Cash for Care: different language; different entitlements?

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