Vulnerable people in rural areas at risk from big changes in care

New legislation has been described as the biggest shake-up in the care system in more than 60 years.

By Western Morning News  |  Posted: October 21, 2014

 Ann McClements and Ken Crawford, of Devon Senior Voice, take a look at what it will mean.

Vulnerable people and their carers will be put in control of the support they receive when the first part of The Care Act 2014 comes into effect next April. It will also cap the amount anyone will have to pay.

Devon Senior Voice (DSV) – the voluntary forum for older people – has keenly followed its various stages and is focusing on the Act for the next six months, explaining the changes to all our members. We have recommended to all branches that they explore and discuss the implications.

The two core principles that run through the Act are personalisation and wellbeing.

Personalisation is: “the core purpose of adult care and support is to help people achieve the outcomes that matter to them in their life”.

Wellbeing means that “local authorities must promote wellbeing when carrying out any of their care and support functions”.

During the consultation period, DSV submitted significant comments on the draft regulations and guidelines that relate to the care and support reforms and provisions coming into effect in April. Additional reforms will come into effect from April 2016, and there will be a separate consultation.

DSV found three major omissions in the consultation document, which we pointed out in our response, along with some observations on the concept of wellbeing.

Governments have been committed to “rural proofing” since 2000 to ensure domestic policies take account of rural circumstances – but there is no evidence that this was considered in the drafting of the Care Act. Without it residents of a rural county, such as Devon, will be short changed. There are substantive differences between the provision of care in rural and urban areas.

In Devon 45% of the population lives in urban areas such as Exeter, Plymouth and Torbay at a population density of 26 people per hectare. The remaining rural 55% have an average population density of 1.17 people per hectare.

Provision of care in the countryside is going to be difficult and more expensive if we are to provide care close to partners, relatives and friends. Many care providers will not take on clients in rural areas. It ought to be enshrined in law that this should not happen, but this objective would be undeliverable without additional funds.

Access to transport plays an important role in the wellbeing of vulnerable people in Devon. Yet voluntary transport schemes – essential for older people – are increasingly under threat from cuts in funding, and some surgeries and hospitals cannot be reached directly by public transport

In West Devon, for example, 10% of parishes do not have a public transport link to their nearest hospital, 50% face a journey of over one hour, and some people face a £35+ charge for community transport.

The quality of housing has a direct effect on care. The majority of social housing is well maintained and social housing providers normally have good policies on adaptations to their properties. However, in rural areas many people live in tied or private rented properties or own their own homes, but cannot afford improvements. Inadequate accommodation means more people have to go into care. Successive governments have paid scant regard to the plight of older people living in their own properties with insufficient income to maintain them.

People who remain in the same house into their old age are prone to save on maintenance, and then become vulnerable to unscrupulous contractors.

Any scheme to help people with inadequate means to house themselves must include provision for maintenance. A universal housing benefit would bring equality between those renting and owning when they need help.

There is a significant cost saving in ensuring that homes are fit for purpose and any money spent on adaptations should be disregarded when assessing capital.

The principle of wellbeing, as defined by the Care Act, enshrines people’s needs and desired outcomes at the heart of the care and support system, because “an individual is best placed to judge their own wellbeing”.

Yet how can this Act enshrine the outcomes desired by individuals when we are losing community services? Libraries are closing, day centres are closing, Devon County Council is no longer able to afford to run care homes, and beds in NHS community hospitals are under review. It seems that an individual has very little control over his or her wellbeing.

By 2016 what funding can we expect to meet the individual’s needs?

The Act says wellbeing would alter from individual to individual.

It does not define this principle, and it seems that wellbeing would be as variable as the question of ‘what makes us happy?’.

The most likely outcome is that this principle will be tested in a series of court cases. Ultimately judges will decide what constitutes wellbeing.