Today the Barker Commission publishes its final recommendations about the future of health and social care.
Alongside welcome proposals for increased investment in care, the Commission has reignited the debate about the best way of merging a health system that’s universally free at the point of use with a social care system where access is rationed through eligibility tests and means-testing.
Political debates about integrating health and social care are also heating up, with recent announcements in the Government’s Better Care Fund, Labour’s Whole Person Care and the Liberal Democrats’ proposals for ring-fenced pooled budgets.
This is not just a debate about older people; it’s about working-age disabled people too.
Integrated support is about recognising that people don’t live their lives in neat public service boxes or have simple sets of distinct needs that can be addressed separately.
Many of the Barker Commission’s recommendations are relevant to disabled adults. The Commission calls for care to be redesigned around individual needs, regardless of diagnosis. It calls for public debate about how much people should be expected to contribute to the costs of support. It seeks to remove duplication and complexity for individuals.
But almost a third of social care users are working age disabled adults and this represents over 50 percent of social care expenditure.
We need to think about how integration might differ for disabled adults. Integrated support can take many forms and means different things to different people depending on their age, needs and aspirations.
We need to look beyond health and social care
Unsurprisingly, disabled adults tell us the purpose of integrated support should be to help them live more independently – to build relationships, choose where they live and work, participate in the community and afford essential goods and services.
These outcomes are all interdependent and we shouldn’t treat them in isolation, but that’s exactly what the current support system does.
For example, a disabled person’s care package affects their ability to work. Without support to get washed, dressed and ready for work, it is almost impossible to get a job.
Scope worked with four other leading charities and Deloitte to show that providing social care for disabled people with lower level needs could create wider financial savings for the Treasury. Better join up between employment support and social care services would allow disabled people, social workers and employment advisers to identify where a lack of social care support is stopping someone from finding sustainable employment and to address this effectively.
So for disabled people, integrating social care with other aspects of support like out of work support – might be more helpful than integrating health and social care.
We also know that life costs more when you’re disabled. Extra costs payments (DLA and PIP) have a distinct role in supporting disabled people to offset the extra costs of disability. Future discussions about integration need to recognise the difference between support needed to live independently and support to off-set the extra costs of disability. Both are equally important.
What should integrated support for disabled adults do?
Because we know politicians are interested in this issue, we’ve developed some principles for integrated support based on what disabled people have told us about their living standards.
We think any integrated system of support should:
- Make it easier to live more independently
- Remove genuine duplication from the perspective of those receiving support (rather than the organisations and systems giving support )
- Have clear, measurable benefits for disabled people, rather than immediate financial benefits for the state
- Prevent or reduce future support needs
- Be holistic and allow people to achieve the outcomes that matter to them
- Capture everyone who needs support and not result in anyone falling out of the support system
- Not drive up extra costs for disabled people
- Be flexible so that people can easily move between different types and levels of support
- Use personalised assessments, systems and processes
- Achieve the right balance between national conditionality and local discretion
Do you ever feel that the support you receive could be simpler or more joined up?
Scope wants to hear your ideas on what integrated support for disabled people should do, and what it could look like.
Over the next few months Scope will be holding conversations what integrated support for disabled adults could look like.
We’re also running an independent Commission to investigate ways of driving down the extra costs faced by disabled people and their families.
Together, we can use the Barker Commission as the start of a much bigger conversation about integrated support for disabled people.