessary hospital admissions and reducing A&E visits.
Association of Directors of Adult Social Services (2013) ADASS Budget Survey 2013 Department of Health (2013) Draft national minimum eligibility threshold for adult care and support: A discussion document
Merging budgets in this way will help drive down costs to hospitals by tackling expensive pressure points in the system (like A&E), by preventing ill health and keeping people out of hospital, and by allowing people to stay in their homes and live independently. Bradford itself has made good progress in trying to integrate health and social care. Established in November 2010, the Integrated Care Management Board was set up to shape the future of integration of care and health support in Bradford, Airedale, Wharfedale and Craven. Reporting in December 2012, the Board stated that four of the pilot/test sites in Bradford set up in Bradford are now operational with each having identified a small number of patients around which services are integrated60. Cath Doman, Head of Community Health Services at NHS Airedale, Bradford and Leeds confirmed that these integrated pilots are linked to groups of GP practices and will test out integrated community teams made up of community health services, social care services and voluntary and community services, and will be organised by one team, with one manager61. However, a progress report in December noted that the pace of reform in Bradford in addressing the problems of a split health and social care system has been slow. However, what is significant about the new money available from the Government is that it represents a new opportunity with additional funding to invigorate the process of integrated care in Bradford. It presents a very interesting opportunity for the Council to work with the NHS in not only funding more preventative care post hospital admission, but to actually fund social care services at the ‘moderate’ level. As evidentially established earlier, providing ‘moderate’ level care is a proven tool in saving significant amounts of money both for the local authority and the NHS. A £1.30 savings for every pound spent62. If Bradford Council worked jointly with local hospitals and local Clinical Commissioning Groups through the Health and Wellbeing Board to apply for some of the £2bn fund to undertake more preventative work, then the Council may be able to afford to continue to provide care at the ‘moderate’ level. Rather than trying to save money in isolation, Bradford Council has a very good argument to suggest that providing ‘moderate’ care is an effective preventative measure that saves money both for Clinical Commissiong Groups and local hospitals. In effect, the Council will be funded to provide services at ‘moderate’ needs. Therefore, rather than doing a quick “cut and shut” job on the provision of care services due to concerns with available funding, with a bit more effort, Bradford Council has a real opportunity to safeguard and improve current adult social care services and by doing so they will be able to continue to provide social care services at the ‘moderate’ level to thousands of vulnerable people in Bradford.
http://www.bdct.nhs.uk/wp-content/uploads/Implementation-of-the-Integrated-Care-for-Adults-Programme-in-Bradford-AiredaleWharfedale-Craven.pdf 61 http://www.thetelegraphandargus.co.uk/news/local/localbrad/9523398.Elderly_health_care_in_Bradford_set_to_be_simplified/ 62 Scope et al (2013) Ending the other care crisis: Making the case for investment in preventative care and support for disabled adults
You may wonder why it is the official dictum to label services which we provide to adults who need assistance to live healthy, active and engaged lives as “Adult Social Care”. If we look up care in the Oxford English Dictionary, it states that to care is to “take thought for, provide for, look after, take care of” and “to have regard, fondness, or attachment for a person”. However, when we talk of care for adults across the country, what we mean to say is support services, not care. If we meant care then we would not have under funding of services by local authorities, people cleaned and fed in only 15minute appointments and horrible abuses in some of our care homes. Some have lost touch with what we mean when we talk of caring for someone. Bradfordians have always cared though about the way that we treat the most vulnerable members in our city. That’s why we have always made sure that adult support services are made available to people that need it and in fact we do this when 87% of other local authorities don’t. It is to the credit of Councillors in Bradford in all political Groups that Bradford retains the FACS eligibility criteria at the ‘moderate’ level. It is apparent that not many local authorities across the country fought as hard as we did to keep our level of services to vulnerable people because since, 2005, there has been a huge increase in thresholds for FACS eligibility. In 2005/06, 53% of the 152 local authorities in England provided care and support to those with ‘substantial’ needs and above and 40% provided services at ‘moderate’ needs. But by 09/10 eligibility threshold had increased so that 72% of local authorities provided care at ‘substantial’ needs and above and by 2012/13, 83% cent were only providing services at the higher threshold of ‘substantial’ needs63. Now according to ADASS there are 87% of Councils have set their eligibility for 2013/4 at substantial or above with only 12% of Council’s providing ‘moderate’ needs64. As a direct result of this a study commissioned by Scope found that 69,000 disabled adults (18 to 64 years) with moderate level needs and 8,000 with substantial level needs had already fallen out of the system65. They note that if all Councils were to raise their eligibility to the ‘substantial` level, a further 36,000 disabled adults would lose the support they receive, or 105,000 disabled adults in total66. However, this demonstrates that the changes since 2010 only represents 15% of the changes to FACS. The biggest change 19%, came before any austerity measures were implemented by the Coalition Government. Whilst this demonstrates that adult social care has been chronically underfunded by governments and by local authorities, it is also symptomatic that Councils have not fought hard enough to keep an appropriate level of
63 64 65
Age UK (2012) Care in Crisis 2012 Association of Directors of Adult Social Services (2013) ADASS Budget Survey 2013 Scope et al (2013) The other care crisis: Making social care funding work for disabled adults in England 66 Ibid.
care and support to vulnerable adults in their areas. It shows that they did not care enough to fight to keep these services and we must not make the same mistake in Bradford. On Monday 15th July, David Ward MP, the local Liberal Democrats and the Bradford and District Disabled People’s Forum were joined by Rt. Hon Paul Burtsow MP, the former Care Services Minister, Scope, Age UK Bradford and up to fifty local organisations and care users to launch Bradford Cares, in the Carlisle Business Centre. Bradford Cares67 was our opportunity to come together with key stakeholders and care users to speak with one voice, making a statement to the Council that we should not put up with a poorer standard of care for our loved ones in Bradford. Just because other council’s have increased their eligibility criteria and the Gov ernment has set their new national minimum at a level we believe is too high, denying hundreds of thousands of people the care and support that they need and deserve, it does not mean that Bradford has to follow their bad example. Why should we settle for a poorer standard of care then we currently have for our vulnerable residents when, with a bit more hard work the money can be found to maintain existing levels of care. The sole purpose of adult social care in Bradford should be to help people remain living as independently as possible for as long as possible in the setting of their choice. Therefore, it is imperative that we care enough to give as big an opening as we can into social care system by keeping eligibility at ‘moderate’ which will help delay the need for chronic, more expensive care, and therefore help people to live more independently, to reduce longer term expenditure for Adult Social Care departments and to help people live the lives of their choosing. We care about how we treat the most vulnerable people in Bradford, local organisations care, and the Council now needs to demonstrate that they care also by not going through with a proposal that will adversely affect the lives of thousands of people in Bradford.
In this paper we have demonstrated that whilst Bradford Council is experiencing both austerity and demographic pressures on their budget, they have comprehensively failed to set out the financial rationale for making devastating and fundamental service cuts to the lives of thousands of people in Bradford. Bradford Council’s plans to increase the FACS criteria and save money are financially unsound. The most disappointing aspect of the Council’s proposals is that with the future funding for integrated social and health services, it represents a once in a lifetime opportunity to fundamentally change the relationship between service users and support providers. With more political will, Bradford Council could actually save money and create an environment that would both secure the provision of ‘moderate’ services and provide better, more holistic health and social care across Bradford. To sum up, below is list of all the reasons why the Council’s proposed social care cuts should be cancelled forthwith: - There are fundamental inaccuracies with the data provided by the Council - we still do not know how many people will be affected by the cuts. - There is no conclusive evidence about how much money the Council will save - the accuracy of the Council’s modelling of future budgetary pressures is weak. - There is no provision for extra resources for the services (information and preventative services) that the Council plan to make available to those no longer eligible for care. - Any potential savings will not be realised in the first financial year. This is contrary to current financial planning in making savings in the next financial year 2014/15. - Providing ‘moderate’ care services is a crucial preventative and early intervention tool, helping support in the early onset of conditions, alleviating the deterioration of health conditions and the need for more expensive acute care and health services. - Providing preventative care in the form of ‘moderate’ care services saves millions of pounds both for local authorities and the NHS. - Ceasing the provision of ‘moderate’ care will cost more to the Council in the future. - With £2bn committed by the Government for joined up health and social care, Bradford Council has the opportunity to work with heath and care partners to secure funding to sustain the provision of ‘moderate’ care services and improve health and wellbeing outcomes, whilst also alleviating the Council’s own budgetary pressures. - With changes in the Care Bill, this will create a whole new system of eligibility criteria by 2015 – it is the wrong time to make changes now. - Bradford has always provided a higher level of services to its vulnerable citizens. It should not change this now just because others have and care less than we do. - And most importantly the incalculable damage that will be caused to the health, wellbeing and basic rights to live an independent and functioning life for all those that will see cuts to their basic care and support. For all these reasons, we urge the Council to withdraw its proposal to change the FACS criteria.