Social care is being restricted to the most vulnerable – a practice that is the opposite of government policy advocating preventive services – a report published this week by the Commision for Social Care Inspection has found.
“Fewer people are receiving services, and those people who do qualify for care have a high level of need,” say CSCI chair Denise Platt and chief inspector Paul Snell in the report.
When councils restrict access to services by tightening eligibility criteria, they increase carers’ responsibilities, says CSCI. Support for carers remains “patchy and limited” and needs addressing urgently, the commission believes.
Local authorities are continuing to increase spending on social care – but struggling to keep up with rising demand from greater numbers of older and disabled people, and growing expectations of higher quality services, the report finds.
Starting with the health and social care white paper in January, 2006 saw the government publishing much well-received policy including papers on older people,
looked-after children and social exclusion.
All emphasise the benefits of early intervention and of choice, control and independence for service users. Integrated services and more client input are promoted.
Yet an ever-growing gap between government policy and the reality of service users’ experiences exists and is highlighted in CSCI’s report.
The report has been widely welcomed by the sector, with organisations including the Association of Directors of Social Services, the Disability Right Commission and many charities saying CSCI outlines current concerns eloquently.
The policy and best practice are out there – but we can’t implement it, choruses social care.
“We are well beyond the need for policy papers and fine words,” said Neil Hunt, chief executive of the Alzheimer’s Society, summing up reaction.
Social care services are gradually improving and modernising, according to CSCI. It cites direct payments and individual budgets as examples of innovation, albeit currently small-scale, and praises integrated models of home care. The report also states that “some” children and families now receive well-co-ordinated social and health care, delivered from local centres.
But modernisation of services is slow, the commission has found.
Apart from perennial funding shortages, updating care is hampered by other pressures including an “underdeveloped care market, continuing recruitment and retention problems, and organisational turbulence,” states the report.
NHS budget deficits are not helping either, affecting joint-working with local authorities, it finds.
Although more home care and residential services are meeting national minimum standards, some areas have worryingly low compliance.
One third of residential homes for older people and adults do not meet standards on managing medication safely, and on improving safe working practices.
One third of children’s homes fail standards on health, safety and security and adequacy of staff.
A “substantial” number of home care services are not up to scratch on standards on medication, recruitment and selection of staff and supervision.
Well known issues in children’s services are raised in CSCI’s report.
One third of local authorities did not have child and adolescent mental health services in place for young people with learning difficulties, according to 2006 data from102 (out of 150) councils.
In one in five of the councils, 16 and 17-year-olds did not have access to appropriate Camhs services.
More than five per cent of children in care did not have a named qualified social worker.
CSCI emphasises the role of service commissioners in the report, an area of concern it has raised previously.
It says commissioning is not keeping pace with ideas of choice, control and independence and criticises local authorities for continuing to commission “the same traditional profile of services” including residential care.
Commissioners “are not yet achieving the range and quality” of services needed, although there are “signs” of more expert commissioning by some councils, it says.
When commissioning, councils are failing to carry out “a full analysis of needs, demand and supply” for all services.
“There are particular shortfalls in analysis for people with profound and multiple learning difficulties, young people with complex needs, older people with learning difficulties and people with mental health problems,” says CSCI.
Service users arranging their own care receive little support, says Denise Platt
Councils restricting services to most vulnerable, says Commission for Social Care Inspection
Tightening eligibility criteria: special report
Commissioning needs to move with the times if home care is to meet user demand
Reaction to the report