Cash
for Care: Changing language; different entitlements?
What
began as a simple concept years ago has changed into a nightmare for statutory
health and social care budget holders, commissioners, operational staff and
people who may need or who already use health and social care services. The concept focused on ‘cash for care’ that could
be controlled by people who needed support to take control of life rather than have
their care arranged by their adult social care department or an agency. The term used in the 1996 Community Care
(Direct Payments) Act was ‘direct payment.’ Now, years later, there are four terms to
describe payments that can be made to an individual. They are: ‘direct payments,’ ‘personal
budgets,’ ‘personal health budgets’ and ‘continuing health care.’
Attached
to each term are different community and health care assessment forms each with
different criteria that, if eligible under the Act, entitle a person who needs
support to various ways in which to have their needs met. They can either have a cash payment, or a
mixture of cash from the adult social care budget, or cash and services, or
even money from a pooled health and social care budget or separate funding from
health and social care and direct services and equipment. They may also be eligible for funding from
other agencies, such as education or access to work. Alongside the community care assessment form
is a financial assessment form to be filled in.
These forms are complex, difficult to understand, and often require a
degree in mathematics! Each authority
has a different set of disability related expenses that can be disregarded and
many local authorities expect service users to pay the full 100 per cent cost
of their care package.
Local
authority and health boards, commissioners and operational staff struggle to provide this complex information
to the public and to service users and in trying to deliver care packages that
encompass ‘cash for care,’ generally find it too daunting. It is easier for care managers and other
professional people to offer traditional services, reducing in number with
decreased statutory funding, as these are few and readily explained and coded
under the plethora of budget headings generated by health and local
authorities.
If
you have got this far and are confused, don’t think it is any intellectual lack
on your part, the paperwork attached to acquiring cash for care is
confusing. It stops people entering the
health and social care systems and leaves people who require support feeling
depressed, lacking self-worth and with little or no idea of entitlements they
might expect within these systems. The
terminology used to describe entitlements amount to the same thing, ‘cash for
care.’ What has happened is that by
making the language difficult to penetrate, a whole industry has built up
around it, creating an increase in senior management and a vast amount of unnecessary
bureaucracy and waste. The straightforward
answer is; one pot of money, one integrated set of criteria for a self-and
community care assessment, one financial assessment form simply explained or
done away with as the vast resources needed to generate income could be used to
create more integrated care packages.
Finally,
with the centrally Government -funded Independent Living Fund being phased out
in the next few months and the money, non-ring-fenced, being transferred to
local authorities, it is not difficult to imagine the difficulties that will be
experienced by existing uses of that Fund.
What
is happening in Manchester also cannot be ignored. What we need to be vigilant about is the
lives of service uses becoming even more medicalised than they already are in
many situations.
Ann
Macfarlane
February
2015
