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TX: 23.06.08 - Portable Care

PRESENTER: WINIFRED ROBINSON
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ROBINSON
Should disabled and frail elderly people take what care provision has been made for them if they move from one local authority area to another? Peers will be voting on that proposal tomorrow, it's been tabled as an amendment to the Health and Social Care Bill, which covers England and Wales. One of the supporters of the amendment is Baroness Ilora Findlay and she told Melanie Abbott why she thinks the change is vital.

FINDLAY
The problem for people is that when they move from one area to another their services or their direct payments for services don't go with them and so they completely fall through the net and they may be waiting to be reassessed. Now if you're very disabled and you're dependent for your independent living on the direct payments then basically your lifeline is cut off if you move.

ABBOTT
It sounds quite a simple thing and some people will be quite surprised that this doesn't happen already.

FINDLAY
I myself was surprised that this doesn't happen already. But it has become very clear that because each area undertakes its own assessment no one area is respecting the assessments of another and so not only is there potential inequity but actually it means that people are completely geographically locked to where their original assessment was made. And that doesn't make sense, it makes sense for people to be able to move nearer relatives, nearer friends, particularly as they get older, as they may need more company and a little bit more help and more integration or because they move because of a job - how dreadful for somebody to have to turn down a job because they can't take with them the infrastructure support for their personal assistance.

ABBOTT
Will local authorities be concerned about the impact on their budgets though because presumably this is one reason why they want to assess the care themselves?

FINDLAY
Well if you take it at a national level I think the whole thing would even out - you will get people moving from one area to another and some will have to pay a little bit more and some will have to pay a little bit less. Actually if we reveal when people move that there are enormous discrepancies then what we will be revealing is gross inequities in the system and they will have to be addressed. So actually I'm not frightened of that at all.

ROBINSON
Baroness Ilora Findlay.

So what currently happens to people who receive care from one local authority area when they do move house? Well David Morris has first hand experience of all that, he's a senior policy advisor on disability equality to the Mayor of London. First of all, tell us a bit about your own circumstances.

MORRIS
Life changes and in December 2006 my personal circumstances changed which required me to move house. And a usual thing that everybody does in their life maybe once maybe more. And I needed to move and I needed to move quickly. The fact is that the transfer of my package of support - I need a high level of support in order - for me to be independent within my community - and I'm still - it still hasn't been completely resolved. And the last thing that you want to do when you're going through maybe a crisis in your own personal life or moving to a new job or both maybe is think about bureaucracy. I made the decision and I moved and then I dealt with the consequences after that, if I'd actually done it first I wouldn't have moved, it would have been too difficult. And many, many people said to me - David, why are you doing this, you're stupid. And a lot of people face considerable barriers in terms of taking up new accommodation, in taking up jobs and moving and moving should be a basic thing that we all have a right to.

ROBINSON
Tell us about the help that you receive then.

MORRIS
I receive a package of support through an organisation called Independent Living Alternatives, who provide personal assistance for me to live independently in the community. I believe through direct payments this offers value for money. One of the things that is clear to me in terms of my personal experience is that we're wasting a lot of money in the reassessment process - I mean I went through sort of four, if not more than four, assessment processes - moving from one place to the other - and my needs hadn't changed, I'm the same person, all I've done is move from one postcode to another postcode. And personally it was a high level of stress, I mean at the back of my mind is always the possibility that this support will break down, there won't be the funding to pay for it and it's a stress that it's difficult to describe but it's about security.

ROBINSON
You use a wheelchair, would you be able to manage your life without help or with a reduced service to the one that you get?

MORRIS
Oh absolutely not, without it I would be - would be dead and that's literal. I need the support and you know you can't - it would not be conceivable for it to stop.

ROBINSON
So you went ahead and moved, what happened then?

MORRIS
I think I was able to use my skills in persuasion and the support of people within the system because I think it's not about people within the system, it's about the system itself. So I got support from people that understood what the situation was and managed to not get into a position where there was a potential of support being taken away but it was always there.

ROBINSON
Edward Welsh is from the Local Government Association, it represents 500 local authorities in England and Wales. This situation obviously isn't ideal, there is the fear of losing the service, the complex process of being reassessed. Some case studies have been presented by those who support this amendment to the Health and Social Care Bill of people who have simply lost their care altogether. You opposed this amendment though - why?

WELSH
Well can I just first of all say that councils strive really hard to provide care for large numbers of people so of course it's absolutely regrettable to hear a story like David. I'm sure I reflect the view of many people in local government, if not everyone in local government, that obviously these kind of situations are not good and it doesn't reflect well on our sector.

ROBINSON
But David made the point that he was able to have his care continued in a seamless way because of who he is and his skills at lobbying, the fact that he had contacts in local government. Case studies have been presented, for example, of a young woman who was expecting a baby and was blind had her support just totally withdrawn at a stroke because she moved house, it's still not there more than a year down the line.

WELSH
Well let me explain why the Local Government Association does not support this amendment. I mean our view is that it needs to be fully assessed for its impact because we believe that what is effectively being suggested here is a guarantee that if somebody moves from one part of the country to another part of the country they will get the same package of care. And what we're suggesting is that this might result in unintended consequences. Councils do different things in different parts of the country and what perhaps is appropriate for an inner city council like Camden is perhaps not appropriate for Cumbria and local government takes decisions with local people about what they think is the right care for their respective communities. So, for example, an unintended consequence could be that because you would expect under this guarantee to have more younger disabled people moving in than you had up till then you might need to end up cutting services to older people or alternatively you might feel - find out that as a council is trying to design its services for the future that again you take unintended consequences. For example, Cumbria might have lots of day centres and find that if it provides this guarantee if there's a change in the kind of people who need the help of the council they might have to reverse the building of those day centres on the idea that - just on the - a sort of a guarantee that people might people arrive not on the reality that they've actually arrived and need the treatment there and then. So what we're suggesting is that these - there are unintended consequences that aren't particularly helpful. So what we're saying is the amendment needs to be fully assessed.

ROBINSON
David Morris, what advice would you give then to anyone who thinks of moving?

MORRIS
My advice would be to think carefully but always I think it's very important that people make the right decisions for them personally and get the support from people that may have gone through the system in order to make sure that people take up the opportunities that are there. One of the saddest things for me is the concept of people not taking up opportunities to develop their own potential.

ROBINSON
What if you had moved to an area which had better services than those that you were being offered, would you have accepted that you should take your old care system with you even if it wasn't as good as the one that might be offered where you were going?

MORRIS
Absolutely, I mean I think that the portability aspect is important in terms of - because my needs are the same wherever I'm going to be and if somebody said we're going to give you more money there would be no reason for that.

ROBINSON
David Morris, Edward Welsh thank you both, no doubt we'll come back to that.

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