The goldrush

Government policy to help service users has
created a rush by local authorities to obtain as much money as
possible from central government, writes James Churchill, chief
executive of the Association for Residential Care.

As implementation of the Care Standards Act
2000 approaches, spare a thought for those in government who have
been charged with making the policies work harmoniously. Staff from
the Department of Health, Department for Work and Pensions and
Department for Transport, Local Government and the Regions, and
from the Care Standards Commission, will have the unenviable task
of trying to implement it after April 2002.

The Valuing People white paper¹ on
the future direction of services for people with learning
difficulties, emphasised the importance of rights, inclusion,
choice and independence for service users and extended these
principles to embrace living in normal housing in the community.
This policy chimes in with another government initiative,
Supporting People^,2 which brings together various
sources of money (mainly housing benefit) to provide a collective
amount of local money to meet housing and support needs in the
local community, decided by local councils in a flexible way
according to local demand.

Large sums of money are at stake and a major
policy and funding change is involved, in which the Treasury has
finally managed to end the blank cheque that the housing benefit
system has had on central government funds. The Supporting People
process moves from having an unlimited universal benefit – housing
benefit – available on demand for every eligible individual who
claims it, to having a fixed sum – supporting people grant –
available for a range of uses, to be decided locally against a set
of nationally set conditions.

The step in the middle, transitional housing
benefit, allows a year for each local authority to establish
exactly what “housing-related support costs” there are in local
services, which in turn will increase the size of the final
supporting people grant for each council. Many local authorities
are energetically pursuing a policy of converting every possible
local service into a situation where it can receive housing benefit
now and transitional housing benefit later. This means councils are
transferring significant local support costs (often millions of
pounds per year for large councils) onto the central budget of the
DTLR and, ultimately, this expenditure will be included in the
Supporting People pot.

The pressure to change services (and save the
council money) affects some groups more than others. Some services
for people with learning difficulties are particularly susceptible
to this pressure in the light of the Valuing People priorities.
Many small care homes are being pressurised into de-registering and
becoming “supported living situations” instead. This brings a
triple benefit where everyone wins: a higher disposable income for
the service user; a saving for the local authority; and the kudos
of delivering on Valuing People policies. The only loser in all
this is the DTLR, which is seeing its budget being blown away by
such manoeuvring.

The April 2002 deadline for local authorities
to ensure all eligible services are claiming housing benefit means
the pressure is on to get these service changes through. The DTLR,
seeing the future cost of transitional housing benefit rising
beyond all expectations is raising fears that housing benefit may
be being “misused”. Stern warnings are being issued that any
service claiming the two benefits “inappropriately” will forfeit
money from transitional housing benefit, operating in the period
2002-3, and supporting people grant from March 2003 onwards. The
problem comes in that it is not clear what level of “housing plus
care” is permitted for the use of housing benefit and also at what
point the nature and level of personal care in a setting requires
registration as a care home. It is accepted that 24-hour personal
care support “in your own home” does not require registration, but
that leaves open the question of how collective provision (such as
very sheltered housing, small group homes and intensive
supported-living packages for groups of two or three) will be
treated.

The National Care Standards Commission,
charged with standardising the regulation of care homes and
domiciliary care across the country, will need to consider the
position of services in de-registered care homes and in very
sheltered housing schemes. Additionally, the DoH is concerned to
see the supported living policy (espoused in Valuing People)
subverted by short-term financial fixes. In particular, the hurried
creation of many independent living services, sometimes in dubious
circumstances and with mainly financial motives, may tarnish the
image of a valuable service style when problems later emerge,
through poor support and lack of understanding.

So, we have a situation where the short-term
pursuit of new money is causing mayhem among purchasers, regulators
are trying to work out what exactly is and what is not a care home,
providers are under pressure to change, and some service users may
at last get what they want.

But jumping into the housing benefit net is no
guarantee of safety for the future of a service. Local control of
budgets will mean choosing priorities and it may well be that some
“unpopular” groups may lose out as funds are switched into new
areas. The rolling review of Supporting People expenditure will
also mean that all services are scrutinised to ensure they meet the
grant conditions, which will be attached to the supporting people
grant. Those that don’t qualify will lose out and the local
authority will have to fund them directly from its own resources.
Finally, the standardisation of regulation will mean some services
may be held to be in fact a care home and so must register under
the Care Standards Act 2000, with all its onerous implications for
services, staffing and procedures.

A consultation document came out earlier this
year³ and the departments have issued guidance, with
more on its way.⁴ The consequences of getting it wrong
will be very serious for many vulnerable people, especially if the
Care Standards Commission staff subsequently decide a service
should register as a care home. If the definition is too tightly
drawn this could include not only many supported living situations,
but also very sheltered housing and a number of housing and care
schemes, where a need to register would effectively close many
down.

What is needed now is some political statement
from the ministers giving a clear steer about the dangers inherent
in the rush for transitional housing benefit, and balancing this
with support for the rights of people to have housing and support
in the community, with confidence in the continuity of service.

If ministers take seriously the words of the
Prime Minister in the foreword to the Valuing People white paper
about “improving the life chances” of people so they can “lead full
and active lives”, then their advice should encourage diversity of
housing plus care provision, while allowing the Care Standards
Commission to scrutinise services that need it. It must be possible
to be true to the ideals of Valuing People and live with the aid of
Supporting People monies. Time is running out for an answer to be
found.

James Churchill is chief executive of
Assocaition for Residential Care. This is a personal
view.

References

¹ Department of Health,
Valuing People, DoH , 2001

² Department of Transport,
Local Government and the Regions, Supporting People, DTLR,
2001

³ Department of Health
consultation paper, Residential Care, Housing, Care and Support
Schemes and Supporting People, is available at www.doh.gov.uk/housingcareconsultation

⁴ Guidance and circulars
are available from the Department for Work and Pensions at
www.dss.gov.uk/hbctb/index.htm
  and from the
Department of Transport, Local Government and the Regions at the
Supporting People website www.spkweb.org.uk