Adult Social Care ‘Have Your Say’ Report
Full report is below or download here
This report is a summary of the discussions which took place on Monday 27th March 2017. The event was entitled Adult Social Care ‘Have Your Say’. The aim of this report is to provide a clear summary and action points for both Enfield Council and Enfield Disability Action (EDA) where applicable. EDA would like to thank everyone who attended on the day and contributed to the lively debate. The council officers provided presentations to explain how the social care process should work from the moment that someone calls through to when they receive a care package and how this is financed. The event was attended by approximately 40 people who receive or care for someone who receives a care package. EDA are also compiling facts sheets about the process and disabled people’s rights under the law. These will be available in the coming weeks on our website www.e-d-a.org.uk
Accessing Social Care and getting an assessment
If you think you need support with any personal care or managing your life at home you should call the access number on 0208 379 1001, you will get through the access team. Their role is to gather as much information as possible about how your health condition or impairment impacts on your daily life. At this point the access team are not establishing whether you get a service but what level of assessment you need. Any assessment should be made without taking into account the input of any family carers. They should follow a law called The Care Act which has a full set of guidance to it. The Care Act should be followed all the way through your assessment process and in the way that your support is provided.
Concerns were raised with the Council Officers present about being able to access the access team and attendees expressed a feeling that the staff are not always thorough in gathering information. There was particular reference made to not being given enough time and space to discuss difficult issues related to disability and impairment that may be hard to talk about.
Managing your package, getting support and paying for your package
If you are eligible for further assessment the care management service should get in touch with you. They should then arrange to complete a thorough assessment, which must be person centred. Roxine Harris LBE Service Manager Adult Customer Pathway stated
“We need to support that person in the process as it’s the person who knows what the impact their condition is having on their daily life”.
The assessment should be done according to need only. At this point money is not taken into account. After your needs have been assessed you should be offered ways in which to meet your needs. This could be through services such as enablement and/or through a personal budget.
Many issues were raised about the assessment process and frank debate which included a feeling that the council are deliberately cutting people’s budgets particularly cleaning and accessing community activities. Questions were also raised about the involvement of family carers in the assessment process and the need for the assessment to be person centred was underlined. These questions are answered at the end of this report.
After you have been assessed you should be referred to the brokerage service they will help you to set up your support package. They support:
- Care management services (18+ and older people)
- Integrated learning disability services
- Mental health services (specialist home care or nursing)
- Hospitals (home care/long term support)
- Enablement service
- Review service
- Access service
- Other councils
There were concerns raised about being able access to the brokerage team and the level of service particularly in relation to emergencies.
Paying for and managing your care service
There are a variety of ways in which you can be in control of your support. After the assessment the council will go through a resource allocation system process, which will help them to assess your indicative budget. This is not your final budget just an indication. The council used to use a system called Quick Heart to do this with but they are now not using this. There were concerns raised over whether the system is user friendly and whether people understood the process.
It is not very clear on the website where the information on the resource allocation system process can be found. The council were asked if they could please supply accessible information on how the process works for distribution to the service users who want it?
Individuals asked if the new RAS is designed to cut budgets. It seems that the allocation system did work within a restricted budget and appeared to be part of helping the council to make budget cuts, although this was not clear.
The council would prefer for people to have their Direct Payments on the e-card system. For some people this gives more flexibility for others it does not. The e-card is a choice and you can have your Direct Payment given to you in different ways. You can get cash out on your e-card but this needs to be arranged and receipts need to be provided. The council assured the meeting that they did not want to micro manage but they have to keep records.
The council has sent out letters to everyone who has received their care package or Direct Payment asking how they would like to be supported with their Direct Payment, a social worker should then have visited. If this has not happened then get in touch with the council.
There were concerns about there not being enough choice of providers in Enfield to help with managing the financial side of the Direct Payment.
LBE are able to charge individuals for services provided and to do this a financial assessment is completed. LBE provided information on the process at the event which is available on request.
There were questions raised on the timing for telling people how much they need to pay towards their care package and that clarity was needed over backdating of charges. Attendees reported that in some cases there have been severe delays in calculating the charge with individuals receiving large bills for back dated charges. It was noted that Under the Fairer Charging Guidance it was strongly recommended that backdated increases were not made. As a result of this discussion EDA will work with LBE for clarification on this issue and will make information available to Council Officers and on our website.
LBE have also recently stopped making home visits to support people to complete the financial assessment form. This can often lead to an incorrect calculation for disability related expenditure or mean that it is not included. Not including the correct levels of expenditure can lead to a higher charge, which can leave individuals in financial hardship. It was raised with LBE that home visits are required by law and EDA will also be working with LBE for clarification on this, information will be on our website as soon as possible.
For some people it’s very difficult to fill out the financial assessment forms so if you do need assistance with filling them out please contact 0208 379 8177.
See Q & A section below:
- Speaker: Do you provide a list of questions before the assessment? This is a statuary requirement.
Answer from LBE: We can do. This is not always available; we will go back and ensure that we are making a list of questions available to every client in order to comply with the law. It should be available in easy read and braille.
- Speaker: Why is the council not paying for cleaning, shopping and gardening? Also the issue was raised that people’s budgets are being cut for going out and about.
Answer from LBE: We don’t specifically pay for these things but if it’s part of the care plan we still will. It needs to be an assessed need.
- Speaker: How often does LBE review the care plan? Do they ensure that person’s communication needs are met?
Answer from LBE: It should be done every year. An appropriately qualified assessor should be assessing your needs.
- Speaker: What is the process if the carer cannot carry out their duties and there is an emergency?
Answer from LBE: We should always put in contingency plans to the support plan. You can also always contact the access team and they will help you to get your needs met in an emergency.
- Speaker: what happens if someone is looking after more than one disabled person and their respite is being cut?
Answer from LBE: We are changing. We want to ensure continuity of respite. It should automatically roll over until it’s reviewed.
- Speaker: Does the brokerage service also support self-funded individuals who need residential or nursing care?
This was unclear and clarification will be sought
- Speaker: If there is a choice to use EDA for support will extra money be put into the account for this?
Answer from LBE: If there is an assessed need for support.
- Speaker: Every year the benefits go up in April but its takes until October to do the contributions and service users get arrears. Why isn’t it done in April? Also if it is an error of the council people shouldn’t get charged.
Answer from LBE: Last year we sent out letters in June. Previous year there was a delay and we didn’t increase charges until October. When there are changes in circumstances we maximise benefits but you must inform us. If there is a delay we will not increase charges till people have enough time. We have a 4 week period of arrears. We offer payment plans if people can’t afford charges. They can ring us and we will assist them paying it off gradually.
- Speaker: Care and Finance is the only company that has been offered and as the council have a statuary obligation to provide choice, what will they be doing to correct this?
Answer from LBE: We also have pay packet, there has been individuals who want to renew their own care packages. Going forward the council understand that people want a choice of more than 2-3 organisations so they are providing a support framework to provide support to users alongside EDA and Udirect offering support and guidance. This will encompass new services such as brokerage, fund holding and support planning.
- Speaker: Is the council allowed to backdate charges? (please also see above)
Answer from LBE: Yes, but we need to look at the document. The Council agreed to forward the guidance they are working from.
- Speaker: If someone needs an advocate who’s responsibility is it to find one?
Answer: Again this was unclear and clarification will be sought.
- Speaker: How will the extra 3% on council tax be used to help pay for our care?
Answer: The adult social care precept has raised £3m. The social care budget is about £75m but we have overspent by £7m. It will help us pay for the change as the population gets older they need more support.
Actions and Conclusion
LBE should ensure that a list of questions that can be expected to be asked during the assessment process is available and service users are made aware this it is available to them in accessible formats.
Can LBE make the RAS more clear and provide accessible information about how the RAS works to service users as a routine part of the assessment process and make it clear on the website?
LBE say they are not aware that budgets are being cut for going out and about. This should not be happening unless it is clearly justified under The Care Act, Will LBE commit to review the situation and implement best practice in this area?
What will LBE do to ensure that service users understand what happens in an emergency and to ensure contingency plans are always put in place particularly given the difficulties in getting through to the access team?
What is being done at a strategic level to ensure that people can get through to the access team and that thorough information gathering process is done with every service user?
What progress has been made with the support framework to provide other organisations with help with administering care packages?
What is being done to ensure that disabled people’s views are being taken into account whilst designing this?
A concern was raised about people being forced onto managed accounts when they didn’t want to be. How is the council going to make sure this doesn’t happen?
What is being done to ensure that service users are being given clear choice with regards to taking on an e-card even though it’s the councils preferred option?