The long-awaited Care Bill has finally been introduced to Parliament. Drawing on work by the Commission on Funding of Care and Support (otherwise known as the Dilnot Commission) and the Law Commission’s review of adult social care law, the Bill has the potential to make significant improvements to the way that social care works. However, we don’t believe it will solve the current care crisis. Nor will the £3.8 billion announced in June’s Comprehensive Spending Review to integrate health and social care, much as we welcome it and the fact the Government are taking care seriously.
The simple reason why the Bill can’t fix the problem, however, comes down to “eligibility” for support. One of the most widely reported aspects of the Bill was the creation of a cap on care costs, which will be set at £72,000 for people of state pension age. Less well known is the issue that really matters for millions of disabled people of working age: the setting of new criteria to decide on a person’s eligibility for care and support.
Currently, there are four levels of eligibility under the ‘Fair Access to Care’ (FACS) guidance – low, moderate, substantial and critical. With local authorities facing increasingly difficult financial situations, more and more are restricting access to care to those with the highest needs. 83% of councils now only provide support to those with substantial or critical needs, up from 53% eight years ago.
The Care Bill replaces FACS with a new simplified national eligibility threshold which will standardise access to social care across the country. This has some clear benefits – it will help people move to different areas without fear of losing their support – but we, like many other disability charities, are disappointed if not surprised that it has been set at the equivalent of the current level of “substantial”. In other words, if you aren’t quite “disabled enough”, you will no longer be entitled to support.
We are concerned that some people who are currently supported by a local authority who do currently provide services to people with "moderate" needs will now see that lifeline severed. And we have seen the devastating effects of this first hand.
We support one woman with a moderate learning disability who had all her support cut after 26 years of receiving help to maintain her household and independence. She quickly became overwhelmed by housing problems she lacked the skills or confidence to resolve herself. At the same time her mental health and confidence went steeply downhill, and she stopped taking medication for a chronic health condition.
She was fortunate. A member of our staff visited her on a voluntary basis and alerted relevant agencies. It was agreed that she would appeal the decision and in the meantime use her modest savings to buy in some essential support. She now receives two hours of support a week: not enough to live a full life, but just enough to prevent further decline.
Sadly, the vast majority people with moderate disabilities do not have savings and cannot count on having people visit them at home to see what is happening and who are able to do something about it. Elderly and disabled people are often socially and physically isolated, and we believe thousands are suffering in silence and invisibility. Without support, their mental and physical health will deteriorate, perhaps sharply, and this will cost the taxpayer even more in the long run as the NHS and other services have to step into the breach. This is the falsest of economies.
Perhaps in an attempt to counterbalance the restricted access to care, the Bill does – rightly – have a strong emphasis on universal preventative support. The Government’s intention is to ensure that the needs of people who are receiving care do not in fact escalate in the way we just described. The Government argues that those who are not yet eligible for care should be able to access universal services which might help to prevent or delay their needs from developing.
However, this policy still appears sketchy to us, raising as many questions as it answers. How will eligibility for preventative services be decided? How will recipients be identified? If the idea is that they will seek out services themselves, then people with learning disabilities, who find navigating bureaucracies almost overwhelmingly difficult, will almost certainly be disadvantaged. How will cash-strapped local authorities fund preventative services? How will the success of those services be measured?
Supporters of the Bill may also point out that local authorities are able to provide services to those who do not meet the new eligibility criteria on a discretionary basis: “if local authorities wish to do so they can meet other needs which are below the national threshold”. Once again, more questions are raised. How exactly are they able to do this legally and fairly? Doesn’t this worsen the postcode lottery the Government said it wanted to tackle?
The final question is the biggest. How will we know if the Bill has worked? How will we accurately measure if social care is more effective after its measures have been implemented? How will we be sure that millions of “ineligible” disabled people haven’t simply fallen through the cracks? In the years ahead it is up to us all - disabled people and those organisations working with them - to stay highly alert for evidence of success or failure, and be outspoken in telling the world about both.
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