Adult Green Paper: Can it plug the growing gap in services?

As the first phase of consultation on the future of adult social care draws to a close, Corin Williams examines the policy implications of the possible changes

Next month, the government ends the first phase of its consultation on reforms to adult social care and support. Ahead of the green paper in 2009, the case for action so far is compelling as evidence shows  tens of thousands of older and disabled people are not receiving the services they need.

According to the Commission for Social Care Inspection’s latest state of social care report, the system has left 1.5 million disabled older people with a shortfall. In future growing numbers of older people and increasing expectations of services will add further strain.

Piecemeal development of adult care policies

John Knight, assistant director of policy and campaigns for disability charity Leonard Cheshire, believes the “piecemeal” way in which successive governments have developed policy has led to the current difficulties.

“The demographics of an increasingly older population, which has been the main driver of this, has been on the cards for as long as I’ve been around,” he says. “Yet successive governments of all political colours have just shied away from it.”

The consensus is that the system started to fall apart as local authorities, forced to limit services under the pressure of insufficient funding, tightened their fair access to care services (FACS) eligibility criteria.

A report by Leonard Cheshire in March – Your Money or Your Life – highlighted the stark human cost of these changes, which have led to an increasing postcode lottery of care.

Knight says: “We had stories of people becoming depressed, falling out of their social networks, some people considering suicide. I spoke to one person who told me that they had to ask a neighbour to change a sheet on their wet bed. It strikes at the very heart of dignity and independence.”

Shortfall in services is dehumanising

The Leonard Cheshire report found more than half believed a shortfall in social care services had led to accidents, serious illness, suicide attempts and further medical treatment. And 14% were concerned that it had led to illness and stress for their carers.

“It’s dehumanising when services are withdrawn because people either have to make do or are propelled into acute NHS services,” says Knight.

Leonard Cheshire’s survey echoed CSCI’s 2008 State of Social Care report, which focused mainly on older people. CSCI found that, as more councils tightened their eligibility criteria, the number of people receiving care at home had fallen from 479,000 in 1997 to 358,000 in 2006. The growing use of means testing for domiciliary care was also squarely blamed.

High charges stop older people using council care

Research last month from the campaign group Coalition on Charging found that 80% of older people stopped using council care services because of high charges.

Anne McDonald, the Local Government Association’s programme director of community well-being, believes the situation comes down to money. “My local authority, Southwark, has to find £3m to £5m a year savings, and they have come to the unpalatable conclusion that they will have to tighten their eligibility criteria,” she says.

McDonald argues that councils do not save money by squeezing services for people with low-level needs. “If you’re not helping people to stay healthy and independent through those lower-level services you’re storing up problems. Some councils have not tightened their criteria for that reason. Evaluation also shows that investing in better quality of life for older people does save money, but there is more than a year’s lag before the investment began to show any payback.”

John Dixon, president of the Association of Directors of Adult Social Services, says: “The biggest challenge is the culture change of making our services personalised for vulnerable people. But there’s a risk that people could be worse off if we get it wrong – unintended consequences happen.”

• More on green paper funding