ENABLE Scotland

COSLA Community Care Charging Guidance Consultation

Consultation Response

September 2011

Introduction

ENABLE Scotland is the largest voluntary organisation in Scotland of and for children and adults who have learning disabilities and their families. We have a strong voluntary network with around 4000 members in 55 local branches as well as 500 national members throughout Scotland. Around a third of our members have a learning disability. ENABLE Scotland campaigns to improve the lives of people who have learning disabilities and their families and carers.

This response has been prepared following consultation with our members, staff and people who have learning disabilities. The views of our membership

were captured through discussion with members of ENABLE Scotland’s local ACE groups – made up of people who have learning disabilities.

Local authorities are currently operating against the backdrop of changing demographics and tightening local authority budgets. These trends have resulted in local authorities tightening their eligibility criteria and increasing charges for community care services. All of these factors make how the care system is funded and paid for a hugely important issue.

At the same time, it is also likely that some people who have learning disabilities will experience reductions in their income as a result of the UK Government’s planned welfare reforms. This is likely to have a significantly detrimental knock on effect on the level of income local authorities will receive through charging for non-residential community care services.

A number of local authorities are looking to include the mobility component of DLA within the financial assessment for non-residential care services. We believe that this should remain exempt.

Community care charging policies are of great concern to people who have learning disabilities and their families and carers. Many people who have learning disabilities make a personal contribution towards the community care service they receive from their local authority. These charges can vary across the country, even though they may be for the same service. These support services provide a lifeline for people who have learning disabilities and their families.

We also see little correlation between the cost of a service and its quality. At present there is no choice for disabled people in the market place. More choice, through the introduction of self-directed support across Scotland, will raise a number of different issues for local authorities.

Responses to Consultation Questions

1.  Do you agree that the personal contribution to the cost of community care services should be based on the ability to pay?

Yes – we agree. ENABLE Scotland believes that any charges for community care services must be based on the individual’s ability to pay. People who have learning disabilities are severely disadvantaged in the labour market[1] and live in poverty. Charging people beyond their means will push people further into poverty. To prevent this, it is essential that proper individual financial assessments are carried out before any charges are applied. People should also have support to maximise their income before any charges are applied.

Many of our members understand, but do not like, the need to contribute towards the services they receive from their local authority. Charging for care is perceived by many people who have learning disabilities, parents and carers as being a “super tax” levied by the local authority. They often resent the indignity of having to spend or give away their savings to get the basic support that they need. People who have learning disabilities, parents and carers rightly expect that if they are being charged for a service this will lead to more choice and control over the service they receive.

COSLA must also be aware that inconsistencies do not just exist in charges for community care services, but also in the quality of care available to people who have learning disabilities in Scotland. The amount you pay for a care service, does not necessarily relate to the quality of the service you will receive.

2.  What would be the benefits of making charging regimes across local authorities more consistent?

Many people who have learning disabilities and carers are concerned that, at present, different amounts can be charged by different Councils for similar services. At present a “postcode lottery” exists for non-residential care charging in Scotland. ENABLE Scotland believes that there should be both equality in the standard of care people receive and also in the cost that people have to pay for these care services.

We believe that even if there is a greater level of consistency over care charges, local authorities would still have a degree of flexibility in operating eligibility criteria for the services they provide.

This would bring the following benefits:

·  Protection for local authorities from the possibility of individual interpretation and application of the national charging guidance leading to legal challenges

·  A more transparent and easier to understand system for the people who use non-residential care services across Scotland. People will be able to see that they are being treated fairly.

3.  What are the advantages of having the flexibility to set charges locally?

There are advantages to local authorities of having the ability to set charges locally, but we are unsure of the advantages this provides to people who use community care services.

We accept the Scottish Government’s approach to allow local authorities some degree of flexibility over their charging policies, however, the ability for local authorities to set charges locally has, over time, led to significant variation in charges for exactly the same services. For instance:

EXAMPLE
Jack is 42 and lives alone. He gets 20 hours of care at home support per week. Jack’s total income for charging purposes is equal to £200.95 per week. Jack is considering moving to Scotland.
In Aberdeenshire, he would pay £40.95 per week
Charge must not exceed cost of the service - £10ph x 20hours = £200 per week
£200.95 - £160 (Council’s threshold for a single person under 60) = £40.95
£40.95 x 100% (Council’s taper) = £40.95
In Falkirk, he would pay £23.90 per week
Charge must not exceed cost of the service - £9ph x 20hours = £180 per week
£200.95 - £113 (Council’s threshold for a single person under 60) = £87.95
£87.95 x 100% (Council’s taper) = £87.95 (this exceeds the Council’s maximum charge of £23.90 per week)
In North Lanarkshire, he would pay £15.56 per week
Charge must not exceed cost of the service - £14.50ph x 20hours = £290 per week
£200.95 - £160 (threshold for a single person under 60) = £40.95
£40.95 x 38% (Council’s taper) = £15.56
In Stirling, he would pay £65.96 per week
Charge must not exceed cost of the service - £9.60ph x 20hours = £192 per week
£200.95 - £113 (Council’s threshold for a single person under 60) = £87.95
Until October 2011 - £87.95 x 75% (Council’s taper) = £65.95 per week
N.B in October 2011, Stirling Council’s taper will rise to 100%. From October £87.95 x 100% = £87.95 per week (£4,753.40 per year).

At present, different people who have similar care needs and similar incomes are being charged significantly different sums for varying levels of service. In effect, enabling local authorities to set their own charges has created thirty-two different systems across Scotland, one for each local authority area.

This means that 32 people who have exactly the same income and exactly the same requirements from non-residential care services will pay different amounts dependent on the area of Scotland within which they live. As a result, people who use non-residential care and feel that they are being overcharged have the following consumer choices:

·  Continue to pay excessive charges

·  Move to a local authority where you will get more for your money

·  Withdraw from support services altogether.

In response to the recent Christie Commission call for evidence on the future of public services, the Independent Living In Scotland project (ILiS) cited the following example of variation in charges across Scotland:

“A woman, aged 22, lived in one area and moved to another to study. In the original area, she paid £700 per month towards her community care and in the new area, she paid only £130.”

Whilst there are situations such as these where moving is to the financial advantage of the individual, there will be as many situations where moving to another area would be financially unviable. As ILiS note this creates barriers to “independent living, freedom of movement and the equal participation of disabled people in the civic and economic life of their communities”.

4.  Do you feel that there is a sufficient degree of transparency and inclusion regarding the development of COSLA’s NATIONAL charging guidance?

This is the first consultation on COSLA’s national charging guidance that we are aware of as ENABLE Scotland has never previously been asked to participate. We are pleased that COSLA has decided to begin consulting on this guidance. Future consultation will be vital in developing a sufficient degree of transparency and inclusion.

Whilst COSLA’s national charging guidance does not take the form of a ‘national prescription’ it does encourage councils to demonstrate that they have followed best practice in determining charges. The guidance recommends a threshold at which charges apply, but is not clear about the sanctions for local authorities, if any, if they do not follow the guidance. We believe that this needs to be clarified to make the guidance more effective.

5.  Do you feel that there is a sufficient degree of transparency and inclusion regarding the development of LOCAL charging policies?

We are not aware of any consultation with people who have learning disabilities on charging policies. Local authorities have organised general surveys about spending priorities, however this is not an appropriate replacement for specifically targeted consultation processes.

6.  What would be the impact of increasing charges to service users?

Many people who have learning disabilities are already seeing their charges for non-residential care services increase. We believe that increased charges have a detrimental impact on the lives of people who have learning disabilities, particularly in the wider context of welfare reform.

Proposed reforms to Disability Living Allowance and the recent abolition of care funding arrangements such as the Independent Living Fund have created severe concerns amongst disabled people and their carers that they are at risk of further financial hardship.

With very little money to spare, what can seem to local authorities like minor changes to charging policies can have a major effect on the lives of people who have learning disabilities. There have been examples of local authorities introducing charges and disabled people withdrawing from the service because they cannot afford to pay[2].

7.  What would be the impact of decreasing charges to service users?

Decreased charges would give people more choice and control over how they spend their income. However, we recognise how unlikely this is whilst local authority budgets are diminishing. If local authorities were to reduce their charges, this would raise concerns over how they will replace the lost income. ENABLE Scotland is concerned that this will lead to the rationing of non-residential care services.

However, likely results of decreased charges would include

·  Disabled people having more control over their income – but remaining in poverty

·  A requirement to make up the funds from elsewhere – possibly reimbursement from central Government

·  An increase in applications for services

·  Tightening eligibility criteria for services

Action may need to be taken to ensure that local authorities have sufficient resources to implement the policy change in order to avoid the tightening of eligibility criteria to “afford” this change.

We believe that the resultant impact would also depend on how a decrease in charges to service users is implemented. In Wales, the recent Social Care Charges (Wales) Measure introduced a maximum £50 a week charge for home care services[3]. However, this was subsidised by an additional sum of money from the Welsh Assembly Government to local authorities. We recognise that the implementation of such a measure in Scotland would be dependent on further investment from central Government.

8.  Do you agree that the COSLA guidance should be linked to DWP thresholds?

Yes – we agree that the COSLA guidance should be linked to DWP thresholds.

However, we note that DWP thresholds can take a standard rate across the country, yet local authorities are able to charge local tapers and home care rates.

9.  Should there be a standard format for charging information?

We are unsure about the requirement of a standard format for charging information, however clear and accessible information and effective communication on both charges and financial assessments are essential requirements for everyone who uses community care services.

In attempting to find out the detail of each local authority’s charging policy for use by our information and advice service, ENABLE Direct, we again found a degree of inconsistency across local authorities. This is despite COSLA guidance which that “all Councils have a duty to provide clear and concise public information”.

While some local authorities provided information on the detail of financial assessments and charges people could expect to pay through their website, many others did not. There were also significant delays when requesting charging information by post or email. Where this information is easily available it is often complicated and confusing.

It is vital to ensure that people who have learning disabilities have a clear understanding of:

·  Why they are being charged

·  How it is decided if they will have to pay a charge

·  What they are likely to be charged

·  How to appeal against a charge

Accessible information is a huge barrier to the independence of people who have learning disabilities. Everyone should be able to access and understand information that affect their lives. In this instance, accessible information will enable people who have learning disabilities to understand the charges they will pay and why. All information must be available about charges in a range of accessible formats – including easy read. This information must also be provided free of charge.