Disability and Social Care

The case that I wrote about yesterday may have a massive impact on adult social care in this country. The outcome of the appeal may make it easier for councils to slash social care services. But, as David Batty points out in The Guardian today, councils in England are already slashing adult social care services due to a lack of funding resulting from the Government's cuts.

The article says that:

The number of councils in England cutting back on free adult social care has increased by 13% this year, according to the Association of Directors of Adult Social Services (Adass).

It found that 19 local authorities had raised the eligibility bar for free adult social care.

Six councils, including the largest, Birmingham, are limiting free care to people in "critical" need, which includes those with life-threatening conditions. Another 116 of 148 councils surveyed only fund people with substantial needs.

Only 22 local authorities now fund people with moderate needs, such as those too frail or ill to eat a meal or take a bath without assistance. Previously, 36 councils gave this assistance.

This is not just a problem for England either, as the knock-on effects of cuts affect services in the devolved nations. Wales and Scotland have some leeway when deciding on their funding priorities, but the squeeze on local authorities in these nations is also causing problems when it comes to social care. This is a problem for Britain as a whole.

The use of the word "free" in the article is slightly misleading, as councils normally charge people some limited amounts for care services, except for those claiming certain income-related benefits (NB: as @Sociable points out, the fairer charging scheme in England means that people on benefits often pay more for their care - as explaiined here). Thus social care services a more accurately described as highly-subsidised than free. What is happening is that councils all over Britain have, or are actively considering, raising their eligibility criteria.

As David Batty points out, "Only 22 local authorities now fund people with moderate needs". When councils restrict care to those with "critical" needs only, they will only provide services to those who would face life-threatening risk without appropriate care, such as being unable to feed or drink by yourself, to maintain a basic level of hygiene or to get in and out of bed safely.

Restricting services to those with "substantial" needs or above is similar to critical-only, but substitutes "significant risk" for "life-threatening risk". Either way, you are restricting social care to a small set of people.

The ironic thing about restricting to critical-only is that you cut care to those with substantial need, i.e. those at significant risk of falling, of being unable to feed or clean themselves, and to carry out domestic routines. Unable to access care services these people will often hurt themselves, fall over, become ill due to hygiene issues or inability to manage their conditions alone.

When this happens, they end up in a hospital bed which costs the NHS more per night than community care for an entire week costs the council. And once they get out of hospital following their period of ill-health, they will often be reassessed as having critical needs which they would not have had had the council not made them ineligible.

Restricting social care to substantial need or above is still not easily defensible. People with critical needs will get their care, as will those with substantial need, but those who face moderate risk in the areas outlined above will miss out. When made ineligible for social care services, they face the same type of problems which may cost more in the long-run. Even if we put aside the moral issues of restricting social care, there is a very strong argument that these policies are fiscally inefficient and hugely wasteful.

Of course, the other issue about restricting social care to those who meet very high eligibility criteria is that the people who lose out will face further obstacles. First of all, people with less substantial care needs are more likely to be in work and paying taxes. Removing their care will often mean that these people are forced into unemployment because they lack the support to do their work. This, in turn, may well leave these people stranded in a spiral of poverty, and the welfare dependency which this Government is fond of complaining about.

More immediately, people who are ineligible for social care services are often completely dependent on their DLA to fund the little care they can afford. DLA reform and the advent of the Personal Independence Payment (PIP) means that the DLA caseload will be cut by 20%, and it is those with less severe needs who will lose out. People who have moderate care needs will then not qualify for social care, and will not get DLA to help them buy it elsewhere.

When these people can no longer afford any care, what happens?