NHS announcement means more control for ‘high-need individuals’

Disabled campaigners have welcomed new NHS plans to extend the number of disabled people with high levels of care and health needs who can control all of their own support.

Simon Stevens, chief executive of NHS England, said the scheme would for the first time “blend comprehensive health and social care funding for individuals, and allow them to direct how it is used”.

He said the NHS would offer local councils a “radical new option” in which “high-need individuals” would be able to control their combined health and social care support through a new Integrated Personal Commissioning (IPC) programme.

The first wave of the new scheme, from April 2015, is likely to include people with long-term conditions, children with complex needs, people with learning difficulties, and people with “severe and enduring” mental health problems.

Voluntary organisations will be paid to support individuals enrolled in the scheme with personal care planning, advocacy, and help in finding and choosing the right services.

A combined NHS and social care funding budget will be based on each person’s annual care needs, combining funds from local authorities and the NHS, while individuals will be able to decide how much personal control they want to have.

Liz Sayce, chief executive of Disability Rights UK, said: “When Simon Stevens announced plans for personal health and social care budgets to become the norm, he was met with a lot of complaints in the media.

“Their line was that we could not give these ‘vulnerable’ people budgets and that they would spend the money on the wrong things.

“We heard all these same arguments against direct payments in the 1990s – and they were proved wrong.

“They’ve also been proved wrong in relation to so-called ‘vulnerable’ people. The evaluation of personal health budgets found that people living with mental health problems actually had the highest satisfaction with personal budgets.”

She added: “It’s time to ditch paternalistic notions of ‘vulnerable’ people and give power to everyone living with disability or long-term health conditions.”

Clenton Farquharson and Marjory Broughton, the two service-user and carer representatives elected to co-chair the Think Local Act Personal (TLAP) national partnership of organisations committed to personalisation and community-based support, also welcomed the announcement.

They said: “For people with support needs and carers, the divisions between health and social care can feel artificial and have a negative impact on their experience.

“For people with complex needs, it is increasingly imperative that health and social care organisations work together to deliver a seamless, person-centred service.

“It is vital to unify health and social care and ensure it is directed by the individual.”

Stevens’ announcement came as the Commons public accounts committee (PAC) warned that the country was facing a “great adult social care squeeze, with need for care growing while public funding is falling”.

In its report on adult social care in England, the committee warns that there was an eight per cent real terms cut in spending on adult social care in the two years from 2010-11, despite the growing number of disabled and older people.

The report concludes that the government’s agenda to improve adult social care is “rightly ambitious” but will need “unprecedented levels of coordinated working” between government departments, between central and local government, and across local authorities and health bodies.

Only last week, an Association of Directors of Adult Social Services survey revealed a 26 per cent cut in social services budgets in the past four years.

The committee warns that the Department of Health (DH) and the Department for Communities and Local Government do not have the information and evidence they need “to understand fully the challenges that local authorities face in commissioning and providing adult social care and supporting carers” under the new Care Act.

The committee also warns that safeguarding referrals recorded by local authorities have risen 13 per cent to 109,000 in the two years from 2010-11, with 43 per cent of referrals substantiated.

DH told the committee it was “unable to explain why the number of safeguarding referrals has risen”, although it may reflect increased awareness of abuse or “overstretched resources and pressure within the system”.

The committee says DH and local authorities need to investigate why referrals are rising and whether this indicates rising levels of abuse.

Meanwhile, new figures from the Health and Social Care Information Centre (HSCIC) show that satisfaction levels with social care in England appear to have held steady in the last year.

Provisional results from the survey, answered by about 74,000 adult social care service-users, show that 29 per cent reported their quality of life was either so good that it could not be better, or was very good (up one percentage point from 2012-13).

The proportion reporting that their quality of life was bad was unchanged at six per cent, with another three per cent saying their quality of their life was very bad or so bad that it could not be worse (again, unchanged from 2012-13).

And 65 per cent of service-users were either extremely or very satisfied with the care and support services they received (up from 64 per cent in 2012-13).

A separate survey published by HSCIC found that the number of contacts with adult social services departments from new clients in 2013-14 was 2,157,000 (up four per cent from 2012-13).

And the number of adults receiving social care from their local authority fell five per cent in 2013-14 to 1,267,000, a fall of 29 per cent since 2008-09.

There was a five per cent drop in the number of people receiving community-based services in 2013-14, and a three per cent fall in those receiving residential care.

10 July 2014