Tag Archives: better care fund

Let’s start a bigger conversation about integrated support for disabled people

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

Where next?

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.

The Better Care Fund shouldn’t be seen as causing an NHS Funding Crisis – It’s helping to solve it

Newspaper headlines in the last two weeks have carried a number of stories about a funding crisis heading for the NHS. Common amongst these stories is the fact that they identify the transfer of NHS funding into social care as contributing to this ‘black hole’.

What is being referred to here is the creation of the ‘Integration Transformation Fund’ at the Spending Review in July 2013. Since then, it has gained the less technical title – the ‘Better Care Fund’ – in recognition of the Fund’s increased political importance.

Despite the change in title, the principle remains the same: this fund – totaling £3.8bn – is to be made available to Health and Well-being Boards to be spent on better social care for disabled and older people.

It is true that half of this money, £2bn, has been earmarked from the NHS Budget in a bold step that the Government has taken towards the hallowed ground of integrated health and social care services. It was a recognition of the obvious – that social care and hospital care are closely tied together, and we must start to think of them as such. An older or disabled person trapped in a hospital bed because they can’t get the support they need at home is perhaps the simplest illustration of how closely the systems are tied. Indeed, most patients just don’t know there is a difference in the first place.

As such, this £2bn doesn’t have to work hard for its place in the Fund. It’s important to remember that the Fund itself it not a straightforward ‘direct transfer’ from health budgets to social care. Health and Wellbeing Boards have to bid for this money – and there are tight national conditions attached. The most important of these conditions is that the money must be spent in a way that works for both social care and the NHS.

Another condition is that the money must be spent on care support that prevents unnecessary hospital admissions at the weekend.

In other words, by its very design, the Fund has to save the NHS money for it to even be allocated in the first place.

In both the NHS and in local authorities providing social care, there is considerable pressure to deliver more with fewer resources. With the core budgets of local authorities being cut by up to 40%, the social care landscape has had to adapt radically and quickly.

The Better Care Fund offers an incentive to both the NHS and to social care services to work together to innovate. It helps to lay the foundations for a much more integrated system of health and care.

And it must – by its very design – save the NHS money, not send it into financial ruin. If it’s not doing that yet, councils and health teams need to work harder together, not walk away. The government’s right – what’s at stake is better care.