Elderly people: CSCI’s care-for-all scuppered by cash shortfall

Councils should support all older people to meet their personal social care needs, regardless of whether they fall into an eligibility band, under proposals set out by the Commission for Social Care Inspection last week.

The idea has been put forward following the CSCI’s third State of Social Care report, which exposed a “sharp divide” in the quality of life between people who receive council support and those who put together care packages themselves.

CSCI estimates that at least 450,000 older people who self-fund are not deemed eligible for state-supported care have shortfalls in their care.

Older people rely heavily on informal carers or are signposted to third sector, community or voluntary organisations, which often have long waiting lists and are feeling the cut in funding, CSCI’s report finds.

Councils also fail to provide adequate advice or information to self-funders to purchase their own care packages, the report says. Monitoring of cases after someone is signposted outside of the council is also “crude or non-existent”.

Two systems

Although the study notes improvements in council services for people who fall within the formal system of social care, it estimates that 281,000 older people, with both high support and less intense needs, currently receive no personal social care services at all.

“We have two systems here side-by-side: one that is improving and one where people are struggling,” said CSCI chair Dame Denise Platt.

At the launch of CSCI’s report, Platt proposed that all older people should be assessed by councils, and then given help and advice about services before funding is considered. And this guidance would continue until the person found the service needed.

This approach is backed by the cross-government Putting People First concordat, which is to launch in April to ensure the NHS, voluntary agencies, local authorities and private providers work together to push through the personalisation agenda and spearhead early intervention and prevention. Under this £520m programme, social care advice points will be set up in communities over the next three years.

Also, this year will see a green paper on social care funding and a revised national carers strategy.

Yet despite a government push to improve the system, Platt identifies a “real tension” between the “hierarchical, narrowing interpretation of social care”, dictated by eligibility thresholds, and the more flexible approach of the personalisation agenda.

CSCI also finds there is little consistency within and between councils on who is eligible for state-supported services as staff interpret the national Fair Access to Care Services (FACS) guidance on eligibility differently in practice.

Rethink criteria

In response to the CSCI’s report, care services minister Ivan Lewis ordered a “fundamental rethink” of eligibility criteria including national eligibility bands, the local application of FACS rules, and resources. Lewis added that eligibility criteria had to be addressed now so that it did not undermine Putting People First.

But David Rogers, chair of the Local Government Association’s community wellbeing board, says: “The bottom line is that if budgets aren’t given a boost, councils will only be able to provide support to the people with the most severe needs by 2009. Councils have been hamstrung because there is not enough money in the system to cope with rising demand.”

Anne McDonald, adult social care lead at the LGA, says that councils would like to support everyone in their communities but they need extra funding.

It is anticipated that 73% of councils will be operating “substantial” or “critical” eligibility thresholds by April 2008. Were the rest to follow suit, it would leave 20% fewer people with home care, while 25% fewer would receive general social care services, according to CSCI.

But the fact that family and friends are providing the bulk of personal care comes as no surprise to Imelda Redmond, chief executive of Carers UK, who says that councils have always supported a minority.

She argues that the current system is outdated and based on 1960s assumptions where women did not work and lived near older relatives.

There are also tensions between government policies, Redmond says, where it wants 80% of people of working age in employment yet at the same time the number of informal carers is set to increase from six million to nine million by 2035.

But Lewis argues that it is not the state’s responsibility to provide friends for isolated older people with low-level needs. Instead, he proposes that a modern care system should be based on a partnership between all social care sectors and the community.

Anne Williams, president of the Association of Directors of Adult Social Services, disputes CSCI’s claim that people are “left languishing” without support. She points to other council services, charities and third sector agencies that provide support to older or disabled people.

But an Age Concern spokesperson says that across England the charity’s centres are facing cuts in council funding, reducing service provision. Also, its centres are now supporting people with much higher-level needs, who are not getting support from councils until they “reach death’s door”. The charity’s director general, Gordon Lishman, says: “A review of eligibility criteria is very welcome but what is urgently needed is a substantial increase in care funding and fundamental reforms, which should follow the green paper.”

But extra funding on the scale Age Concern wants does not appear to be on the political agenda. For Lewis, reform of the existing system by councils and providers, not new money, is the solution to the care gap.

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Caroline Lovell