A growing number of councils in England are planning to increase charges for non-residential care. This is likely to deter users and lead to increased crisis care later. Vern Pitt reports
“Oh no, I don’t think I’ll bother then dear.” That’s the response Ruth Cartwright, the British Association of Social Workers’ joint manager for England, has heard all too often when she has told clients about the charges for social care. It’s a sentiment social workers can expect to hear more of in the coming year.
Several councils in England have issued plans to increase non-residential care charges this month. These include plans to raise or abolish maximum charges for care, raise hourly rates for home care or day rates for day care or reduce subsidies that currently protect users from being charged the full cost of their care.
All councils means-test for care and government guidance protects service users from having their incomes reduced to less than 25% above income support or pension credit levels. However, for people who are just above this “buffer” level, charges can “go through the roof”, says Association of Directors of Adult Social Services president Richard Jones.
There is longstanding evidence that rising charges deter people from accessing care.
A report by the Coalition on Charging (COC) in 2008 found that 80% of those people who had stopped using social care services said charges played a part in their decision. A fifth of those using services said they would stop if charges rose.
This means that while councils may save money in the short-term by increased charges, they are likely to face higher costs in the long-term as more people enter the system in crisis.
Helga Pile, Unison officer for social workers, says: “We know that people are very sensitive to those charges and they may decide they are going to rely on friends and family to fill the gaps of services. They will have unstable care arrangements that then break down.”
Her concerns are shared by the COC, which is writing to all councils this month in an attempt to persuade them not to raise charges.
People who withdraw from council support may be at risk, warns Stephen Lowe, social care policy adviser at Age UK. “It means that there is no external oversight, if the person is vulnerable say because of a lack of capacity, there is nobody monitoring their care,” he says.
Those service users who see charges rise are likely to be those with extensive needs, says Andrew Cozens, the Local Government Association lead on adult social care. As a result many will simply cut back on the amount they receive, rather than dropping completely out of the state system, he says.
This will be cold comfort for social workers faced with breaking the news of their increased charges to service users.
“Rising charges have already harmed the profession’s image,” says Cartwright. “We are seen as people who concentrate on what you can’t do and then say we can’t help.”
Cartwright says elected members and senior officers have a duty to break the bad news as they are the ones taking the decisions on charges.
Apart from the need to raise more funds, councils are also changing their charging systems in line with personalisation, moving from charging people for specific services to deducting contributions from their personal budgets.
However, Cartwright claims rising charges militate against the personalisation agenda by resulting in care packages that are “prescribed in 10-minute slots”, rather than designed more innovatively to meet people’s needs.
What’s more, those on personal budgets can see most or all of it taken back in charges, says Pile. “It makes a mockery of that whole idea that you have choice and control if councils charge most of it back.”
If increasing charges will not deliver long-term savings, damage social work and obstruct the reform of social care, what are the alternatives?
“There are a limited number of things a council can do to balance its books,” says Jones. Besides increasing charges, they can raise eligibility criteria to restrict access to care or reduce levels of support for those who are eligible. As Community Care reported last week, councils are tightening eligibility criteria, but this option suffers from similar flaws to increased charges.
Though councils are faced with making cuts of 25% to 40% from 2011-15, under ministers’ agenda to reduce the deficit, COC chair Neil Coyle says government plans to remove ring-fencing from council funding streams may enable authorities to protect adult social care from the worst of the cuts.
However, Lowe is less optimistic: “Our view is that cuts of 25% are basically unachievable, we don’t have any advice on how to do it because it probably can’t be done.”
Case study: David Gower, home care service user, Luton
“I simply don’t know where the money will come from to pay for it,” says 75-year-old service user David Gower, who fears Luton Council’s plans to increase charges will mean higher rates for him (see box below).
He has severely restricted mobility from an undiagnosed neurological problem and pays £300 a month for four visits from a carer each day. With his pension frozen Gower says he will have difficulty meeting any increased charges.
“It could well be the case that I have less care,” says Gower. “That means I won’t get a cup of tea between 12.30 and the next time I see someone, which would be the next morning at 8.30. And I do like a cup of tea,” he says.
Gower has already made major sacrifices saying he cannot afford a carer to take him out of the house in his wheelchair. His only time outside is a twice weekly trip to Luton provided free by the local shopmobility scheme.
Despite his fears Gower doesn’t blame the council for considering increasing charges saying their hands are tied. Rather he would like to see a change of policy at central government level. “You don’t pay a mortgage back in five years or 10 years it’s 15 to 20,” he explains.
“It has to be spread over a number of years this debt but they want to cut everything and stuff the lot of us.”
Luton says it does not anticipate that there will be much or any change in charges for most customers. It says it needs to change the way it charges for care because of the impact of personal budgets.
Council charging changes
Bolton plans to raise £250,000 a year from reducing subsidies for day and home care.
Derbyshire is proposing a system to recoup contributions from personal budget holders – capped at £200 a week – that would raise £6.5m to £8.5m a year.
Hertfordshire‘s proposals include abolishing a weekly charging cap of £346.50 a week.
Isle of Wight plans to raise £2.15m a year by ending free care for the over-80s and increasing user contributions to personal budgets.
Lewisham‘s options include raising weekly maximum charge from £290 a week to £395, or abolishing the maximum, and reducing subsidies for services.
Lincolnshire is proposing to generate an extra £1.8m a year by charging for day care, ending subsidies for home care or removing weekly limits on charges for users.
Luton is proposing to introduce charges for lower-level day care and transport to day care, alongside a system for personal budget users to contribute to their care costs.
Poole plans to raise almost £500,000 a year by increasing its maximum weekly charge from £320 to £433 and charging for day care and transport.
Stoke plans to remove its maximum charge and charge for day care.
Warwickshire is proposing to remove or reduce subsidies for home, day and respite care charges, and remove its £387.13 maximum charge.
Westminster plans to raise £750,000 as part of charging review.
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This article is published in the 23 September issue of Community Care magazine under the heading Charging ahead