A shorter version of this article has also been published in the Somerset County Gazette and can be found online here.
This month the King's Fund and Nuffield Trust published a report called 'Home Truths'. The report comments on the state of social care for older people in England. It is not very positive reading. The headlines include:
- Compared with 2010, 26% fewer people are receiving support from Local Authorities.
- Social care providers are under unprecedented pressure. Home care services are in a critical condition everywhere and large scale care provider failure is now a matter of 'when' not 'if'.
- Access to care depends increasingly on what people can afford - and where they live - rather than on what they need.
- Under-investment in primary and community NHS services threatens to undermine the policy objective of keeping people independent and out of residential care.
- The potential for most local authorities to achieve more within existing resources is very limited and they will struggle to meet basic statutory duties.
The report states:
"If the government is unwilling to provide adequate public funding to support the current system it must be honest with the public about what they can expect from publicly funded services. This would mean establishing a fresh and more explicit policy framework, which makes it clear that primary responsibility for funding care sits with individuals and their families, creating incentives for people to plan ahead for their care needs and revisiting some of the new duties and rights created by the Care Act 2014 so that expectations are aligned more realistically with what the government is prepared to fund and local authorities can afford."
In the course of the last two years I have seen a change in the way people are assessed to determine their care needs and the way assistance is provided to meet those needs.
When the Care Act was introduced the expectation was that a consistent assessment process would be delivered and that people would receive personalised, integrated support.
We hoped that the importance of unpaid carers would be recognised. Carers were promised help to perform the role and balance it with a life independent of that responsibility.
Initiatives were taken to pool funds and ensure that the NHS and Local Authorities worked more closely together to generate more positive outcomes for families.
The clients I see across the South West suggest that reality matches the 'Home Truths' report rather than the aspirations we had in 2014.
So what does that mean in day-to-day practice?
The nature of my job means that I see cases where the system struggles to meet the demands placed upon it. However, I also attend events and seminars across the South West and that helps me form a broader view.
The following are things that seem to be emerging as features of the care system in our region:
- It is more likely than not that you will not be assessed for Continuing Healthcare funding (CHC) when you leave hospital for another care setting. If you are eligible for CHC, the NHS should meet the costs of providing your care.
- If you have assets, excluding your home, that exceed £23,250 in value then you will probably be given some leaflets and be left to make your own care arrangements.
- You may receive short-term funding from the NHS to encourage you to leave the hospital setting. However, if you are self-funding that support can be withdrawn without a re-assessment of needs and without any alternative arrangements being put in place.
- If you return home and have assets with a value of less than £14,250, the Local Authority is likely to offer a maximum of four visits from a carer per day. Those visits will usually last between 15 and 30 minutes.
- If you require more 'paid' support to remain in your home the Local Authority may advise you that you need residential care. If you own your home (and no-one else lives with you) you will be classed as self-funding. You will probably be given some leaflets and be left to make your own care arrangements.
- If you want to continue to live at home, the Local Authority may limit their contribution to the cost of residential care. You may be offered a 'Direct Payment' for the equivalent cost of a residential placement. You will be expected to arrange your own care and make up any funding shortfall. This may well force you into residential care.
- If you select a home that charges more than the rate the Local Authority believes it should pay, and you run out of money, you may be told that you must move to a cheaper home, or that a third party will need to make up the difference.
- If you have needs that might qualify for CCH funding you may be discouraged from applying. If you insist on an assessment being performed there will probably be a long delay before a 'Checklist' is completed.
- When the 'Checklist' is completed it may understate your needs. You and your family may not be given notice that the Checklist is to be completed and you may not be invited to contribute. You may not be given a copy of the completed Checklist.
- You may be discouraged from requesting a full assessment (via a 'Decision Support Tool' - DST). If a full assessment is performed there will probably be a long delay and you may not be given advance notice of, nor invited to attend, the meeting.
- The assessment may understate your needs. If there is disagreement over the level of need the lower category will probably be selected. If a condition results in multiple needs, they will probably not be recorded in all those areas to avoid double counting.
- You may be told throughout the assessment process that you do not meet the threshold or that there is not adequate evidence to support eligibility.
- You may not be given a copy of the DST before it is submitted to the Clinical Commissioning Group ("CCG") for a decision. If you are provided with a copy it may not reflect the discussion at the assessment meeting. Levels of need may have been reduced following the meeting. The assessment may focus on evidence of 'positives' and understate 'negatives'.
- There may be a long delay before the DST is put before the CCG for a decision. If the DST recommends eligibility the CCG may well substitute their own (reduced) ratings for the areas of need and refuse funding.
- If you want to dispute the CCG's decision you will be invited to an informal resolution meeting. That meeting cannot change the outcome and will probably be used try to convince you not to appeal.
- You may die before eligibility for CHC is finalised. In the meantime you will have to fund/arrange your own care or cope with the support you can obtain from the Local Authority, relatives and friends. If you do not have a network of free support or the money to fund care while this process is conducted your needs may well be unmet.
- If a positive decision regarding eligibility is reached after a delay the CCG will not compensate you for the inadequate care you receive in the meantime and the strain this places on you your friends and your family.
These features demonstrate, in practical terms, how the problems surrounding funding are coming to affect the experience of people needing care and their families.
If they sound familiar then you should seek support to ensure that your needs are recognised, assessed and addressed in a way that is compliant with the statutory obligations placed upon Local Authorities and the NHS.
If you are unable to afford the services of a solicitor or other paid support you can contact 'Swan Advocacy' who are a free advocacy service supporting