The Department of Health guidance on fair access to care services is titled "prioritizing need in the context of putting people first". Ironically my colleagues at the disabled self-advocacy charity York People First viewed the subsequent consultation issued by their Local Council as about money and not people.
I had turned up for my weekly meeting with the group to discuss their business development, ahead of a meeting that I am having with Big Society Capital next week. YPF were pleased to see me but they had only one thing on their agenda. A letter that they had received from York City Council which said that the authority was consulting on fair access to care services.
In a nutshell, the authority said that to better meet the needs of people with critical or serious need, people of 'moderate' need should no longer receive care. Many of the people at York People First have a moderate level of need so the letter was really notification that they would lose their service. They were desperately worried and could think of little else.
Sometimes we think that people with learning disabilities are not capable of understanding what is going on. The individuals at York People First do. They say, quite correctly, that this is to do with money. The council's stated position of seeking to better support people with substantial or critical need is disingenuous. What they really mean is that they can only afford to meet this level of need by cutting services to people who seem to be managing ok.
Of course money is tight so let's not waste it. The DoH guidance recognizes this, saying "Public funding for social care will always be limited in the face of demand and such resources as are available should therefore be allocated according to individual need in a way that is as fair and transparent as possible. There is evidence that in recent years, financial pressures have influenced local authorities to shift their focus towards those groups with the highest needs. Many councils have raised the level of their eligibility threshold, leading to concerns that some people who ought to be receiving support are now being ruled as ineligible. This is despite evidence indicating that limiting access through raising eligibility criteria has only a modest and short-term effect on expenditure".
But we are taking away people's independence. For one of my friends who has a learning disability and is considered to have 'moderate need', her independent life; living in her own flat, will be threatened. The fact is that she enjoys that independence because she gets 15 hours of care per week. This is used strategically to ensure that she does the things that we all have to do to live our lives, eats properly, keeps her flat clean, pays her bills and engages with her community.
With this care and support her life works for her but without it her circumstances will deteriorate, I have seen it happen so many times before where we get a situation to the point where everything is working and then withdraw the support, it never works.
The DoH is correct when it says that the money saving potential is only modest or short term. Once support is withdrawn situations can and do deteriorate to an even worse position that requires substantially greater expenditure.
City of York Council is by no means the only case, and is doing more than creating anxiety and threatening services; it is also storing up a problem for itself. I have written previously about local authority charges. I warned of the dangers of predicating a budget on savings that may not happen. This is exactly the same. The council will predicate budgets on the assumed exclusion from services of those with moderate need, which even if it survives judicial review is deeply flawed because the saving will not be realized in the medium term. They are setting themselves up for a funding crisis.
There are more imaginative solutions to save money and we are part of that solution. The guidance speaks of the importance of "smart housing" and as a special needs real estate investment trust SAF Housing is providing this. However, this requires an ongoing commitment to provide the services that back this provision up.
We are in the eye of a financial storm and there is worse to come. We have to have a more open and honest debate about what and how we will fund in terms of social care. We must recognise the need for structural changes to service provision and as is always the case we cannot do this overnight. The harsh reality is that it is faster to cut services than it is to carry out a more positive structural change that is more likely to achieve savings.
If the DoH is saying that the stated aim of the eligibility criteria is to meet needs by putting people first does that not then mean, just for now, that we put money second?
I know that my critics will say that such pleas must fall on deaf ears and that I should recognise how no money exists to fund the gap while new more cost effective services are developed. However, this is simply not true. Eric Pickles published a list of reserves held by local authorities in late 2010. It revealed that York City Council holds in excess of £13.5m in reserve. So it is possible to fulfil the objectives of the department of health guidance and put people first. I think we should.
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