Councils have been repeatedly accused of wrongly referring disabled people to the Social Fund for aids and adaptations they should pay for. Vern Pitt investigates
The Social Fund was set up to help people in need who were unable to access assistance from other statutory agencies. But the 2009 annual report by its watchdog, the Social Fund Commissioner revealed that many disabled people were having to resort to applying to the fund because councils were failing to meet their needs for equipment.
This is not a new problem – it was mentioned in the commissioner’s two preceding annual reports. The 2006-7 report had already highlighted the need to clarify the boundaries between agencies.
Karen Manuel, external business manager at the fund, estimates the cases now number in the thousands, instead of a few hundred three years ago. “We do see cases quite often where the person assessing [in local authorities] is saying, ‘We don’t have enough to pay for beds’.”
In one case an adults’ services department applied for a specialist bed costing more than £1,000 on behalf of a young woman who was paralysed from the waist down, had hydrocephalus and was severely visually impaired and incontinent.
The bed was assessed as constituting “higher substantial” needs under the council’s eligibility criteria, and the assessor described it as “a vital piece of equipment to facilitate [the applicant’s] independence”.
However, in support of the application to the Social Fund, the assessor said social services’ duty to provide aids and adaptations did not cover the cost of specialist items such as beds.
College of Occupational Therapists members have raised concerns about blanket council policies on equipment. “Unless there is a legal challenge, local authorities can use them as a means of managing their resources,” says the college’s head of professional practice, Julia Skelton.
However, John Nawrockyi, joint chair of the Association of Directors of Adult Social Services’ physical disabilities network, says councils would have “nothing to gain” by applying blanket bans on equipment purchases. “It’s just not the way the system works,” he says.
There are concerns that council policies add to the delays disabled people experience when applying for equipment. Even before any equipment has been recommended there are often “considerable delays” before disabled people are assessed, says Christine Shaw, chief executive of the Disabled Living Foundation. These can be due to local policies or the lack of availability of occupational therapists, resulting in disabled people being passed between agencies.
Expensive wheelchairs overlooked
The consequences of receiving the wrong equipment can be severe. Mencap‘s national officer for profound and complex learning disabilities, Beverley Dawkins, points to evidence from disability charity Postural Care that shows bad posture can damage health and, in some cases, be life-threatening. She says Mencap has been concerned that more complex and expensive wheelchair models are often overlooked on cost grounds.
For all the confusion, the legal picture is simple, says Ed Mitchell, a solicitor and editor of Social Care Law Today. “The provision of care aids is no different from the provision of any other community care service,” he says.
Disabled people are assessed for eligibility under the NHS and Community Care Act 1990, and councils use the Department of Health’s Fair Access to Care Services (FACS) criteria to decide the level of need they will meet.
Although a council can take its level of resources into account, this should only happen when deciding what level of FACS need they will meet, not in setting blanket policies on certain types of equipment regardless of a client’s FACS level.
This might raise the bar of eligibility, but Manuel says it at least makes the system clear and equal within a particular local authority. “There are a whole group of people who could apply for a community care grant from the Social Fund who wouldn’t be eligible for council assistance,” she says. “It’s about trying to make sure that area of work is protected.”
Lack of specialist knowledge
Just understanding the legal and policy framework is not enough, though. There are additional problems with a lack of specialist knowledge, says Scope head of policy Marc Bush. “We have found that when disabled people try to get equipment, they tend to be passed around because no-one is quite sure what the equipment is for,” he says.
Bush says the equipment market moves fast and many items serve several purposes, which do not neatly fall into the domain of either health or social care, further confusing which budget should fund them.
Meanwhile, Skelton says a lack of expertise is contributing to the problem. “There is a huge range of people assessing and recommending equipment but many of them are not qualified occupational therapists,” she says, adding that occupational therapists are best positioned to keep up with the latest equipment developments.
The situation is more difficult for people with complex needs. Bush says Scope receives many calls from people given multiple pieces of equipment where one would do. This is especially true for people with complex communication needs.
“We had one situation where someone’s wheelchair fell over because a communication aid mounted on the front of the chair was so heavy,” Bush says. He believes this is the type of situation that could be avoided with joint working between professionals.
Strong role for social workers
Bush sees a strong role for social workers in solving problems because they are more engaged with a person’s whole life rather than the functional outcomes that are often the focus of health. One of Scope’s clients found their social worker invaluable in brokering a rugged laptop, which is more durable than standard models, instead of specialist communication devices, because they wanted to go to gigs and clubs.
With limited resources in the system, there will always be some people who lose out, but by knowing entitlements to council assistance and options when that is not available, social care professionals can at least make navigating the system as painless as possible for disabled people.
Occupational therapist overcame council block
51-year-old woman with physical and mental health problems was unable to turn, sit up or get out of bed without help. Her mother, who was her carer, had just died.
An occupational therapist had been involved throughout but there had been no expert assessment of the applicant’s needs.
Instead, the occupational therapist applied on the applicant’s behalf to the Social Fund for a specific adjustable bed.
This was on the basis that the local authority did not meet these sorts of needs, so there was no reason to conduct an assessment.
● Occupational therapists are in the best position to make an assessment. They should be up to date on how equipment works and what it can do.
● The Disabled Living Foundation can advise service users about sourcing equipment.
● Looking at the person’s whole life and aspirations can ensure the right equipment is used.
● Blanket policies, where they exist, need to be challenged at a local level.
This article is published in the 14 January 2010 edition of Community Care under the headline “Failure to adapt”