Hampshire Council’s inquiry into adult care revealed frustration at the system’s inequities. But will its message of greater universality be heeded by the government, asks Amy Taylor
From in-depth submissions by user groups to a single piece of notepaper from an elderly woman in the New Forest who wanted to have her say, Hampshire Council has seen and read it all during its year-long inquiry into adult social care.
The predicted £6bn gap in funding for adult social care over the next 20 years has been recognised by the government, but debate continues over how to fill it. And just when the public may be required to fund the system, more councils are cutting the number of people eligible for services – creating a major problem for ministers.
Hampshire Council, keen to feed into next year’s government adult green paper, launched its own inquiry last January. Its findings, released in November, showed that Hampshire residents felt the system was unfair and many felt alienated from it.
At the start of the process, the council appointed 13 commissioners from across social care and a reference group of service users, carers and user-led organisations to work alongside the commission. Anyone could submit evidence throughout the process and direct approaches were made to a variety of private, public and voluntary sector organisations. The inquiry was also advertised heavily.
The effort paid off. Evidence was submitted by 132 members of the public and 36 organisations and presented at four public sessions over the summer.
The commissioners also analysed a range of social care research and the council commissioned two pieces of evidence on demographic change and economic diversity in Hampshire.
One of the commissioners was Madeleine Starr, carers and employment manager at Carers UK. For her, the fact that Hampshire managed to reach out to the public was significant, as many people who would qualify for services are unknown to the system.
“The outcome and the process have been very impressive because it was a robust exercise in asking Hampshire’s people what they wanted, and not only service users and carers as they are only a small number of people that require services,” she says.
The inquiry makes recommendations for Hampshire and for the UK. Council leader Ken Thornber says the government’s response has been measured but welcoming.
“The senior civil servants [the council has shown it to] were very interested but very cautious,” he says. “But they did indicate they were thinking about some of the ideas.”
The commissioners found the same issues recurring. One of the most cited was the system’s penalisation of people with moderate savings. Those who had saved resented those who hadn’t having their care paid for by the state. In response the commission proposes raising the threshold for means-testing from £22,250 to £50,000 in savings and capital.
The charging system for social care was also flagged up as unfair. Many felt it offered them little choice or control and there was just an expectation they would pay the asked-for sum.
The inquiry calls for charging to be replaced with a system of means-tested personal contributions supplementing individual budgets that recipients would be able to use for both home and residential care. It would be up to them how they spend their budgets and the personal contribution would not be compulsory instead individuals would be able to decide whether they would prefer to simply receive less care.
Fairness the priority
Jonathan Montgomery, one of the commissioners and chair of Hampshire primary care trust, says that people don’t object to contributing to the cost of their care as long as they think the system is fair. He says personal contributions mean that individuals can vote with their feet.
“If you have a means-tested charging system you are going to be charged for care even if you find the service is flawed. If you tip it the other way around and ask people for a contribution that they can spend how they like, you have a way of dealing with poor services,” he says.
The government introduced The Fair Access to Care Services guidelines in 2003 to ensure that people in similar circumstances had access to the same level of care regardless of where they lived. But councils are allowed to take their own financial situation into account when deciding on how much care to provide, so FACS hasn’t worked.
A recent Commission for Social Care Inspection report reviewing FACS highlighted how wide the discrepancies in service provision had become and called for the framework to be replaced.
Starr agrees that a national system is long overdue: “Really, community care harks back to the poor law. If you move out of your parish you lose your parish relief.”
For many people it comes as a shock to find they qualify for no or little free social care at a time when they feel most vulnerable. The inquiry found that many people felt abandoned, left to sort out their care on their own.
“People have to take these decisions without having good support, particularly if they are assessed as self-funders,” says Montgomery.
The inquiry argues that everyone, regardless of wealth, should instead be entitled to a “universal offer” consisting of access to information, advice and supported self-assessment about the care available. It also proposes giving those with more intense and urgent care needs the right to brokerage to support them in arranging care regardless of their means. The council sees the measures as creating a fairer system.
Hampshire acknowledges that extra funding is likely to be hard to come by but calls for health service investment in social care, with new performance targets to act as an incentive, to help pay for the changes.
The economic climate will make ministers more cautious about spending commitments. But Starr says the government needs to disregard this and commit to an overhaul of the system in the green paper: “What we would hate to see in the current economic situation is having the debate break down to just how we tweak services into something a little bit different.”
|CASE STUDY – Tony and Sabine Holland|
Tony Holland and his daughter Sabine, 25, who has a severe learning disability and Down’s syndrome, gave evidence to the inquiry.
Two years ago they were one of the first families in Hampshire to use an individual budget. Tony says that, instead of attending a day service, Sabine can choose to carry out activities such as work experience in a local café, horticulture on a farm and shopping.
“Sabine didn’t want to go to day services but was told she had to because that was the only way the council could discard their duty of care,” he says. “Now she makes the choices for herself.”
Tony helps Sabine decide how to spend her budget, which minimises bureaucracy.
“Sabine’s college changed the days of her course. It took four months to change her care package to fit in with this under the old system, whereas under the new one we were able to change it in a week,” he says.
The inquiry’s report and more information on the work of the commission
Published in the 8 January 2009 edition of Community Care under the heading Universal Truths