Equal Lives Response to the Norfolk County Council Consultation on the Cuts
“It’s taken the pressure off my family, off the children and left me being able to go out and do my own shopping and do an activity, maybe with them as a family where I couldn’t before. It’s taken the stress off the children, they can now be children and not young carers.” Personal Budget User
At Equal Lives, we know, because of our vast experience and knowledge, that the cuts proposed to Adult Social Care will be the end of personalisation. The suggested cuts will result in disabled and older people becoming ‘prisoners’ in our homes, as well as imposing an intolerable burden on families and carers. While it may seem to an accountant that the ‘social activity’ part of personal budgets is a luxury that can be easily dispensed with and offer an easy way of saving money, this calculation ignores both the personal impact on the lives of service users, as well as also the medium and long-term financial costs, and the short-term costs, that will inevitably follow as people are forced up the ladder of need. It goes against almost every aspect of the Council’s own Prevention Agenda. In short, it will result in a massively false economy – a lose-lose proposal.
Equal Lives
Equal Lives (formerly The Norfolk Coalition of Disabled People), its members and service users have worked in close partnership with Norfolk County Council since the passage of Community Care (Direct Payments) Act 1996 to develop Direct Payments (DP) and subsequently Personal Budgets (PB). Our organization has been supporting people to use direct payments since 1998. In 2001 it won Norfolk County Council’s tender for a direct payments support service and established Independent Living Norfolk (ILN), just one of the services which was managed by the Norfolk Coalition of Disabled People. At this time just 80 people used direct payments in the county.
In April 2013 the organisation was rebranded and is now known as Equal Lives. We provide specialist advice and support services to more than 3,000 people using self-directed support in Norfolk. More than 1,700 personal assistant employers use our payroll service and we hold more than 2,500 supported accounts on behalf of direct payments users in Norfolk.
Equal Lives provides advice and support to individuals using Personal Budgets and/or Direct Payments funded by the local authorities in Norfolk and Suffolk, the NHS, through personal health budgets or to individuals who fund their own care and support.
In relation to self directed support our services include:
- Assisting an individual to think about how they might like to use their Personal Budget and assistance with writing their support plan
- Support to set up Direct Payments
- Advice on arranging individual care and support
- Advice on arranging care and support for disabled child
- Support with recruitment of personal assistants
- Advice and support to individuals on being a good employer
- A payroll service to support individuals in working out wages
- A Supported Account service to support individuals to manage their Direct Payment monies
“The proofs in the pudding, I’m still here and I’m still reasonably happy, I can cope with life, I’m in control of my own life, responsible for myself and I have quite a few friends that have received personal budgets, mental health service users and it’s had exactly the same effect for them as well. It’s given them choice, it’s given them confidence, self esteem and it’s got them re-engaged with their communities, so to me personal budgets are essential.” PB User
Wider Implications of the Proposed Cuts
These proposals violate the UN Convention on the Rights of Persons with Disabilities (CRPD) which the UK Government has signed and ratified. In particular they violate Article 19 which states:
“Persons with disabilities must be able to live independently, to be included in the community, to choose where and with whom to live and to have access to in-home, residential and community support services”.
Norfolk spends less per head of population on adult social care than most council’s across the UK (see Appendix 1 below). On top of this, Norfolk’s population has more older and disabled people than most other counties, so the cuts will have both a disproportionate and discriminatory effect.
The Council’s own high level equality impact assessment states:
“At this early stage in the process, it is clear that the budget proposals, if implemented in their current form, would disproportionately impact on disabled residents of Norfolk, their carers and families. Because of the association between disability and the increased chance of developing medical conditions and frailty as people age, older people will also be disproportionately affected. This impact is likely to be felt in several ways. It may limit disabled and older people’s independence and resources, and affect their quality of life and mobility across the county. It may restrict their access to the built environment, public transport and leisure activities. It may increase their vulnerability to loneliness and social isolation, and place greater responsibilities of care on their families, friends and colleagues.”
“Very vital, because it’s actually getting me out doing things and when I first took my PA on, I was having a number of transfusions over two months and that was in 2009 and in the last four years I’ve had only 3 blood transfusions for my anaemia so obviously getting out and about and staying active at work does help.” PB User
Analysis of the Impact of Proposed Cuts to Services and Charges
The details given in the consultation do not allow a proper, detailed analysis of the proposed cuts. The implications from the information provided are the following:
Reduce funding for wellbeing activities for people receiving support from Adult Social Care through a personal budget
What we believe this could mean.
- Some people would get less money in their personal budget
- There would be no support for accessing leisure and non-care activities
Change the type of social care support that people receive to help them live at home
What we believe this could mean?
- Older and disabled people becoming ‘prisoners in our homes’
- Reduction of independence and quality of life
- Move away from personalised social care to expensive agency care which costs more and results in worse outcomes
- Increase in stress on families and carers
Reorganise how we provide care for people with learning disabilities or physical disabilities
What we believe this could mean?
- Disproportionate cuts to services – poorer quality of life, poorer health and less independence
- Turning the clock back to the bad old days where we were ‘hidden away’ from society in institutions
- Move away from personalised social care to expensive agency care which costs more and gets worse outcomes
Work better with the NHS to deliver the re-ablement and swifts service
What we believe this could mean?
If this works well it could be a positive move, however:
- It could mean institutionalisation and greater reliance on residential and hospital care – again turning the clock back
- The N&N contract is sucking people into hospital not creating effective preventative schemes
Reduce the number of Adult Care Service users we provide transport for
What this could mean?
- A rolling back of our rights to independence and equality with our peers in the rest of society
- These charges on top of charging for day services will put transport out of the reach of the poorest disabled people. This will mean disabled people will be institutionalised at home
“And it’s going to damage people. We’re whole people, we’re not here for our bodies to be serviced and washed and fed and we’ve got needs of being able to take part in the community and if you take that away then we will become sick and we become a greater burden. PB User
Evidence for the benefits of Personal Budgets
The first National Personal Budget Survey (In Control, 2011) provides clear evidence that people managing their own personal budgets as direct payments achieve significantly better outcomes than people whose budgets are managed by Councils.
The second survey carried out this year found that:
Over 70 per cent of people who hold a PB reported a positive impact on being independent, getting the support they need and want and being supported with dignity
Over 60 per cent reported a positive impact on physical health, mental wellbeing and control over their support
A further 50 per cent reported a positive impact on feeling safe in and outside their home, and in their relationships with paid supporters. The survey found only small numbers of people reporting any negative impact.
For the first time, the same survey was also run with 195 people who hold personal health budgets (PHBs) and 117 of their carers. This group reported similar positive results as those with social care PBs.
At the Think Local Act Personal summit on 13 September 2013 the following successes, challenges and opportunities were outlined:
- Personal budgets have been liberating for many people, enabling them to take greater control over their lives and improve the support they use
But…too many people experience a rhetoric/reality gap. For example:
- Councils can often be too prescriptive on what personal budgets can be spent on e.g. only on personal care, rather than what meets outcomes
- Service users are sometimes penalised for wanting to have a direct payment
- Managed personal budgets too often don’t offer real choice and control
Challenges:
- Having a system that is simple to understand, transparent in the allocation of resources, how decisions are made, and monitoring arrangements and lets people use money creatively
- Ensuring there are good brokerage and support systems that help people to think through the variety of ways in which outcomes can be met, avoiding the ‘task and finish’ approach
Opportunities
- Co-production – councils can shift to an approach of working with service users to design and deliver services and personal budgets together thus avoiding service that no one wants
- The integration of personal budgets across a number of funding streams including health and social care and rolling out the Right to Control could enable people to pool PBs across all areas of their lives
“We’re not just pawns in a game of chess, we’re real people and these cuts are really going to be devastating for us in it just changes completely from what we are now to what we were before.” PB User
Personal Budgets In Norfolk
In Norfolk good progress has been made towards meaningful personalisation for some service users. However, there are still too many for whom their personal budget is not ‘real’. The current proposals for savings as they stand would mean an end to meaningful personalisation and personal budgets. To restrict personal budgets to personal care, respite and day services goes counter to all Government guidance in TLAP and MIR. This is not an acceptable way forward for disabled people and their families.
Norfolk’s experience to date clearly demonstrates the cost effectiveness of direct payments compared to directly commissioned services. In Norfolk it costs about 40% less to employ one’s own personal assistants directly than to pay an agency or have the Council arrange services. This is a conservative estimate and takes into account the cost of the specialist advice and support services provided by Equal Lives.
There is also clear evidence that people who are in control of their own money through direct payments are very prudent. About 10% of direct payments made by Norfolk County Council are returned to or recovered by the Council unspent. This amounts to approximately £1.2m a year. This is money which can be reinvested in services.
A strategic co-production partnership between Equal Lives and Norfolk County Council, together with a robust funding model, has also been critical in enabling thousands of disabled people in Norfolk to empower themselves to live more independent, equal and active lives.
Having a Disabled People’s Organisation (DPO) managing the self-directed support service has also been critical to the success of direct payments in Norfolk. Equal Lives has embedded its values in the delivery of its support service and its partnership work with Norfolk County Council, including a social model of disability approach and the concept of professionals being ‘on tap, not on top’. This has led to a focus on peer support, including the creation of a network of independent living groups, and has ensured that the expertise and lived experiences of disabled people have and continue to shape the development of self-directed support.
“If these proposed cuts go ahead and I lose my supported activities, I can’t see why I’d want to get out of bed in the mornings. It would just be devastating. PB User
Equal Lives Proposals for Saving Money and Achieving Better Outcomes
- NCC ACS and Equal Lives co-produce and implement a plan with to increase to 10,000 service users who take all or a large part of their personal budgets as direct payments and manage their own care using personal assistants. We believe this scaling up will produce better outcomes for individuals and save money.
- Work together to identify those who have some of the highest care packages and work with the service users to increase their choice and control and decrease the use of managed services.
- Identify those service users who live with elderly parents and work collaboratively with the families to move them to independent/supported living to avoid institutionalisation at a later date.
“It’s been something that I couldn’t imagine being without now. It’s changed my life. I don’t get so depressed and it’s given me a reason for going on, for living. It’s been a wonderful journey and I’d love to see that continue.” PB User
Mark Harrison – CEO – Equal Lives
Shaun Hobbs – Chair – Equal Lives
Norfolk Coalition of Disabled People Trading as Equal Lives
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Appendix
The cuts in Norfolk – the second round of misery
Chris Edwards
1. Cuts in Norfolk
In 2010, Norfolk County Council proposed cuts of £136 million over the three years between 2010-11 and 2013-14. This was 23% of the Council’s total expenditure in 2010-11 of £579 million. This short report focuses on adult social care. The net expenditure on Adult Social Care was to be cut by 22% over the three years (see Edwards, January 7, 2011, 18).
What were the actual cuts over this period?
For total expenditure, the cuts over the three years would seem to be about £140 million. This was the figure given in ‘Your Norfolk’ dated Autumn 2013 (NCC Autumn 2013, page 2) by the Leader of the Council, George Nobbs. In the County Council’s Statement of Accounts for 2012-13, the corresponding cuts figure is given as £139 million (see NCC, 2013). This is a cut of 24% of the 2010-11 total.
What were the actual cuts for adult social care? In 2010-11, the NCC’s net expenditure on adult social care totalled £262 million. In 2012-13 the actual expenditure had fallen to £233 million, a fall of 11%. But note that this is in cash terms. Over those two years, prices (the Consumer Price Index) rose by 6.3% so that in real terms, expenditure on adult social care in Norfolk fell by about 17%. The cut in 2013-14 is scheduled to be about 7% (from £233 million to £217 million) which brings us to a cut over the three years of 24% for adult social care.
Therefore both total expenditure and adult social care will have been cut by 24% over the three years to March 2014.
Now, as if this was not bad enough, the Council is planning to cut a further £189 million over the following three years (2014-15 to 2016-17). £91 million of this is due to a cut in the funding from the Government and the rest (£98 million) presumably comes from the Council freezing its share of the Council Tax (NCC Autumn 2013, pages 2 and 5). This cut of £189 million is 32% of total expenditure in 2012-13 of £592 million.
So on top of a cut of 24% over the three years from 2010-11 through 2013-14, we will be getting a further cut of about 32% over the following three years, that is from 2014-15 through 2016-17. This means that if these cuts are implemented, the Council’s expenditure will have been cut by over a half over the six years
It is these cuts and the budget that are to be decided by the full Council (of 84 members) on 17 February 2014 (NCC Autumn 2013, page 5).
‘Your Norfolk’ claims that the Council has identified cuts of £140 million for the next three years with Adult Social Services being cut by a further 5% (NCC Autumn 2013, page 4). Some, but only some of the horrendous details of service changes are given on page 4 of ‘Your Norfolk’.
2. Why are we facing these cuts? We are not in this together and there are alternatives
The cuts are being imposed by the Coalition Government accompanied by the cry of “we are all in this together”. We are not. If we look at the changes in taxes and benefits and the cuts in government expenditure over the years up the next election in 2015, the cut on the poorest fifth is 11% whereas the cut on the richest fifth is only 4%. The cut on the poorest fifth is almost three times as great as that on the richest fifth even though the disposable income of the richest fifth is more than six times that of the poorest fifth (see Edwards, March 2013).
The deficit could and should be closed by taxing the rich (for details, see Edwards, January 7, 2011, 36).
3. Back to the expenditure on adult social care in Norfolk…..and the miserable record of Norfolk
We have seen that expenditure on adult social care been cut in Norfolk and continues to be cut. And yet these cuts are from an already low level. Table 1 below shows the expenditure on adult social care as a percentage of total Local Authority expenditure in 2011-12 for the 27 Shire Counties in England, the comparator group for Norfolk.
The table shows that in 2011-12, the 27 Shire Counties spent 43.9% of their total expenditure on Adult Social Care and yet the figure for Norfolk is only 22.9%. Norfolk came 27th out of 27 – the bottom of the lot and the proportion that Norfolk spends on adult social care is only a little over a half of the average for the comparator counties.
The table also shows that the percentage spent by Norfolk was even lower than the average for England (of 26.9%) whereas it should be much higher, as is the average for the comparator group – the Shire Counties. It should be higher because these 27 Counties have a relatively large share of their population in costly-to-reach rural areas and their population is older. The latter is true of Norfolk which has an above-average percentage of ‘old’ people, defined as those who are 65 years and over. In 2011, of the total population of Norfolk of 858,000, 21% was ‘old’ compared to only 16% for England as a whole.
We have seen that the proportion spent on adult social care in Norfolk is only a little over a half of the comparator group’s average. Given this it is not surprising that in the same year (2011-12), the proportion of Norfolk’s expenditure on disabled adults (18-64) was much lower than the proportion in the comparator group. Table 2 below shows that Norfolk’s expenditure on disabled adults was only 10.8% of its total expenditure only slightly more than half the proportion spent by the comparator counties. Norfolk’s share was even below that of all local authorities in England.
Sources
Edwards C, January 7, 2011; An Impact Assessment of the cuts (both national and through Norfolk County Council) on disabled people in Norfolk
Edwards C, March 2013; The Austerity War – Misery and Meaning, presentation for the Norfolk Coalition Against the Cuts (NCAC)
HSCIC, September 2013; Use of Resources Report for 2012-13, Health and Social Care Information Centre (HSCIC)
NCC, 2013; Statement of Accounts 2012-13, Norfolk County Council
NCC, Autumn 2013; ‘Your Norfolk’ (the magazine of the Norfolk County Council), Issue 42
This version is dated November 28, 2013 and saved in ‘Word/hardest hit/cuts in Norfolk’. Comments and queries to c.edwards4@btinternet.com.
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