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  

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