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IN TOUCH 鈥� Social Care

TX:听 19.10.2021听 2040-2100

PRESENTER:听 听听听听听听听 PETER WHITE

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PRODUCER:听 听听听听听听听听听 BETH HEMMINGS

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White

Good evening.听 There鈥檚 been much talk about social care in recent months and the need to give it the financial support that it requires.听 Most of that talk has been about the kind of care some of us will need towards the end of life and how it can be fairly paid for.听 A very justifiable concern and one which has consistently been kicked into the long grass for at least the last couple of decades.听 But what has hardly had a mention, from either press or politicians, is the kind of support a disability might make necessary, often coming out of the blue and in the middle of life.听 When people think about the sudden or gradual loss of sight, they tend to think about its emotional effect but the truth is that there are a great many practical skills which can be relearned, which can make the process of coping far easier than most people imagine.听 And that鈥檚 where social care comes in or it should do.听 But social care, unlike health care, is not a national service and it depends on local provision.听 And that鈥檚 where the problems can start.

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We鈥檙e going to be discussing why in a moment but Carly and Penelope have been telling me about the difficulties they鈥檝e experienced in getting the help they feel they need.听 Penelope was registered visually impaired in June and she was told that the registration would be sent to her local authority and she would be contacted about an assessment in a couple of weeks.听 Nothing happened until she contacted the RNIB, an organisation she hadn鈥檛 even heard of until then, and only then did things start to move.听 She explained why she felt so anxious.

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Penelope

I needed help mainly in the home because when I boil a kettle instead of the hot water going into the cup, it tends to go on the side sometimes.听 Even going out to do every day shopping and stuff like that, I can鈥檛 see the kerb, I don鈥檛 see humps and bumps.听 And so, I really needed some kind of guidance which I was told I was going to need, like stick training, which I still haven鈥檛 got at the moment.听 But things to do in the house, like I can鈥檛 have a bath because I can鈥檛 get up because I鈥檓 also an amputee, so I have to have showers but I haven鈥檛 got a rail 鈥� a handrail 鈥� to hold on to, so my daughter has to come in and help me with certain things like that.听 And it was 鈥� it got to a stage where I was getting so stressed that I got psoriasis, where my hair dropped out, I started getting lumps in my head etc. etc.

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White

Can I ask you?听 How long have you had to wait and have you had an assessment yet?

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Penelope

I had to wait until September, where 鈥� because of the RNIB, social services recruited a new person and she鈥檚 such a lovely lady and as soon as she read my case she phoned me up and she鈥檚 ordered me things to help me in the house, like with gadgets to help make my tea.听 I don鈥檛 see colour, everything is black and white, so she鈥檚 ordered me gadgets to tell me what colour my clothes are and stuff like that.听 But it took a while and it caused me anxiety and I suffer with depression but it just made my depression worse.听 I felt like I was alone, I didn鈥檛 care, I didn鈥檛 count, I was just another statistic.

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White

Carly, if I can come to you.听 Tell me about your own circumstances when you needed help and what happened.

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Carly

After I had children, my eyesight deteriorated dramatically and that鈥檚 when I needed help.

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White

Tell me about the kind of help that you felt you needed.

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Carly

Well, at the time, it was just basic things in the house, sort of kitchenware, you know when you鈥檙e cooking, chopping veg was becoming difficult.听 I was listening to Penelope before, pouring your kettle was always a bit of a disaster as in your bench is covered in hot water.听 So, I did get [indistinct word] support out a couple of times and they did offer certain things to help me but nothing that made a difference but at the time nothing really needed to change, it was later on, as things developed and got worse, and I tried to seek help from the local council and nobody would come out and see me.

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White

You asked for help from the local council, how long did you have to wait?

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Carly

Well, I didn鈥檛 wait long for the [indistinct word] support, but when I asked for the council they went through everything on the phone and said you can have an assessment but you won鈥檛 鈥� because at the time I was living on benefits 鈥� you won鈥檛 qualify for any extra support because your husband should be helping.听 I had two young children, so, obviously, I was struggling with keeping the house tidy.听 At the time, that was my major worry.

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White

And what was your feeling about that, when you said that your husband should be doing these things for you or helping you?

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Carly

I think, at the time, I was a bit shocked, it makes me feel a bit isolated.听 I wasn鈥檛 in a very supportive marriage; he wouldn鈥檛 accept my disability.听 So, no, that wasn鈥檛 an option.听 But the whole independence, you feel like you鈥檝e lost everything.

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White

And how much do you know about what your rights are?

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Carly

Well, I probably think I know quite a bit but I probably don鈥檛, because you don鈥檛 know what you don鈥檛 know do you.

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White

No.听 Can I just ask Penelope the same thing 鈥� how much did you know about what you were entitled to?

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Penelope

I just feel like my independence has been taken away from me because I鈥檝e always worked, I鈥檝e worked in health and social care, palliative care, end of life and right now I just feel like my independence is being taken away and that鈥檚 not me.听 But because I haven鈥檛 had the support, I feel like I鈥檝e been let down a lot.

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White

Penelope and Carly.

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Well, since raising their cases, we鈥檝e heard from both local authorities involved.听 Penelope lives under Lambeth Council, they told us that staffing issues had, unfortunately, resulted in a delay to the specialist sensory assessments undertaken by their rehabilitation officers for visual impairment.听 They say: 鈥淲e apologise for the delay and for any inconvenience caused by delays in contacting people who鈥檝e recently received a certificate of visual impairment.听 We are now fully staffed and extra resources have been provided to support clearing the backlog of CVI registrations.鈥�

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Meanwhile, Carly comes under North Tyneside.听 Their Director of Adult Services said: 鈥淲e鈥檙e committed to enabling our residents to live their lives as safely and independently as possible.听 We鈥檙e very sorry to hear if someone is disappointed with the support they鈥檝e received.听 We consider people鈥檚 own strengths and the support available to them from their wider networks, alongside any local authority support.鈥�

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Well, we鈥檝e subsequently heard that Carly has received a call offering her a further assessment of her needs.

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So, a little intervention does no harm.

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But organisations of blind people and rehabilitation officers themselves feel that it鈥檚 the local nature of the way help is offered that is often bound to lead to inconsistencies throughout the country.听 Well, to discuss this situation and how we got where we are I鈥檓 joined by Professor Fred Reid, a long-time campaigner on behalf of visually impaired people and Simon Labbett, Chair of the Rehabilitation Workers Professional Network and a rehab officer for the blind himself.

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Simon Labbett first.听 Just explain what should have happened in cases like Penelope鈥檚 and Carly鈥檚.

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Labbett

Well, my heart sinks when I hear those two stories but what should happen is you would be entitled, in law, to a specialist assessment.听 The RNIB says within 28 days.听 So, an assessment carried out by someone who has the knowledge and understanding to probe and ask the right questions.听 And from that point on, presumably a referral would be made for vision rehabilitation.听 So, that鈥檚 what should happen.

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White

And how typical is what actually happened to them, I mean how likely is that to be an outcome around the country?

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Labbett

Well, yeah, three months was cited then, three months is a long time, it can be 12 months and in Lambeth鈥檚 case there was indeed a worker in the end, some areas of the country, local authorities don鈥檛 have one.听

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White

So, there are some places who do not have rehab officers?

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Labbett

Indeed.听 In a local authority they鈥檙e normally round about two or three, sometimes more than that but in a few cases, there are no rehab workers.

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White

So, why the difference between what should happen and what did happen?

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Labbett

I think people don鈥檛 know what you鈥檙e entitled to.听 So, when you do struggle, you don鈥檛 know that the local authority has a duty to support you or at least to assess you.听 And so, when you do make contact, if you finally get around to doing that, you may be talking to someone at the local authority who doesn鈥檛 know the service exists in the first place.听 I mean a lot of local authorities operate a single point of access, rather than a specialist hotline for visually impaired people.听 And unless you ask the right questions, you may not get through that initial screening process.

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White

So, this is lack of specialist knowledge about visual impairment?

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Labbett

It is, lack of specialist knowledge by the employers themselves and lack of knowledge, unsurprisingly, on behalf of people who don鈥檛 know what鈥檚 out there and why would you know that there鈥檚 a specialist service until you come to want one?

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White

Let me bring in Professor Fred Reid.听 Now you鈥檝e written a paper on several aspects of this problem for the National Federation of the Blind, including its history.听 How did we get to this point?

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Reid

There is a postcode lottery, it really depends where you live what services you get.听 And there is a feeling abroad that that鈥檚 something that has developed recently, say since the start of 2010 with the notorious austerity cuts.听 But actually, the situation has much deeper causes than that.听 And the basic cause is that in 1947/48 health was set up under central government, the famous National Health Service, but welfare services were left to local authorities and they ran a patchwork of services for all sorts of people, including blind welfare.听 Now that was a situation that was left right up to 1970, when the government of the day legislated for all local authorities to set up a social services department that would bring all the services together.听 Each local authority was to submit a plan for integrating all the social services under their care and the government promised large amounts of money annually to build up that degree of universal social services.听 And so, from the 1980s onwards, they introduced, what was called, a mixed economy whereby some services were delivered by private organisations, some by voluntary organisations, some by social services themselves.听 And the truth is that that situation has been left in spite of many attempts to reform it, including the Care Act of 2014, it鈥檚 been left as a patchwork and we鈥檝e got this postcode lottery that we鈥檝e inherited from the past.听 There hasn鈥檛 been political agreement regulated centrally by central government telling the local authorities how many professional workers they must employ and what standard of service they must deliver, it鈥檚 simply left to the local authorities to work their budgets as best they can.

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White

Right.听 I want to bring in Simon Labbett.听 On this question of a national service, because I think you have doubts about whether a national service, as opposed to a system run locally, is necessarily the right thing.

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Labbett

I think vision rehabilitation is all about people engaging with their communities and I think at a local level that鈥檚 the best place to decide what鈥檚 needed for an area.听 And certainly, I wouldn鈥檛 advocate vision rehabilitation goes into the NHS because what we鈥檙e talking about here is not a medical model, we鈥檙e talking about people learning skills and regaining confidence.听 Though it鈥檚 not really care either, it鈥檚 not welfare, it鈥檚 rehabilitation and it鈥檚 giving people back skills and self-esteem, so it鈥檚 hard to know where it fits in.

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White

Well, I was going to ask you both that.听 Originally this was welfare, then it was thought of as rights, which may well be the case, but isn鈥檛 it, really, education 鈥� the kind of services that people need, blind people need, are ways of relearning skills aren鈥檛 they.听 I mean, Fred, would that be a better way to look at it?

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Reid

There鈥檚 a lot of merit in that.听 And by the way I鈥檓 not in favour of giving vision rehabilitation to the National Health Service.听 But there is a kind of medical component in it, in that many people suffer great psychological trauma as they go through the sight loss journey and the great thing about having specialist workers is in part for this very important reason of this psychological trauma, they can鈥檛 just bounce back in six weeks, like you get over a fracture, it鈥檚 not like that.听 Or they may be sunk in depression over just the trauma of losing their sight and not being able to see their children.听 This is a hugely complicated area and it needs highly skilled, highly trained professional workers.听 And I agree with what Simon says about locality being the point where it should be delivered but there has to be an agreed standard of what resources are provided to deliver it.

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White

I should say, at this point, we did invite the Minister for Social Care to join this debate, she wasn鈥檛 available but the Department of Health and Social Care told us: 鈥淲e want everyone who needs it to have access to high quality and compassionate care.听 Local authorities are responsible for assessing eligibility and individual care packages.听 We have supported them with over 拢6 billion to tackle the impact of Covid-19, as well as almost 拢2.4 million for adult social care.听 The 拢5.4 billion announced last month, as part of our social care reform plans, includes investment in the Disabled Facilities Grant, to enable people to live independently in their own homes.鈥�

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Labbett

Can I just say there, eligibility doesn鈥檛 come into this, rehabilitation is a requirement in the Care Act and it is not a question of eligibility.听 If you can reduce or delay the costs of care then you should be looking at early intervention and rehabilitation is just that, so it鈥檚 a cost saving measure.

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White

Simon Labbett, Professor Fred Reid, thank you both very much indeed.

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So, what are the prospects of change?听 Well, for the past three years John Dixon has been policy lead on social care at the RNIB, before that he was cabinet member for health and social care with Cardiff Council.听 Now you鈥檙e attempting to make some changes to deal with some of this, particularly the lack of rehab officers, and there is a care bill going through parliament at the moment.听 What are you actually proposing, what are you trying to do?

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Dixon

Vision rehabilitation it is not what we call a regulated service, so while it鈥檚 a statutory service it鈥檚 something that every local authority in the UK has to provide, it鈥檚 not regulated, so no one checks whether it鈥檚 being provided or not.听 The changes RNIB wants to make to the Health and Care Bill would be to make rehabilitation services more widely and vision rehabilitation, more specifically, regulated services, so, for the first time, we would have inspections, we would have standards, we would have reports, we would have a consequence for failure if local authorities aren鈥檛 providing properly.听 But it鈥檚 quite easy to overlook a service that you feel is a nice to provide, rather than I must provide this service and I think that鈥檚 the difference that this would make.

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At the moment, no one knows what鈥檚 going on.听 If we look at rehabilitation more widely then these are critical services that we need, as a country, to recover from covid.听 So, regulation, for me, is an obvious no brainer.

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White

Some might think after what we鈥檝e heard and indeed you鈥檝e said it, that it鈥檚 almost a Cinderella service, that this is just tinkering at the edges.听 What about this idea that the only total answer to this is a national social care service run along the same lines as the NHS?

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Dixon

I mean that鈥檚 what they鈥檙e looking at in Scotland and my guess would be that if they鈥檙e thinking about in England as well then they鈥檒l let that play out in Scotland and see what happens there.听 There are plusses and minuses.听 It is attractive superficially because you would have national standards, you would, presumably, have reports that were going from across the country to the Secretary of State.听 But, on the other hand, my worry is that a national care service could end up being the servant of the NHS, purely there to get beds clear to reduce transfers of care, completely forgetting about the rehabilitation element of it as well, which is getting away from the original point of social care, which is to maximise people鈥檚 independence.听 It鈥檚 not just about bringing someone food on a tray in their living room, it鈥檚 about encouraging them, giving them the tools to get up into the kitchen and make the food themselves.

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White

John Dixon, thank you very much indeed.

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And that is it for today.听 We鈥檝e issued an open invitation to the Minister for Social Care to appear on In Touch to answer some of the questions raised in this programme, we look forward to seeing her.听 We also look forward to your views on social care, you can email intouch@bbc.co.uk, leave a voice message on 0161 8361338 or just go to our website bbc.co.uk/intouch.听

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From me, Peter White, producer Beth Hemmings and studio managers Carwyn Griffith and Jonathan Esp, goodbye.

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