Analysis of proposals – Jane

It is understood that the Council has a shortage of money which has been exacerbated by the Government Spending Review and is the real reason for the proposal to increase charges to disabled and older people for social care services. It is also understood that the Council is required to follow Department of Health guidelines in relation to these charges. However, from the perspective of Kingston’s disabled service users, the reasons for and sources of the pressures do not change the highly disadvantageous and unfair effect of the proposals. In fact, in the light of proposed changes to the benefits system, the effects of the increase in care charges proposed at the Council’s Executive committee on 29 September will undoubtedly be exacerbated by central government cutbacks.

In these circumstances, Kingston Council needs to acknowledge the very real threat to the health and well-being of disabled people in the borough and stretch every sinew to mitigate the effects of the totality of the cuts. This will be difficult but the Council should start from the principle that those whose quality of life is most at risk (disabled people) should be the best protected and those residents with the broadest shoulders (generally, non-disabled people) should bear the biggest burden.

 Equality and fairness

1. Charging for community care services is effectively a tax on disability, or, to put it another way, a tax, or charge, on undertaking the most basic activities of daily living such as going to the toilet, washing and dressing – in fact, staying alive.  These proposals seek to plug the shortfall in the council’s finances by fleecing disabled and older people who do not choose to be in need of services. This is not a progressive proposal as it is manifestly not the case that disabled and older people needing help with daily living are the wealthiest borough residents.

2. In modern Britain, particularly under the transformation agenda, community care services are intended to support disabled people to live as independently as possible and to ‘level the playing field’ between disabled and non-disabled people in society. However, these laudable aims are completely undermined if disabled people, whether in paid work or not, have to spend so much of their income and savings on support for independent living that they cannot afford anything remotely approaching the lifestyles enjoyed by their non-disabled peers.

3. Research by Leonard Cheshire and others has identified the disincentive to saving which results from social care charging. There is a particular unfairness consequential on applying a capital limit above which a service user must pay the full cost of care and doubling the tariff income calculated on savings below that limit. These measures will increase the already inequitable position currently faced by younger service users who will find it even harder to save to purchase their own home. In addition to facing a huge shortage of private wheelchair accessible homes to purchase, and the high cost of private market housing in Kingston, such disabled service users will be prevented from saving for a home by the imposition of huge charges once their savings towards a deposit have reached a moderate level. In addition, many older people who have saved prudently earlier in their lives have to use their savings to supplement their income, which at current interest rates already causes considerable hardship.

4. Recent research by Leonard Cheshire has found that a number of disabled people in Britain are pushed into poverty by care charging – see the recent reports on disability poverty on the Leonard Cheshire website – eg  ‘Disability Poverty in the UK’( January 2008) and the annual ‘Disability Review’.

5. The proposals are very likely to increase fuel poverty among younger disabled people who do not, of course, get the winter fuel allowance as older people do, although many believe winter fuel payments should include younger people whose impairment means they need to spend more on heating. (In fact it appears quite possible that the government will abolish all winter payments).

6. The proposal to take up to 100% of a person’s disposable income to pay for the cost of their care has major equality implications. It will mean that disabled people have very much less control over how they spend their own money and a considerably lower standard of living than non-disabled people, further increasing the social inequality they face. It will also mean that disabled people who are unable to work will be discouraged from improving their standard of living by generating an income, eg by renting out a room in their home (should they indeed have spare capacity), as most or all of that income is likely to go straight to RBK.

7. The council needs to consider the effect of these proposals on disabled people who are already terrified about what will happen to their benefits under this anti-disabled people coalition government. The government wants to spend 20% less on DLA for adults by bringing in a new test which may well not be fair (the current work capability test for ESA is widely known to be deeply unfair). People are already fearing the loss of their Motability cars (ie their mobility and freedom), their income and will now be fearing the loss of their social care services as well. People may not be aware of the fact that, particularly if they are unable to benefit from the Motability scheme, disabled people who are unable to drive and yet want to get out in a car may have to pay around £35-40,000 for a wheelchair accessible vehicle as well as paying a driver. There are second hand vehicles but sitting in the back as a passenger is grossly uncomfortable, often painful and the visibility is poor. A disabled person needing such a vehicle would be unable to save enough to purchase one if they have to fund the full cost of their care once their savings reach £23,250.

8. One of the most inequitable elements of the current charging policy arises when someone retires and, as would be expected, their income reduces markedly. At this point their care charges increase hugely because earnings are disregarded but pension income is not. This inequitable situation, which particularly affects disabled people receiving care who have to retire before retirement age, will not be addressed by the new policy as it stems from Department of Health guidance.

9. The proposals, if implemented in full, will arguably change the social care landscape in Kingston much more than the transformation agenda. It will no longer be worthwhile for those assessed for a moderate level of personal budget to accept a service unless they are very poor or unless most of their income is earned. Consequently, the proposals will result in a much smaller number of service users, generally those with high care needs, the very poor and those fortunate enough to be able to work.  Does the Council really want to balance the books on the backs of those with the highest needs?

Kingston’s reputation for social care services

10. I believe the proposed changes to the charging regime will completely destroy what remains of Kingston’s hitherto excellent reputation for social care services. Reputation doesn’t pay the bills, but if the politicians and officers could find more innovative ways of making money without having to balance the books on the backs of disabled and older service users that would also raise the council’s reputation – for being an innovative council which is not seeking to plug the funding gap by increasing charges on those needing care. I really hope senior officers and politicians will consider their moral obligation to follow in the footsteps of those (eg Jenny Webb, Roy Taylor) whose actions in the past made Kingston a beacon of good practice in relation to supporting disabled people to live independently.

The comparison with residential care charges

11. The comparison with residential care charges is a complete irrelevance to younger disabled people for whom it is widely accepted that independent living is greatly preferable to being incarcerated in institutions, and of whom there are consequently very few in residential care.  Similarly, for older disabled people residential care is, or should be, a last resort. It is known that Kingston currently has the fourth highest number of older people in residential care in London.

12. The alignment of charges for domiciliary care and residential care is fundamentally flawed from a financial perspective.  People in residential care do not have to pay for gas, electricity, television licence, home maintenance and other home-related expenses, and presumably even their food is provided as part of their residential care fees. People living in their own, or rented, homes, have to meet all or most of these costs, depending on tenure, on top of their care charges and other living expenses.

13. If there is a genuine desire to compare and align charges for domiciliary care with charges for residential care, RBK should give allowances for utility bills, home maintenance and other costs that people living at home have to meet and that people in residential accommodation do not.

Financial considerations

14. These proposals are unlikely to increase income to the Council by very much, as many people will decide it’s simply not worth accepting services. The only increase in income will be from those who have just enough income and/or capital to pay the charges but who cannot manage without a substantial level of care. Does the Council really want to balance the books on the back of those with the highest needs?

15. The Council could find more innovative and fair ways of making money – see examples at http://www.apse.org.uk/charging-trading/case-studies.html and http://www.communities.gov.uk/newsstories/localgovernment/1716793 

Suggested changes to make proposals fairer to disabled people

16. Ensure that all other possible sources of income have been explored, and provide evidence of this, before seeking to plug the funding gap on the backs of disabled and older people who do not choose to need care.

17. Do not take 100% of people’s disposable income, as doing so greatly increases social inequality for disabled people and considerably reduces people’s ability to improve their standard of living.

18. Increase the range of allowances to take account of the costs borne by people living in their own or rented homes – eg utility bills, home maintenance.

19. Ensure that advice is available to all service users to enable them to claim allowances for all of the high costs of disability, including supplementing poor NHS equipment and materials such as bed sheets, shoes etc. Equipment such as specialist mattresses, powered wheelchairs, specialist seating etc is extremely expensive.

20. Remove the requirement for service users to contribute to their personal budget, ie allow service users to use only their net personal budget towards achieving the objectives set out in their support plan. The advantage of removing this requirement would be that service users have a greater choice in how they use the portion of their personal budget that is their own money and have more scope to tailor the level of support to what they can afford. Any argument that the Council must protect people by insisting they use their whole personal budget for their assessed care needs is fallacious as the Council cannot protect those people who decide not to receive a service because it is not financially worthwhile for them to do so.

21. Cap contributions at less than 100% of a person’s personal budget, to make it worthwhile for people to accept a service. Taking contributions up to a person’s full assessed PB will dissuade a large number of people from taking a PB because it will be a pointless waste of time – ie extra paperwork and a separate bank account to have the Council dictate how you spend your own money – bonkers.

Some additional requirements for the consultation process

22. Provide full information on allowances and disregards and much more realistic and detailed examples to help people understand how the proposals will affect their own situations. Include examples of people on personal budgets and direct payments, people who have children, people in work etc.

23. Calculate prospective care charges for individual service users, so they can see how the changes will affect them and respond on the basis of fact.

Jane Young

3 October 2010, amended 19 October 2010 and 11 November 2010