Recently in disability Category

Charities are warning that disabled people are facing abuse on the streets and accused of faking their conditions due to the government's cuts to benefits for the group, reports The Guardian.
Some are declining to use disabled parking bays lest they accused of not being worthwhile recipients of support for their impairment, with people with less visible disabilities at particular risk of abuse.

Here's a reminder of those cuts to benefits and services for disabled people (though one of the 10 listed here - the cut to mobility benefits for people in residential care - has been dropped), illustrating just how stark they are. The government has an opportunity to make concessions after a number of its benefit cuts, in the Welfare Reform Bill, were overturned by the House of Lords; however, ministers just reimposed the cuts in the House of Commons.

And there seems to be no let-up to the twin narratives that there are many thousands of people claiming or applying for sickness benefits who should be looking for work, and that disability living allowance is just too expensive and going to people who aren't really that disabled.

However, the disability movement has been fighting back with a vigorous campaign, illustrating the difference these benefits make to people's lives and the genuine need of claimants. For those of you with a bit of time on your hands, here's a recent dispatch from that campaign: an e-book written by leading campaigners against both the Coalition's reforms to welfare and those of its Labour predecessor.

(Image on Flickr from Byzantine_K and taken from Disabled People Against Cuts poster)

The ongoing battle over the government's cuts to (or reform of) disability living allowance is reaching crisis point.
Today, as the House of Lords prepares to debate the proposals in the Welfare Reform Bill, 16 charities have written a letter pressing the government to call a halt to the bill and subject its plans to replace DLA with a cheaper personal independence payment to review.
This follows a feverish day yesterday in which the government announced one concession - agreeing to keep the qualifying period for the benefit following the onset of disability at three months, rather than doubling it to six - while also confirming the sheer scale of the change it is proposing. Replacing DLA with PIP would mean that 500,000 fewer working-age adults would be receiving the benefit by 2015-16 than with the status quo.

Meanwhile, the mainstream media, and not just the Guardian, has taken hold of the issue, with a head-to-head on this morning's Today programme between disability minister Maria Miller (left) and reform critic and disability activist Lord Low over the way forward.
The Lords have already shown themselves ready to give the government a bloody nose over disability benefits cuts, inflicting three defeats on its sickness benefit plans last week.

There is also an amendment to the bill today that will seek to achieve what the charities are calling for by ensuring PIP is piloted before being rolled out.

I'm not nearly close enough to the politics to know whether it will succeed, though I understand that Labour and many crossbench peers - the same coalition who inflicted last week's defeats - will back it.

But what exactly are the issues?

The government's chief beef is that it believes many people are claiming DLA wrongly because they have not been reassessed on their eligibility following an initial claim. Some 70% of claimants effectively get DLA for life.

The campaigners - disabled people, charities and others - believe that the government has not proved its case, and that by pursuing its current course, many thousands of people could be robbed of the opportunity to live independently and free of abject poverty. They also claim that this will not serve to help the government reduce its deficit as cutting DLA will shunt costs onto health and social care.

Reassessing people on their eligibility for DLA or PIP seems fine, so long as the assessment itself is robust and fair.

Disabled people's past experience - based on the hated work capability assessment for employment and support allowance - is that the assessment is likely to be anything but. WCA is now subject to annual reviews to ensure that it improves.

So why not pilot the PIP assessment and see whether ministers' case stacks up?
I imagine that view has some sympathy within the DWP, but the Treasury's demand for the promised savings from setting up PIP to be delivered may make it a non-starter.

(On another note, not all disabled people are opposing the government. Former Community Care columnist Simon Stevens has given a dissenting view, in which he claims that campaigners against reform want disabled people to have "rights without responsibilities").

(Blog updated 3.45 16 Jan 2012)

Lots about care funding in the news today so it's worth trying to unpick what's going on. Here are the main lines in descending order of importance:-

• The government is considering imposing a cap of between £50,000 and £60,000 on people's lifetime care costs, with the state picking up the bill above this point, reports The Daily Telegraph. This is significantly above the £35,000 cap proposed by the Dilnot commission last year and hence quite a bit cheaper for the public purse.
  
• Cross-party talks on forging a solution on care funding are due to start tomorrow, reports the BBC, the first such talks since the acrimonious breakdown of discussions before the 2010 election over Tory allegations of Labour plans for a "death tax" to fund care.
• Three-quarters of people support a cap on lifetime care costs as proposed by Dilnot, an Age UK survey has found, reports The Daily Mail.

The latter is hardly a surprise: who would not want more rather than less help from the state?

As for cross-party talks, who knows? Labour's current position on care funding is unclear and expecting health secretary Andrew Lansley and care services minister Paul Burstow to come together with Labour's Andy Burnham and Liz Kendall on social care when they are at daggers drawn on the government's NHS reforms may be asking too much. But let's be optimistic.

The idea of a £50,000-£60,000 cap is more worrying. Andrew Dilnot (left) was not theological about having a £35,000 cap but instead proposed a range of £25,000 to £50,000. However, he said that £35,000 was "fair and realistic" and that anything above £50,000 would not be fair, on the basis that people with lower levels of wealth may not receive adequate protection from the risks of needing social care.

A £60,000 cap would cut down the bill to the Treasury of implementing Dilnot from £1.7bn a year to about £1bn a year.

However, it would mean the reforms would fail a key test: namely, protecting people from the risk of high levels of care costs in older age.

£60,000 is a considerable sum (and it's worth noting that the cap excludes living costs in residential care, which would be additional to the £60,000); a cap of this level would make people far less likely to save or take out products to insure themselves against future care costs (another key goal of the Dilnot package), meaning that a market in such products would fail to emerge; and while making little difference to wealthy families, would hit those with moderate levels of wealth (for whom the difference between £35,000 and £60,000 is most significant).

(Updated bit) The DH has now distanced itself from the £50,000 to £60,000 figure in a statement to this Guardian story. The story also provides a useful link (see emerging findings on this page) to the source of the story: a paper in November by one of the groups feeding into the government's engagement process to shape the forthcoming White Paper on care reform. 

Contrary to what I have said above, this group, which was looking at the role of financial services in the care system, suggested that a cap of this level could stimulate people to save for their care and encourage the financial services sector to develop suitable products to enable them to do so. However, it's also clear that this figure was also given with a nod to making care funding reform more affordable for the public purse.

The group, which included civil servants and representatives from the social care and financial services sectors, also said more analysis was needed on the impact of different levels of cap. Hopefully, this is being done now and the results of this - rather than efforts to keep the overall bill to the state down - which shapes the White Paper.

The Care Quality Commission has released the latest 10 reports from its post-Winterbourne View inspections of learning disability hospitals and similar services, and the results are a bit of a mixed bag.
Of the 10, which includes NHS and private sector services, four were fully compliant with the two standards being assessed - safeguarding and the care and welfare of service users - while two had moderate concerns with both (no provider had major concerns with either).
If you work in this area it may be worth taking a look at the inspection reports but the full story from the 150 inspections will be told in an overview report this spring.

Another day, another report on integration for the government, this time from the NHS Future Forum (the advisory body set up to inject common sense into the government's NHS reforms).

The proposals are pretty similar to those put out in last week's report from think-tanks the King's Fund and the Nuffield Trust: strong support for social care and the NHS to be measured against the same performance indicators, for pooling budgets and commissioning and for building services around patients' needs.

Notably, for professionals, there is a call for every person with long-term conditions to have a named care co-ordinator, who could be a social worker.

The government has, largely, accepted the proposals.

However, the question is, will this work where other initiatives to do the same over previous decades have not? 

Social care academic Bob Hudson thinks not, in a powerful piece for The Guardian today, in which he argues that the whole issue is being looked at from an NHS perspective (with adult social care seen as the "handmaiden" to the health service), weakening its potential impact.

More significantly, he says the agenda amounts to yet more exhortation for health and social care organisations to integrate - precisely the approach that has failed for 40 years, he says.

Also, he notes the big tension in the government's NHS reforms between competition for business between providers and integration of care pathways for patients.

Not an easy square to circle, he says.

I fear we may be revisiting this topic with another mountain of reports in years to come.

(Added 13 January: Just spotted this blog post from social worker and psychotherapist Claudia Megele about the government's integration plans, which raises important concerns about the compatibility of these with other government actions, such as the injection of greater competition into healthcare through the Health and Social Care Bill).

Happy New Year! I returned to work today to see social care at the top of the news headlines.

Social care's great and good have written an open letter to the prime minister (in the Telegraph) urging that he and his fellow party leaders deliver on social care funding reform this year to put an end to indignity and isolation for older people, dependence for disabled people and the denial of life opportunities for carers.

It's great to see social care on the front pages and at the top of news bulletins, and you cannot fault the timing: this is, of course, the year in which the government publishes a White Paper setting out how it plans to reform social care, including its funding. Moreover, cross-party talks are due to start.

Before Christmas, we predicted that the government would not deliver on social care funding reform, specifically that it would not implement the proposals of the Dilnot commission to put a £35,000 cap on lifetime care costs for all because of the £1.7bn bill.

An optimist might argue that we made the wrong call, and that the festive period showed that both government and opposition were up for making social care funding reform work.

On this line, Labour has shown how much of a priority it puts on social care by putting out research over Christmas showing how much charges for home care and other community services had risen in the past couple of years (6% for home care). Releasing the research, shadow minister for care and older people Liz Kendall urged Cameron to engage in serious cross-party talks on reform. The positive narrative would also point to action from government in the shape of a £170m injection of cash into social care services for people discharged from hospital to manage winter pressures over the coming months.

This money - one-tenth of the cost of Dilnot - was found from Department of Health savings but meeting the full cost of Dilnot is a call that only the Treasury (and Number 10) can make. Moreover, whatever the pros and cons of the Dilnot package it doesn't, in itself, purport to solve all or most of the problems outlined in today's letter to Cameron.

This is because Dilnot is about expanding the existing publicly-funded social care system to cover self-funders (who would benefit from the cap); it is not about filling the funding gap in the existing system (put at £2bn to £4bn), which manifests itself in rising charges and eligibility criteria, squeezes on providers and inadequate quality.

This £4bn-6bn black hole (Dilnot plus funding gap) is not the whole story. As the government, councils and the sector know, the way social care operates needs fundamental reform  through better integration with health and housing, more personalisation (in the widest sense) and more intelligent commissioning. This should generate efficiencies that would reduce the Dilnot plus funding gap black hole from £4-6bn a year to something less than this.

However, I very much doubt that even the reduced figure would be something the Treasury would stomach, particularly in the current economic climate.

That is why I remain a pessimist - though I would be beyond delighted to be proved wrong.