Council charging lottery creates ‘community care refugees’

A postcode lottery of care charges for people with learning disabilities means some individuals and families are paying so much they have to cut back on support or social activities, while others in neighbouring council areas pay nothing at all, according to campaigners.

Learning Disability Alliance Scotland represents a range of charities including Enable Scotland, Quarriers, Leonard Cheshire Scotland and Crossreach. It worked with the Scottish Parliament’s cross-party group on learning disability to ask local authorities what they would charge for three different case studies.

The cases highlighted by the MSPs and LDAS are all based on real individuals. They found that “Joe”, a 25-year-old young man relying on housing benefit and needing nine hours of home care support a week would be charged nothing in 16 council areas, while someone in the same situation in Aberdeen would be charged £45.84 per month and in Moray, £68.60.

In another case, Florence and Peter, a couple in their 40s, both have learning disabilities and need 25 hours per week home care. In addition, Peter attends a local authority day centre for six hours a day, twice a week. Freedom of information requests determined this couple would pay anything from no charge in Fife, Western Isles, East Lothian and Perth and Kinross to £220.52 a month in West Lothian and a whopping £270.40 a month in Argyll and Bute.

The final case study, 30-year-old single parent Morag, a lone parent with a learning disability, whose son Daniel is six, needs 21 hours home care support per week, and help with shopping, cooking, household management and social skills. Three councils: Falkirk, Fife and South Ayrshire, said they would not charge Morag at all. Meanwhile other charges varied from a low of £38.40 per month in West Dunbartonshire to a high of £363.92 per month in West Lothian.

LDAS co-ordinator Ian Hood said the way councils charge for care services was so complex that using case studies was the only way to make sense of it.

In general, councils set a threshold to determine how much of a person’s income is spare, and set a price for services. However, some set a maximum limit above which charges cannot rise while some also limit the proportion of a person’s spare income which they can be asked to pay.

Hood added: “The councils themselves send staff on training courses to understand all this, so how is the individual meant to?”

While the prices charged vary widely – some would say wildly – across the country, there is no corresponding difference in the quality of service, Hood argues. In some cases the same charity can be providing the same service on behalf of different local authorities, who have different rules on charging for that help.

“There is no rhyme or reason to how these care charges are worked out,” Mr Hood said.

“People don’t mind making a fair contribution when they can afford it but local authorities can charge whatever they want without a clear explanation of how they worked out this charge. No other company or local authority service is surrounded in such mystery and obscurity.”

LDAS is also highlighting the way such charges can swallow up state benefits related to a person’s disability. These include incapacity benefits and disability living allowance. Mr Hood believes it was never intended that such benefits should simply cover the costs of care. “Disability benefits are provided by the Government to meet a range of additional costs associated with disability – additional heating, special diets, additional transport costs. In some local authorities almost all state benefits related to disability can be swallowed up by care charges,” he said.

In 2002 the Community Care and Health Act provided for the Scottish Government to intervene to ensure consistency in care charges across the country. This has been done so far by allowing the Convention of Scottish Local Authorities (Cosla) to issue members with national charging guidance, the most recent version of which was published in April 2009.

The new research was led by Jackie Baillie MSP, convener of Holyrood’s cross-party group on learning disability. She said it demonstrated that Cosla’s guidance was not working and added: “It is clear already that the guidance issued in April is not being consistently applied. It just isn’t working. Ministers already have powers [to change this] and they need to use them.

“We can’t have a situation where Argyll and Bute charge £270 for a couple, per month, neighbouring West Dunbartonshire charge £3 and the Highlands would charge the same couple £36.”

Ms Baillie said she knew of residents in Helensburgh in Argyll and Bute who were looking to move to Balloch in West Dunbartonshire, purely to avoid current or future care costs.

Mr Hood described such cases as “community care refugees”. He added: “We would like the Scottish Government to acknowledge that Jackie Baillie’s research highlights a problem across Scotland. As a result they should commission research into the extent of local variation in care charges and then engage with Cosla and other stakeholders about how a pattern of consistency can be established within a reasonable timescale.”

The Arbuthnott report published last week also called for Clyde Valley councils to co-operate to ensure greater consistency in the amounts charges for services. Sir John said: “The councils should work together to introduce consistency across the Clyde

Valley on charging, where this does not cut across local priorities, to make this more easily understood by citizens and to avoid a postcode lottery for fees and charges in neighbouring authorities.”

Councillor Ronnie McColl, Cosla’s health and wellbeing spokesperson, said Cosla had been working with councils since 2002 to achieve greater consistency in the amount charged for non-residential care services.

He added: “To that end, Cosla created national guidance, which was most recently published in April 2009. It is important to point out that the guidance is not intended to produce uniformity; it provides discretion to councils to establish their own charging policies in order to align with local priorities and local needs. This is right and proper.

“At the same time, we want to make sure that we respond to public concern. I met with council social work conveners from across Scotland last week and we agreed that Cosla would redouble its efforts to ensure that local authorities are better sighted on the charging regimes in place across Scotland.”

He concluded: “I know that many people do not feel councils should be allowed to charge for social care services – but in an era of diminishing resources and rising demand, this is a vital source of income for councils.

“We avoid charging wherever possible and people should know that the income we receive in charges is only a tiny fraction of the total resource spent on social care.”