Community care policy

Law Centre (NI) briefing   

December 2006

1.  Introduction

This briefing paper outlines some of the main issues relating to community care policy in Northern Ireland as identified by Law Centre (NI).

2.  Key Statistics

	The number of older people living in residential care homes in the UK is estimated to be approximately half a million[1]
	Approximately 20,000-30,000 service users in the UK are estimated to be receiving direct payments[2]
	Between 1996 - 2036 it is estimated that the percentage of the population in Northern Ireland aged 65 or over will almost double from 13 per cent to 24 per cent[3]
	27.9 per cent Northern Ireland ’s population is aged 60 years and over[4]
	There are an estimated six million carers throughout the UK ,[5] and over 185,000 carers in Northern Ireland [6]
	The work of carers saves the UK economy approximately £57 billion a year[7]
	3 out of 4 carers surveyed in the UK are physically and financially worse off since becoming a carer[8]
	65 per cent of people with a caring responsibility did not identify themselves as a carer in the first year of caring.  For 32 per cent it took over 5 years before they recognised they were a carer, thus they have missed out on substantial social services benefits and additional support.[9]
	Estimates from 2005 indicate that carers in Northern Ireland are missing out on almost £4 million in unclaimed benefits, and are not getting the services or information they need, particularly in the vital first year of caring.[10]

3.  Summary of Main Issues for Community Care in Northern Ireland

	Free personal care
	Third party top-up payments
	Continuing care costs
	Direct payments
	Jointly owned property for benefit assessments
	Care packages
	Care services and facilities for children with special needs who move from children to adult teams within social services
	Carers right to assessment

4.  Law Centre (NI)

Law Centre (NI) works to promote social justice and provide specialist legal services to advice organisations and disadvantaged individuals through our advice line and our casework services from our two regional offices in Northern Ireland .  It provides a specialist legal service (advice, representation, training, information and policy comment) in five areas of law: immigration, social security, community care, mental health and employment.  The community care legal representation service deals with personal and support services for a range of people including those who are elderly, ill, disabled, incapacitated and carers.  Our community care advice line operates from both our offices and our community care legal representation service provides training for trusts and social services.

Law Centre services are provided to almost 500 member agencies.  Members include local Citizen Advice Bureaux, independent advice agencies, local solicitors, trade unions, social services, probation offices, constituency associations of local political parties, libraries and other civic organisations. 

5.  Free Personal Care

5.1 We support the implementation of free personal care for older people in Northern Ireland .  We aware that this issue has been tabled for debate by the Assembly and will be providing a more detailed response in due course.

5.2 Law Centre (NI) is a member of Rights in Community Care (RICC), an umbrella group of organisations including UNISON, Age Concern, Help the Aged, Alzheimer’s Society, Carers NI and Disability Action.  RICC have previously campaigned regarding this issue and we will be working as part of that group to raise awareness and support of this issue in the New Year.

6.  Third party top up payments  

6.1 In Northern Ireland people who require publicly funded residential care are given a choice of which home they wish to reside in to receive their care.  Each Trust has a capped amount which they will pay for residential care based on an assessment of an individual’s needs. If the home chosen by the person who requires the care charges more than this capped amount the person or their family are required to pay the difference in a top up payment.  More often than not, despite the offering of a choice, there is usually only one home that will meet an individual’s needs.  Despite this, if that home still charges more than a Trust’s capped amount a top up payment will still be incurred.  

6.2 The majority of residential homes in Northern Ireland charges a top up fee and this can range from £20 to £100 per week.  When the person who requires the care is admitted a family member is required to sign a contract to confirm they will meet the top up payment.  The family member will often sign at times of extreme stress without full knowledge of the ramifications of signing the contract. 

6.3 New guidelines released by the Department of Health, Social Services and Public Safety in July 2006 have improved the situation but some education still needs to be done to ensure that Trusts and residential homes are correctly implementing the guidelines. 

7.  Continuing Care and Other Care Issues

7.1 In Northern Ireland individuals who have over £21,500[11] in capital have to pay for their health care costs (nursing and accommodation) if they are discharged from hospital but need continuing care in a nursing home.  In England and Wales there is often no charge for continuing care costs, dependent on the assessment of the individual’s health related needs.  We would welcome the recognition of the need for parity within the United Kingdom in regards to these costs.

7.2 People who want control over their own care package are assessed and given a direct payment from their Trust so they can arrange and fund their own care.  The direct payments are capped by the Trust and again differ across Trusts.  Many people who receive direct payments are using the same care agencies as the Trusts but often the care agencies charges individuals more than the Trusts.  It is important that those who wish to maintain their independence and retain control of coordinating their own care packages are not disadvantaged as a result and charged more for receiving the same service.

7.3 Another issue for those in receipt of community care in Northern Ireland is the lack of sufficient back-up systems for when care packages break down.  When care packages break down there is insufficient support in place to ensure back-up care is provided.  Individuals may be temporarily placed in a home until the care package can be fixed.  This leads to disruption and distress for the individual requiring the care and their families.  Work needs to be done in this area to ensure that sufficient thought and effort is put into ensuring that back up care can be provided efficiently.

7.4  We are concerned by the interpretation of Departmental guidance relating to the assessment of a person’s capital when a person is placed in residential care.   One of the major issues in the assessment of capital is the calculation of the interest held by a person in a jointly owned property.  Trust’s are not clear in the interpretation of the guidance and as a result we have concerns that incorrect valuations of property are occurring which can have a significant impact on the services and benefits available to the person concerned.   

7.5 We have considerable concerns regarding the provision of facilities and services for young adults with special needs involved with social services.  When these young adults turn 18 years old or leave school, on average, at 18 or 19 years old they are moved from children to adult support services.  This often results in young adults with special needs loosing contact with their children support services social worker.  This change can cause considerable distress for a young adult who has established a relationship with a social worker only to have to move to a new social worker who may not have the relevant skills and experience of working with young adults with special needs. 

7.6 There are also considerable gaps in the provision by adult support services of appropriate facilities for young adults with special needs, in particular there is a lack of appropriate respite an/or daycare facilities to provide the support and assistance young people with special needs require. 

8.  Carers

8.1 The Carers and Direct Payments Act ( Northern Ireland ) 2002 gives carers the right to request an assessment of their individual needs and places an obligation on Trusts to meet the needs of carers as assessed.[12]  The Act contains a duty to provide the services required yet no extra funding was earmarked to meet the requirements of the Act.

8.2 Carers represent one of the most socially excluded groups of people for whom the Government’s inclusion policy appears (to date) to have failed.[13]  Many carers remain unaware of their rights under the Act and further awareness raising is required regarding the right to an assessment.  Consideration also needs to be given to the allocation of resources by the Trusts to ensure that when assessments are completed there is funding for the recommendations to be implemented.

9. Where to Next

9.1  Law Centre (NI) aims to continue to work on these policy issues to ensure that those requiring community care have access to the services and support they require and that Trusts and residential care homes are held accountable for the services they provide people in Northern Ireland .

9.2  The policy team will work closely with our community care legal representation service so our work is informed and shaped by the real experiences of people in Northern Ireland .  This provides a unique and exciting opportunity for campaigning and lobbying on policy issues to be directly informed by community care users, carers and family members.   

Notes