The Disabilities Trust makes representations to government and other stakeholders on a variety of public policy issues that affect the Trust.
Contracts and Funding
The majority of the Trust's service contracts with local authorities are year-on-year. This means that every 12 months we must re-negotiate existing contracts and secure a yearly funding uplift that takes account of our costs.
We are now experiencing increasing difficulties when negotiating these contracts as many local authorities appear unable or unwilling to adequately fund third sector providers. To add to the difficulty the recent three-year Comprehensive Spending Review announced by the Government, gave local authorities a yearly uplift of just 1% each year. This is a tight settlement and means that negotiations over the next three years are likely to become even more difficult.
The Government has also introduced three-year funding settlements for all central government departments and as consequence ministers have increasingly talked of the desirability of local authorities agreeing longer-term contracts with the sector. Whilst longer-term contracts would potentially create a more stable market, inadequate funding would still mean providers are unable to deliver the services that are needed.
The Disabilities Trust acknowledges that there are acute pressures on local authority finances. However we believe there must be a continued commitment to adequate and sustained funding of service contracts for people with disabilities and that local authorities and the NHS recognize it is legitimate and necessary for third sector providers to seek fee increases that fully reflect the cost of providing a service.
Cheryl Gillan's Autism Bill received its second reading on the 27 February and enough MPs supported the Bill to ensure it survived a vote and now moves on to the third reading and its committee stage. This represents a significant step forward and means that the Bill has a better chance of becoming law. The Trust will continue to back the Bill and we hope it will be passed and become law at the end of this current parliament.
Linked to the issue of contract funding is a worrying new development in local authority and NHS commissioning policy. A number of authorities and NHS Trusts within a particular region may decide to group together to negotiate with third sector service providers. They invite potential providers to sign up to a contract and agree a fee level set by the authorities concerned. In addition they also demand increasingly detailed and potentially sensitive information from each provider before agreeing a contract.
This development greatly concerns the Trust because not only might this policy leave third sector providers unable to achieve full cost recovery, it would also appear that it is not compliant with the Compact, which is supposed to guide the relationship between the statutory and third sectors. Despite all this however, the attitude appears to be 'sign up or we will not refer'.
The Disabilities Trust is always willing to work with local authorities and the NHS to ensure both parties are getting value for money but we will only enter into contracts that are financially sustainable and will not be placed in a position where we have to effectively subsidize public services.
Another pressing problem is the increasing number of funding disputes involving the issue of 'ordinary residence'.
Because social care is means tested, ordinary residence is the criteria local authorities use to define the normal place of residence of an individual when considering whether they have an obligation to fund their social care or residential accommodation. This concept comes from the National Assistance Act in the forties and means that if someone is not defined as ordinarily resident, from the age of 18, in an authority's area of responsibility, then effectively that authority does not have a statutory obligation to fund their care.
Because the Trust has specialist services in various parts of the country - particularly our brain injury services - we often have people referred to that service from many miles away. Sometimes funding is initially agreed by the local authority where the individual previously lived, in conjunction with the NHS. When that NHS funding is reduced or withdrawn, or the person wishes to move to a different type of service, this can then lead to problems over ordinary residence rules. In most cases these conflicts begin when both the original authority where the person resided and the new authority where they now live, dispute which of them has responsibility for their continued funding.
As many local authorities seem to be under ever greater financial pressure and are tightening the eligibility for social care, these kinds of disputes are likely to increase.
The Disabilities Trust believes that it is essential that this problem be addressed and we would urge the Government to look again at clarifying the rules surrounding the concept of ordinary residence.
Following the passage of the recent Health and Social Care Bill and concerted pressure from members of the Voluntary Organizations Disability Group, including The Disabilities Trust, the Government has recently announced that they will be consulting on ways to clarify the ordinary residence rules to ensure there is clearer understanding over who has responsibility for funding social care services where there is a dispute over residency. This is a welcome move by the Government and should help to ensure that disputes over ordinary residency are dealt with much more quickly and satisfactorily.
Regulation of the Third Sector
The Disabilities Trust fully supports an effective regulatory regime that will ensure stakeholders have full confidence in the sector. However despite some improvements there are continuing problems with the way in which regulations are sometimes interpreted and applied.
The interpretation of regulations is an ongoing concern. Individual inspectors can sometimes interpret regulations in very prescriptive or widely varying ways, leading to a lack of consistency with what are supposed to be clear, national standards.
In addition, for the purposes of inspection, the current social care regulator, the Commission for Social Care Inspection (CSCI), does not specifically recognize autism and acquired brain injury and so will often inspect and judge a service based on criteria appropriate for other services such as learning disability.
This can be particularly inappropriate in the case of services for people with autism where for example the sensory environment that you might expect to see in a learning disability service may be highly detrimental to the well-being of someone with autism.
Furthermore, the Government has again decided to restructure regulation of the sector, integrating health and social care inspection in a new body, the Care Quality Commission, which is due to take over in April 2009. It is to be hoped this latest restructure will not lead to a period of confusion and uncertainty for the sector as the new body beds down. The CQC will also have more extensive powers to close services it believes are not up to standard and we will need to watch and see how the new regulator uses these powers.
The Disabilities Trust believes that regulation of the voluntary sector must be proportionate and consistent and that a regulatory regime that is too inflexible, prescriptive and costly may adversely affect the sector's unique strengths and diversity and impact upon its ability to deliver services.
Specific Funding for Autism and Brain Injury
Currently there is no statutory obligation for local authorities to fund services for people with conditions such as autism or acquired brain injury.
The funding for such services often comes from funds allocated to meet an authority's statutory obligations, such as services for people with a learning disability.
Unfortunately, because there is no obligation to fund services specifically designed for people with autism and brain injury, individual service users may be placed in services that are not specifically tailored to meet their needs.
This is something that particularly seems to affect people with autism, some of whom may be placed in learning disability services despite the fact that autism is not in itself a learning disability.
The Disabilities Trust believes that these unique and complex conditions should be specifically acknowledged as disabilities in their own right and that local authorities should have a statutory duty to fund specialist services for people with autism and acquired brain injury.
If you would like further information about any of these issues please contact Matt Townsend, Public Affairs Officer on 01444 237 295 or email email@example.com