Social Care: From Crisis to Catastrophe

 

Peter Wilson's summary of David Planks

‘SOCIAL CARE : FROM CRISIS TO CATASTROPHE’ 

Published by Cambridge Commons

 

Introduction

This report examines the extent of the cash limits placed upon Cambridgeshire County Council [CCC] with particular reference to the devastating impact of these upon users of Children, Families and Adults Services [CFA]–which account for over two-thirds [67%] of total County Council budget. Crucially this report examines the human impact of the ‘savings’ in the period 2013-2020.

 The report’s author is a former local government chief executive and director of social care.

What started it?

According to the National Audit Office, the Govt. reduced its funding to local govt. by 37% in real terms from 2010/11 to 2015/16. This amounts to a 25% fall in local authorities’ total income when Council Tax receipts are taken into account. CCC had to set absolute cash limits starting in 2014/15 to meet a reduction in expenditure of £25.4m. BUT with inflation and significant growth in the number of people living in the area [see below], the actual savings required are £32.5m. It has to be remembered that these are recurrent savings and were to be followed by further recurrent savings in the succeeding 5 years leading to a cumulative reduction in spending of £125m.

What is the ‘Triple Whammy’?

1)    The number of 0-14 year olds living in Cambridgeshire is set to increase by 17.8% between 2011-2021; the number of 75-80 year olds will increase by 33% and the number of 85+ year olds will increase 48.9%. These are the key age ranges in relation to take up of social care services. Across all age groups the County population will increase by 14.9% -or 92,000 people. Due to this increase in population –but also due to medical advancements and other factors, the number of people eligible for social care services [e.g. children with a disability] is increasing.

2)    Inflation over this period 2014/5-2019/20 is estimated to be 11% which further erodes the actual value of cash spending on services.

3)     New statutory duties [e.g. The Care Act 2014] will continue to place further burdens on the CFA budget. The CFA services already have a large number of crucial statutory responsibilities which they must carry out for people who have ‘critical’ or ‘substantial’ care needs* –or for whom the Council has safeguarding or parental responsibility. It is not a question of simply stopping doing things and having the discretion to do so.  [*these terms are defined in the National Eligibility Criteria for Adults’ receipt of Social Care services]

-All this must be managed with a CFA budget which decreased by £32m in 2014/5 and will decrease by a further £25m in 2015/16; by £26m in 2016/17; by £19m in 2017/18; by £16m in 2018/19 and by £7m in 2019/20. The cumulative savings that CFA will have to make over this 6 year period amount to £125m – in a time of increased demand. This is on top of the savings of £138m already made by CCC from 2010/11 to 2013/14.

 

 

What does all this mean for Older People with ‘Critical’ or ‘Substantial’ care needs?

It means: having their incontinence pads changed less frequently; less help with personal toileting; washing and bathing; less assistance to go to the toilet- making distressing incontinence more likely; more reliance for essential activities on housebound and/or frequently frail and stressed carers with greater risk of breakdown; loss of self-esteem which is known to be related to increased illness and earlier death; greater likelihood of abuse of service users by their carer-pushed beyond breaking point; or of abuse to the carer by an older person with severe dementia; more frequent changes of paid home carer; and less time per visit with associated stress and isolation.

What does this mean for Adults with mental health difficulties and /or ‘substantial’ or ‘critical ‘care needs?

It means: less chance of getting a much needed place in a residential care; delayed admission and associated deterioration and distress; less home care support; reduced day and supported accommodation and advocacy services –leading to increased isolation and possible alienation from carers and family and community support; preventable deterioration in their condition; increased burdens on stressed and sometimes frail carers with greater risk of breakdown in the placement. These people may be suffering from extreme anxiety, depression, bi-polar disorder, Alzheimer’s or senile dementia as well as having substantial or critical care needs. In most severe cases there will be greater risk of hospitalization.

What does this mean for Adults with Learning Difficulties with Critical or Substantial Care Needs?

It means: provision of crisis care only in most instances and withdrawal of care where it would have continued in the past; less help at home including for people with multiple disabilities; reduced ability to live independently due to less support with personal care e.g. washing/toileting and essential routines e.g. shopping ; less opportunity for them to live a normal life and to go out as there is reduced availability of suitable people to accompany them; more imprisonment within the 4 walls; more frustration with daily life due to less support and diversion; more challenging behaviour for carers-including occasional violence; less opportunity to go out and work [L.A. supported employment schemes are being cut]; increased burdens on some carers leading to greater risk of breakdown.

What does this mean for Adults with Physical or Sensory Disabilities and Critical or Substantial care needs?

It means: less ability to live independently; less opportunity to live a normal life and go out; more isolation and loneliness; more ‘imprisonment’ within 4 walls and more associated stress and agitation; less opportunity for some to go out to work or use their talents in other ways; more demands on stressed carers and heightened risk of breakdown in some cases-due to ill health, or being no longer able to cope with heavy lifting, toileting, changing clothing or assistance with washing or bathing. This category includes those suffering from a wide range of conditions : degenerative diseases such as Huntington’s Chorea or Multiple Sclerosis; to severe effects of Thalidomide; to severe paralysis and double incontinence as a result of industrial or other accidents to lifetime blindness and deafness with physical disabilities . We are also talking about severely disabled young adults emerging from the more supported environment of the school or college into a very cold adult world with little opportunity for supported employment or gainful activity .

 

What does this mean for Children and Young People taken into the Council’s Care?

It means: Less independent contact, monitoring, personal support and advocacy due to pressures on social work time. Children/Young People are much less likely to be placed in specialist residential or fostering facilities which are geared to tackling serious personal issues arising from past abuse or neglect. These might include serious self-harming; violent behaviour, sexually aggressive behaviour, absconding frequently, being exploited by inappropriate adults. Potentially less support for Young People when they leave care with associated greater risk of mental health difficulties, homelessness and offending behaviour.

In line with national trends the number of looked after children in Cambridgeshire is very high. Across England and Wales the figure is the highest it’s ever been. [my italics]

Pressures are increased by current Social Worker vacancy rate of 23.5% and significant levels of sickness and absence among the work force. Also, the overall effect is compounded by large reductions in NHS Child and Adolescent Mental Health [CAMHS] spending in recent years.

What does this mean for Children, Young People and their Families?

It means: less social work time to help children and their families in difficulty and at risk of deterioration or breakdown with increased risk of problems further down the road such as becoming looked after [in care ] or continuing to suffer abuse or neglect.

Less support to encourage the use of free child care for 3 and 4 yr. olds with attendant development risks for some children and perpetuation of educational disadvantage.

Reduction in operation of Children’s Centres which offer targeted services to parents with under-developed parenting skills. [see beelow]

The complete cessation of Youth Work with disaffected young people not in touch with mainstream services with associated risks for this group of substance misuse or involvement with youth offending services.

What does this mean for Children with Disabilities and their Carers?

It means: reduced support to families with disabled children who are under great pressure due to the needs of the child; reduction in capacity to provide much needed respite; greater risk of breakdown within families. Many of these children have severe physical and learning disabilities and often significant health problems including distressing degenerative conditions. The children often have disturbed sleep patterns –with great emotional and physical demands on parents who almost always show huge commitment towards their child. The parents and other siblings within the family often need outside support to maintain this commitment and enable all the children of the family to fulfil their full potential.

How is the Council proposing to reduce expenditure on people who fall into the substantial and critical criteria?

By interpreting eligibility criteria even more stringently - to the point where many people in the ‘substantial’ or ‘critical’ eligibility categories who would previously have been offered a service –or a more of a service- are now finding themselves going without.

Regardless of how the hard-pressed Council officers describe the measures they propose to take –it amounts to increased rationing of scarce resources in ways that they must know [my words] are not in the best interests of their elderly, disabled , infirm or young service users. On the contrary, in many cases the reduced service will almost certainly lead to a serious deterioration in their health and wellbeing.

In examining Council Reports 2014/15 to look at examples of how savings are to be made in the Adult Social Care sector, measures being taken include: “strengthening financial accountability”; “more robust assessment processes”; “robust reviews of care packages”;” reviewing functions that should  or can be met by other organizations”; “prevention of the escalation of need  and more pro-active use of voluntary sector to support carers”; “making better use of extra care housing”; “reducing expenditure on support and activities”; “developing a model of progression aimed at developing and enhancing skills and reducing the level of service required” . The fact is many providers have already been squeezed to the point that a viable service cannot be provided and the voluntary sector is also being hit by reduced local authority funding and central government grants. Expecting carers to do even more is the default position-which, in a significant number of cases, will lead to a deterioration in the service users’ wellbeing and increased risk of breakdown.

With regard to the Children and Families services, savings are to be delivered through the Children’s Placement Strategy- “a whole system change to reduce the risk of children entering care, reduce the length of time children are in care or reduce the risk of them returning to care”. However the number of children coming into care in Cambs. –in line with national trends- is going up and the preventative support and intervention services are being reduced.

Children with a Disability will have less access to Section 17 Support funds [used to promote and safeguard the welfare of children in need –which most disabled children are eligible for] and “identifying alternative ways of achieving inclusive outcomes with families’ use of personal budgets.”

In preventative services, children’s centres will have a reduced budget [24%], leading to reduced opening hours, reduced staffing and an increase in volunteers. Amongst other things, children’s centres are an important targeted family support service aiming to prevent / reduce bigger problems down the road. This move therefore runs entirely counter to the previously stated aim of reducing the need for so many children to come into care. Volunteers cannot replace all the functions of a skilled workforce who are trained and experienced in working with parents with underdeveloped parenting skills and working on reducing the risk of children being harmed.

Is the Government sufficiently informed of the impact of the spending limits imposed on Local Authorities?

No. In November 2014, the National Audit Office alerted the Govt. to possible implications of the ‘savings’ and the need to have a clear understanding of the likely impact. “The Department really needs to be better informed about the situation on the ground among local authorities across England in a much more active way…It should look for evidence of financial stress in L.A.s to assure itself that they are able to deliver the services for which they are responsible.’’[The Comptroller and Auditor General]

The NAO Report found: concern among local auditors about future financial sustainability of some L.A.s and their capacity to make further savings; the Department did not have adequate means of measuring the ‘scale of the financial challenge facing L.A.s over time’; none of the govt. department submissions following the proposal to cut L.A. funding by 10% assessed the capacity of different types of L.A. to manage further reductions.

Many of the people who are or will be affected in the reduction of social care services are also harmed by the welfare reforms which have already been implemented : the bedroom tax, cap on maximum benefit entitlement, the benefit sanctions regime, end of automatic entitlement to Housing Benefit for out of work 18-21 yr olds; freezing working age benefits for 4 years; limiting tax credits to 2 children; reducing income thresholds in tax credits; cuts in the Employment and Support Allowance paid to many sick or disable people.

 

Report Author’s Recommendation

‘It is recommended that the County Council commissions and publishes an independent assessment of the real effects on people of the savings its Children, Families and Adults Service is being required to make to keep the Council within its government determined spending limit; and that these effects are monitored each year and a report published in plain language to inform public debate as well as the Council’s own deliberations.’

 

Final Comment from Peter Wilson (former Head of Safeguarding and Standards 2008-13, Directorate of Children and Families, Cambridgeshire County Council).

A devastating report that demands to be read by: current service users and their families/representatives; those currently seeking a service from CFA; all those who pay Council Tax; all those who vote in local and national elections ; trade union members; County Councillors, County Council employees and politicians of all hues.

It would be interesting to supplement these findings with further data showing a) the numbers of people currently affected by the ‘savings’ and the increased demand for CFA Services over the period 2014/15-2019/20 from people assessed as having ‘substantial’ or ‘critical’ needs [enquiries; referral rates; assessments; new cases opened; cases closed; existing total caseload; cases opened to review; cases transferred to/from other agencies; + all other cases entered onto the client database as requiring CFA input];  b) the number and type of care provider organisations that have withdrawn from providing a service to CCC following the re-negotiation of their contracts.(this can be highly –disruptive for service users and quality of service may be compromised)  and c) data showing Staffing Levels over time [substantive posts; joint-funded posts; turnover; vacancies; agency staff; pool staff (Zero-Hours) .

 

                                                                                             

Peter Wilson

17th October 2015.

Summary by Cambridge Commons

Cambridge News article 

Summary by Cambridge Commons

Cambridge News article 

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