CHALLENGES OF IMPLEMENTING SOCIAL CARE
POLICY FOR PEOPLE WITH DISABILITIES IN THE
UNITED KINGDOM
Dr Raymond Lang
Honorary Senior Research Associate
Leonard Cheshire Disability and Inclusive Development
Centre
University College London
r.lang@ucl.ac.uk
International Forum on Social Security & Social Services for
People with Disabilities
Gaungzhou, China
1st December, 2009
Slide 1
Policy Context
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The UK has ratified the UN Convention on the Rights of Persons with
Disabilities (including the Optional Protocol)
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8th June 2009
Reservations on Education, the Armed Forces and “stateless persons”
Sign of power of the parents’ lobby
These reservations are being challenged by the disability movement
Disability discrimination is outlawed in the UK
– Disability Discrimination Acts, (1995 and 2005)
– Single Equalities Act (2009)
• Review of Social Care Service Provision
– Initiated by the current Labour Administration, who published its consultative
Green Paper in July, 2009
– Presents a number of different models
• Social Security
– System is complex and ambiguous
• Overall political context
– Now very much in a “state of flux”, with the upcoming general election
Slide 2
Health and Social Care Service Provision
• Access to Health and Social Care Services
– Under the UK’s National Health Service, health care services are
free at the point of need
– This is not the case for social care provision, where “need”, which is
assessed on the ability to pay and severity of impairment
– “Social care” encompasses a very broad portfolio of services
including meals on wheels, support in day care centres and care
provided in people’s homes
– 2 million disabled people receive social care services at a cost of
£14.2 billion (23.5 billion USD)
– Entitlement is assessed on four bands – “low”, “moderate”,
“substantial” and “critical”
– However, a recent Commission for Social Care Inspection Report
states that the vast majority of local authorities on fund services for
those classified with “substantial” and “critical” needs
– Hence, many disabled people, often on very low incomes, have to
pay for their own care, which increases the likelihood of them living
in poverty
Slide 3
Green Paper on Social Care
Shaping the future of Care Together, Department of Health, July 2008
• Proposes to establish a new National Care Service, to provide
strategic oversight
• Outlines four possible options for models of social care
– Pay for yourself – all social care costs are paid for by the disabled person.
Impractical given poverty levels and lack of disposable income.
– Partnership - Everyone who needs social care would receive a basic
entitlement from the state which could be supplemented by further support,
eligibility for which would be determined by a means-test, any costs not met
by the state would need to be met by the individual. May act as a
disincentive to disabled people to find employment, as this approach will be
means-tested.
– Insurance - Enable disabled people to take out insurance for future care
needs. However, this model does not cater for the needs of younger disabled
people.
– Comprehensive - All social care provision will be provided free at the point
of need, analogous to health care services provided under the National
Health Service. This would be the best option but will inevitably be expensive
for the public sector.
Slide 4
Challenges to effective social care provision I
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The current system is perceived as unfair, with those with “low” and
“moderate” needs being effectively excluded from the social care system
Cutbacks on social care budgets by local authorities will result in
disabled people having to rely on family and friends for support
This may also result in increased isolation and social exclusion of
disabled people, as social care is for many a prerequisite for sustaining
long-term employment and effective participation in local community life
Some disable people had experience of charges for residential care, for
example, actively preventing them from working, or had been unable to
build up savings or assets, or been trapped in poverty because of social
care charges.
Within the current system, there are huge disparities in service provision,
eligibility criteria and charging policies between local authorities were a
major problem, both in terms of a feeling of inequity and also a
considerable barrier to independence and people being able to choose
where to live.
Slide 5
Challenges to effective social care provision II
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Some disabled people are of the opinion that they are not involved
directly in decision-making at the top levels within the care and support
system there would both be better decisions reached.
In the long term, an ageing population will inevitably mean that more
people will need social care services, but there will be insufficient
qualified support staff to cater for these needs.
In the UK, the social work profession has come under increasing public
scrutiny, in the light of high profile cases of abuse of young children and
adults.
In conclusion, too many disabled people can miss out on the support that
they need because of tightening eligibility criteria, informal carers are not
well enough supported, charging policies can provide an active
disincentive to work and keep disabled people trapped in poverty, local
variations in services can leave disabled people unable to move house
for fear of losing their support.
Slide 6
Principal Findings of the Leonard Cheshire Disability
Annual Survey 2009
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National survey of 1,253 disabled people with a wide range of
impairments
42% of respondents are finding it difficult although it difficult to manage
on their current income
63% are experiencing fuel poverty
42% incur additional expenses as a direct result of the impairments
54% who were disabled before they had indeed the education has
encountered discrimination at school, college or university
25% of all respondents are actively looking for work, and 68% of these
have been doing so for more than six months
60% of respondents with social care needs rely on relatives or friends for
informal help
Slide 7