1

Contents Page

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15.

Foreword Executive Summary Introduction Note on the Summer Survey Background to Coalitions Social Care Reforms Access to Care in Bradford Local Government Spending in Bradford Reform of Social Care Funding Access to Information Loneliness Quality Minority Provision in Bradford Prevention and Integration Personalisation Summary of Conclusions

4 5 7 9 10 12 15 18 25 27 29 32 34 39 41

1.

Foreword I have been asked why I decided to ensure that as many people as possible in Bradford were aware of the Governments proposed reforms to social care. The answer is: how could I not? The future Care and Support Act and longer term funding reform will directly or indirectly affect everyone in Bradford, and indeed everyone in the country at some point in their life. It seemed crucial that Bradfordians were not only aware of but also had an opportunity to contribute to the legislation. While accepting full responsibility for the final content of this report, its depth and breadth could not have been achieved without the support and help of a wide range of groups, organisations and key individuals and I would like to thank them very much for all they have done. It has been hard work but also highly rewarding. I look forward to continuing to work with all of the contributors to this report on this incredibly important area of social policy in the months and years to come.

David Ward Member of Parliament for Bradford East February 2013

2. 2.1

Executive Summary Our research suggests that a number of the major issues raised by care users in Bradford may be addressed through the Governments proposed reforms within the draft Care and Support Bill. Major issues identified through our research with a particular local resonance were: The need for more local provision of specialised housing and a greater use of alternative funding streams to pay for it; Reducing waiting times for major home adaptations, Addressing issues around hospital discharges; The need for more face-to-face contact for people when accessing support services; The need for more Council programmes to combat loneliness in the elderly community; A greater role for the Council in driving up standards and the quality of care; More funding for integration work to engage with and enable harder to reach communities to access the support services that they need and to ensure appropriate support services. There is overwhelming support with 97% of people we surveyed stating that they wanted to maintain Bradfords home care eligibility threshold at moderate and we urge the Government, as part of the new National Minimum Standards of Care, established within the draft Care and Support Bill, to set the eligibility threshold at the moderate level. Through our research we have established that 65% of care homes in Bradford charge top-up fees and that over one-third (35%) of care homes in the Bradford area would only accept local authority funded people if a Third Party top-up fee was paid. These are troubling statistics and we urge the local authority to further investigate the suitability and sustainability of its standard rate charge. In our research, we found evidence that self-funders of social care often encounter price discrimination compared to local authority funders. There is a strong argument that Bradford Council, and Councils more generally, should ensure that self-funders can take advantage of the Councils buying power to access services at local authority funded rates. We found strong support in Bradford for the implementation of a life time cap on care costs which should be paid for within the Governments current spending on older people, with emphasis on tackling universal benefits for the elderly.
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2.2

2.3

2.4

2.5

2.6

2.7

The introduction of a care capping system, proposed by the Dilnot Commission, will help people fund and tackle the lottery of long term care costs in Bradford and enable people to plan for their financial future. Due to the Governments dedication to tackling this long running problem, the majority of people in Bradford who have to pay for care costs will now be able to stay in their family homes. However, with high deprivation rates in Bradford and the level of the care cap that will be introduced as a proportion of income relative to local care costs, those in Bradford that will still have to contribute, will still get a raw deal out of the current arrangement. Before the introduction of the cap in April 2017, we find that there is a further need for the Government to investigate the feasibility of a regional care cap to take into account local circumstances. Whilst the work that is already being undertaken in Bradford and places like Torbay in piloting integrated care arrangements is admirable, with the final implementation of integration programmes being a fundamental pillar in ensuring a complete wellbeing package for older people, neither the integrated care model nor the introduction of a care cap are a panacea to finally tackling the care conundrum. As a running theme throughout this research, the one true ill that befalls the care system is the issue of funding. The need for more funding for social care is absolute with Bradford Council alone having to make savings of 16% over the past two years1, and a further 7m needed in 2013/14. With an increasingly ageing population, the need for more funding in social care is essential. Sat alongside social care reforms, we believe that some of the more serious issues that emerged in the course of our research can only be addressed through significant increases to social care funding.

2.8

2.9

2.10

https://www.gov.uk/government/organisations/department-for-communities-and-local-government/series/localauthority-revenue-expenditure-and-financing

3.0 3.1

Introduction Last year, the Coalition Government announced reforms to the social care system heralded as the most radical in over 60 years. At the same time, Adult Service departments in local councils are having to cope with an unprecedented squeeze on their budgets in addition to increasing demand for services as a result of an ageing population and rising levels of complex needs. Reform of the social care system is crucial for nearly 15,000 people who rely on Council commissioned social care services in Bradford, but equally for the many others who pay for care themselves. This research is part of an ongoing project to ensure that the important voices of Bradford residents are heard in the national debate that will shape the future of social care. It will be presented to the Joint Committee on the Draft Care and Support Bill and will provide the evidence base for the Member of Parliament for Bradford East to campaign for fairer, better quality care in his constituency. This report provides a snapshot of the social care system in Bradford District and an initial response to the Governments proposed reforms. It is based on an analysis of a survey of 35,000 households carried out over the summer 2012, together with interviews with carers, care users and experts. We also received written submissions from Bradford Council, Bradford Alliance on Community Care (BACC), Bradford & District Age UK, Bradford Alzheimers Society, Ideal Care Homes, Bradford Disabled Peoples Forum, the Consortia of Ethnic Minority Organisations, and Carers Resource. These are collated in Volume 2 of the report. On 10th January 2013, in partnership with the Bradford Alliance on Community Care (BACC), we held a Social Care Summit at the Carlisle Business Centre in Bradford. The Summit was attended by 136 members of the public who were invited to contribute their views on the proposed social care reforms. We also heard presentations from BACC, Bradford & District Age UK, Dementia Shipley, Bradford Council, Carers Resource, Bradford Disabled Peoples Forum and The Consortium of Ethnic Minority Organisations. The important views expressed in the summit have helped to shape this report.

3.2

3.3

3.4

4.0 4.1

Note on the Summer Survey Over the summer 2012, we sent a written survey to over 35,000 households in Bradford and also provided postcards for stakeholder groups to give out to clients so that we could gather as diverse a range of responses as possible. We ensured that the summer survey was available online whilst also providing an audio version should it be required. To date, we have received over 500 written responses to our survey. Two-thirds of our respondents were aged over 60, and 1 in 10 in ten were over 80. This can be demonstrated be referencing Figure 1 below. Two fifths of respondents were either a carer or had acted as a carer in the past. 41% indicated that either they or a relative had used care services, including residential care, domiciliary care and care from a friend or relative. With such a high response from carers in Bradford, this adds weight to the results of our research and demonstrates how important this issue is to many people in Bradford.

4.2 4.3

4.4

4.5

Figure 1 Age of Respondents to Survey2

60.0 50.0 % of respondents 40.0 30.0 20.0 10.0 0.5 0.0 <20 20-40 40-60 Age 7.0 25.1

55.1

12.3

60-80

>80

David Ward Summer Survey 2012

5.0 5.1

Demand for care in Bradford There are currently 79,410 people aged over 65 living in Bradford. This is expected to increase to 84,700 over the next ten years. At the same time, the number of people aged over 85 is expected to increase by 38.5% to 12,700, which is slightly below the national trend. People aged over 85 are the biggest consumers of care services and this increase is therefore likely to lead to a significant rise in demand. Bradford Council estimate that, based on the current provision of services, population growth will result in approximately 5.5m of extra demand by 2015 and 31.4m by 2025. Bradford Council Adult and Community Services Department also cite the increasing complexity of cases and a growth in the number of people with learning disabilities as being major factors driving up the cost of providing care. The number of people with learning disabilities is expected to grow from 7,594 in 2012 to 10,332 in 2017. The financial impact of this growth is projected to be an additional 507,000 by 2015 and 10,332,000 by 2025, from a base of 33,774,000. Over the same time, the number of people aged under 65 with disabilities is expected to grow by 32%. In addition, the Council also faces rising numbers of adults with dementia. In Bradford there are currently estimated to be 5500 people living with dementia, however only 52% of these are currently diagnosed. Figure 2 Bradford Population Projections3
2011 based (interim) Population Projections v 2011 MYE
90 80 70 60 50 40 30 20 10 0 5000 4000 3000 2000 1000 2021 Males 2021 Fem ales 0 1000 2000 3000 4000 5000 2011 Males 2011 Fem ales

5.2

5.3

5.4

Age

Male s

Females

City of Bradford Metropolitan District Council response to the Department of Health consultation on the July 2012 White Paper see Volume 2.

6.0 6.1

Background to Coalitions Social Care Reforms In May 2010, in Our program for government the Coalition Government announced that we understand the urgency of reforming the system of social care to provide much more control to individuals and their carers and to ease the cost burden that they and their families face.4 In July 2012, the Coalition Government published three documents outlining proposals for the reform of the social care system. These were a draft Care and Support Bill, a White Paper entitled Caring for our Future: Reforming Care and Support and a progress report on funding reform, Caring for Our Future: Progress Report on Funding Reform. The key components of the reforms can be broken down into the following areas: Access to care universal legal entitlements to care, including a national minimum eligibility threshold for care services and the portability of assessments between local authorities. Carers will be given an entitlement to access care themselves, with a clearer simpler assessment process. Reform of social care funding an acceptance, in principle, of the funding model set out by the Dilnot Commission on the Funding of Care and Support, including a cap on the lifetime cost of care. Information establishing a new national information website and providing start-up funding to allow Councils to develop online information about local care options. Quality developing a new code of conduct and minimum training standards for care workers. Developing comparison information and feedback websites to enhance local competition based on quality standards. Requires local authorities to provide a diverse market place of providers and ensures the ending of the current practice of contracting by the minute. Prevention and integration places a new duty on Councils to incorporate prevention and early intervention into care commissioning and planning. Personalisation legislating to give people an entitlement to a personal budget as part of their personal care plan and developing the use of direct payments. Improves access to independent advice to help people develop a care and support plan.

6.2

6.3

6.4

Aspects of these changes were analysed through our Summer Survey, and others were tested through interviews, discussion groups and submissions from local groups and Bradford Council.

http://www.direct.gov.uk/prod_consum_dg/groups/dg_digitalassets/@dg/@en/documents/digitalasset/dg_187876.pdf

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6.5

There was a general feeling that while the proposals were good in principle, their impact in Bradford will ultimately depend on detailed regulations and guidelines that are yet to be published. In addition, the provision of adequate funding and the response of the local authority are both crucial in ensuring their successful implementation. The draft Care and Support Bill is currently undergoing pre-legislative scrutiny as part of a joint committee of the House of Commons and House of Lords and is due to make recommendations at the end of March 2013 with a Bill likely to be finally published later this year.

6.6

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7.0 7.1

Access to care in Bradford Eligibility Criteria

7.1.1 Bradford District currently provides means-tested home care to individuals whose needs are classed as moderate under the Fair Access to Care (FACS) criteria. Eligibility has been retained at the level of moderate in Bradford in spite of a growing national trend toward higher thresholds for eligibility of care due to increased funding pressures. 7.1.2 However on 15th January 2013, Bradford Council announced plans to undertake a three month consultation on proposals to downgrade its eligibility threshold from moderate to substantial. Moderate needs apply to those people that need help with several personal care duties, domestic routines or need help in several aspects of work. Substantial needs is a higher threshold and apply to those that have an inability to carry out the majority of personal care or domestic routines and need help in many aspects of work, education or learning. 7.1.3 A Bradford Council report states that a downgrade to the moderate level would mean that 2078 people (788 care users aged 18-64 and 1290 care users aged over 65) currently receiving local authority funded care would no longer be eligible for support5.

7.1.4 In response to our survey, there was very strong support for keeping the level of access at moderate in Bradford with 97% of respondents opposing any downgrade. 7.1.5 The Other Care Crisis, a report by five leading disabilities charities6 raises concerns about the impact of further downgrades to FACS eligibility thresholds on disabled people of working age. The report suggests that for many disabled people, care and support is critical in enabling them to participate meaningfully in the labour market. The report cites research by the National Autistic Society, which shows that just 15 percent of people with an autism spectrum condition are in full-time employment, with a lack of adequate support being a key barrier. 7.1.6 A number of those we interviewed in the course of our research raised particular concerns about the impact on those with learning disabilities who are often classified as having moderate needs but may not be able to live independently without some support. In 2011/12, 33% of Bradfords local-authority funded care users aged 18-64 had learning disabilities.

Bradford Councils Executive is currently considering downgrading the FACs threshold to substantial. The Executive will decide whether to consult on this proposal on 15 January. Details of the change can be found in a Report of the Interim Director of Adult and Community Services to the meeting of the Council Executive to be held on 15 January 2013. 6 The Other Care Crisis: making social care funding work for disabled adults in England (January 2013) Available here: http://www.scope.org.uk/sites/default/files/The_Other_Care_Crisis.pdf

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7.1.7 Despite these fears, a key proposal of the Governments social care reforms is to implement a national minimum eligibility threshold which the Government is likely to set at the substantial level7 rather than the current moderate level in Bradford. The former Health Secretary, Andrew Lansley, himself indicated this to the Health Select Committee in July 20128. 7.1.8 Whilst national standards of care are of course welcome with 75% of respondents to our survey supporting the proposal, which would ensure consistency of care throughout the country, as demonstrated this will significantly reduce the number of people in Bradford that are eligible for care services. This is further emphasised by the Alzheimers Society in Bradford who in an interview confirmed their fears to us that the introduction of a national minimum standard could lead to authorities such as Bradford, which currently offer a more generous provision leveling down. 7.1.9 In addition to this, there is evidence that people with learning disabilities in Bradford are frequently having their needs under-assessed. We received several anecdotal reports that people felt that social workers allocated to learning disability cases often had insufficient training or experience to deal with more complex cases. Finding: There is overwhelming support for maintaining Bradfords home care eligibility threshold at moderate and the Government should look to set the new National Minimum Standards of Care at the moderate level. 7.2 Access to care for Carers

7.2.1 A further key proposal that is included within the Draft Care and Support Bill is to include a new duty for councils to carry out assessments for both carers and those being cared for, whereas previously the onus was on a carer to identify their needs and make an approach for support. Furthermore, it removes the requirement that the carer must be providing a substantial amount of care on a regular basis. Some of the enormous pressures borne by carers supporting relatives in need is illustrated in two examples below. Mrs Es daughter is severely disabled and is reliant on care and assistance with all aspects of her everyday life. Her daughter is currently studying at Shipley College for two full days and two half days per week. Mrs E needs assistance with caring for her daughter while she is not at college. Mrs E contacted the Council and was told that she should change her working patterns in order to accommodate her daughters needs. Her employer could not accommodate this. She was then told to commission the care herself from other benefits that she receives, but the amount received in benefits went towards her college fees and there was not enough remaining to commission further care.

http://www.communitycare.co.uk/articles/17/01/2013/118841/ministers-urged-to-find-2bn-to-fund-moderate-carethreshold.htm 8 http://www.publications.parliament.uk/pa/cm201213/cmselect/cmhealth/uc317-iii/uc31701.htm

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Mr Fs father was returned home from hospital where he was diagnosed with dementia. He was returned home with carers who were supposed to visit regularly. Mr F discovered that his father had routinely missed taking his medication, had gone many days without bathing, and was often found by neighbours wandering the streets. He was also duped out of money by a doorstep trader. Once Mr F discovered this, he sought to find a place for his father in a residential home. This took several months, during which time, Mr F missed a lot of work in order to be available to help his father as nobody else was there. The care workers were only there for a small amount of time each day, so he was only monitored during those times or when Mr F finished work. 7.2.2 In an interview with us discussing these new assessments, Anna Jackson from Carers Resource stated that it was necessary for carers needs to be assessed separately from those they care for. Anna told the Social Care Summit that: They would rather be assessed on their own so that they are able to be open and honest about their true needs and concerns [...] In fact the concept of grouping did not appeal to the carers at all. They never come first. Furthermore a Carers Resource consultee stated that As a carer, I want to have my own assessment and to be confident that it will result in me getting some help. 7.2.3 In a fact sheet published by the department of health on the Draft Care and Support Bill titled The Law for Carers it does seem to imply that individual assessments will be undertaken unless specifically requested by the people within the support framework9. 7.2.4 In addition, Carers Resources response to the Draft Care and Support Bill calls for greater clarity about how carers are defined for the purposes of eligibility to receive support services. They have proposed an impact framework to identify carers based on the impact that caring is having on their lives. They also propose that Carers Assessments should be rebadged as Carers Needs Assessments to remove carers perceptions that the assessment is designed to test their ability to care. 7.2.5 Carers Resource has called for a wider range of support services to be provided to carers. They state that respite and sitting services are currently the most common form of support offered to carers. They point out that these are services for those being cared for and should therefore be assessed based on their income rather than the carers. They also cite demands for more support for carers in the following areas: More emotional support, both face-to-face and via a help-line. Specialist carer counsellors to deal with relationship issues and loss. More training to enable them to care competently and safely, including training on moving, handling, communication and medicines. Peer support networks to share experiences.

Finding: That Carers Assessments should be rebadged as Carers Needs Assessments.

http://moderngov.rotherham.gov.uk/documents/s48407/CareandSupportAppendix6.pdf

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8.0

Local government spending in Bradford

8.1.1 The Local Government Grant Settlement reduced Bradfords formula grant by 11.3% in 2011/12 and 7.9% in 2012/13. When combined with the impact of inflation and service pressure, Bradford Council has had to reduce its annual spending by 72m per annum. In addition, the ring-fences surrounding social care funding have been removed and a number of specific social care grants have been rolled into the formula grant. This has meant that the adult services budget is coming under greater scrutiny as other areas of local authority spending are squeezed. 8.1.2 Bradford Councils total spending on social care increased by roughly 10% in real terms between 2007 and 2011. Figures from the Department for Communities and Local Government show that Bradford Council has reduced its spending on social care by 16% over the past two years10, and a recent Council report states that a further 7m reduction is scheduled for 2013/1411. (N.B. the 2007-11 and 2011-12 figures are not directly comparable as they come from different sources). 8.1.3 The largest part of the increase in the cost of care between 2007 and 2011 was accounted for by increases in spending on younger people with learning disabilities, which more than doubled from 25.6m to 53.2m. Residential care accounts for 23% of the current Adult Services budget and around 53% is spent on older people. Figure 3 - Real terms social care spending per care user ()

9574 8367 19481 29824 Mental Health Learning Disability Physical Disability 9300 6334 10425 2007/8 9598 2011/12 Older people

10

https://www.gov.uk/government/organisations/department-for-communities-and-local-government/series/localauthority-revenue-expenditure-and-financing 11 Fair Access to Care Services (FACS) (08 Jan 2013) Report of the Interim Director of Adult and Community Services to the meeting of the Council Executive to be held on 15 January 2013. Document "BB".

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8.1.4 In the spirit of the Care and Support White Paper 2012, Bradford Council are actively pursuing a strategy of shifting the balance of care and support away from care homes toward community based provision. Figure 4 Bradford Council Adult Services Budget ()
(000s) 200 180 160 140 120 100 80 60 40 20 0 2007/8 2008/9 2009/10 2010/11 2011/12 Other Mental Health Learning Disability Physical Disability Older people

8.2

Charging

8.2.1 A revised contributions policy was introduced by Bradford Council in August 2012. This removed the previous 199 cap on weekly care costs and increases the notional costs12 of day care, home care and a sitting service. The Council argue that the new notional costs are closer to the actual cost of providing these services. The charges are means-tested and only those who are found able to contribute have to pay. So far, around 600 people have been affected by the increased charges. Individuals contributions to the cost of their care are expected to contribute an additional 1.1m in 2012/13. 8.2 Day care

8.2.1 There are nine day-services across the District specialising in dementia care for frail older people, and a further two specialising in younger people with dementia. The utilisation rate was only 58% in 2011/12. Bradford Council has recently closed a number of its Day Care centres, citing declining usage rates. 8.2.2 Bradford & District Age UK told us that the reduction in demand for day facilities was caused by the introduction of charging and does not reflect any reduction in need. In 2012 charges were introduced for transport to and from day centres and for meals, while the notional costs (essentially a charge) were increased from 20.50 to 25. The Chief Executive, Keith Nathan, called the introduction of
12

Notional costs are the costs against which non-residential care services are charged to users and are intended to reflect the actual costs that a local authority incurs in providing a service. Depending on their ability to pay, an eligible care user might pay all part or none of the costs of a service. For example, the notional cost of home care is 13.75 per hour.

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additional charges rationing by price and that, in light of the increased cost, reduced demand was not at all surprising. He also questioned Bradford Councils claims that the true cost of providing day centre places was 35. 8.3 Residential care

8.3.1 Bradford District currently has 137 care homes for older people with a combined capacity of 4200 beds and has a vacancy rate of 9.5%. Five new homes are currently being developed which will focus on providing long and short term dementia care, intermediate care and respite services. 8.3.2 A Bradford Council review of residential homes13 estimated that approximately 65% of care homes in Bradford charge top-up fees. These must be paid by a third party (i.e. not the person being cared for) and can therefore contribute to financial hardship of family members, especially if they have previously acted as an unpaid carer for the individual. In the northern half of Bradford District there are only three care homes that offer care at the standard local authority rate. 8.3.3 Furthermore, what was concerning is that in a report by Laing & Buisson in 2009, it states that it found that one-third (35%) of care homes in Bradford would only accept local authority funded people if a Third Party top-up fee was available. This is an indicator that the local authority rate set by Bradford Council is insufficient to meet current care demands. 8.3.4 A recent report by the Think Local, Act Personal partnership14 estimated that 48% of Bradfords care home residents are wholly funded by the local authority, 31% are self-funded and 21% received Third Party top-up fees from family or friends. The level of residents receiving Third Party top-up fees is higher than the national average which is likely to be a reflection of relatively high levels of poverty in Bradford. Finding: With the projected growth in the Bradford population, coupled with budget cuts in social care funding, this results in a higher proportion of care residents having to pay top up fees for their care. Finding: With the number of top-up fees paid in Bradford, the Council could investigate increasing the current local authority rate for residential fees.

13

Bradford MDC (2010) Long Term Support For Older People The Future Of The Councils Residential Care Homes and Day Care Services. Report of the Strategic Director of Adult and Community Services to the meeting of Executive Committee to be held on 3rd December 2010. 14 http://www.thinklocalactpersonal.org.uk/_library/Selffunders/Follow_on_study_Older_people_who_pay_for_care.pdf

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9.0

Reform of social care funding

If youre younger its harder. My situation is that I care for my husband full time [...] I still continue to work and pay taxes, but am also paying for my husbands care. Ive got a double whammy in this sense. I am working to keep the house and be in an area where Phillip knows. [...] The Government needs to look at the needs of those at the younger end such as us. Social Care Summit attendee. If they make him move and sell his house, hed be totally disorientated. Its just a retrograde stephed be in a state. Bradford Alzheimers Society consultee. 9.1 The Dilnot Commission

9.1.1 With ever increasing pressures on funding in social care both for individuals and the taxpayer, the government asked the renowned economist Andrew Dilnot to investigate suitable and sustainable ways to pay for long term social care. 9.1.2 Launched by the Government in July 2010, the Dilnot Commission proposed in its recommendations published a year later, the introduction of a lifetime cap on the amount that any individual would have to pay toward the cost of their social care of between 25,000 and 50,000, with all further costs being met by the state. The Dilnot Commission itself recommended that the cap be set at 35,000. It also recommended increasing the asset threshold for the residential means-test from 23,250 to 100,000. These Dilnot proposals were set at 2010/2011 prices. 9.1.3 Under these proposals individuals would still have to contribute to their hotel costs (food and accommodation), but the report recommends that these should be capped at between 7,000 and 10,000 per year. 9.1.4 In many households, the only substantial asset available that could be used to pay for unexpected care bills is to sell their house. The necessity to sell a house to fund long term care can often cause more stress and heartache in already difficult circumstances. This can be exemplified by the distressing story of Mrs J below. Mrs J Mrs Js father had worked until the age of 74 and owned the family home, which was valued at 140,000. After a stroke he was moved to a nursing home. Mrs Js sister continued living in the family home, having developed early onset Alzheimers in her 50s. Residential care for Mrs Js father was paid for under a deferred payment scheme. Mrs Js father only became eligible for NHS continuing care in the final month of his life, despite being bed ridden and having suffered multiple strokes. After 9 months in residential care he accrued a paper bill of 36,000 which would have to be met from the sale of the family home. As Mrs Js sisters condition worsened she was also transferred to residential care where she died at the age of 59. After the death of her father Mrs J was placed under intense pressure to sell her fathers home to cover the bill for his care. Her sisters dementia had caused her to put valuable possessions into bags of rubbish that filled the house. It took 9 months for Mrs J to clear the house before it could be sold by which time the value of the house had fallen substantially due to 18 the slump in house prices.

9.2

Dilnot in Bradford

9.2.1 Bradford is characterised by low house prices and high levels of deprivation. The average house price in Bradford is 94,180 compared with an average of 161,605 in England and Wales15. It is ranked 26th out of 326 local authorities on the Index of Multiple Deprivation (where 1 is the most deprived and 326 is the least deprived). The rate of owner occupancy among the over 85s is relatively high at around 61%. 9.2.2 The Dilnot Commissions report highlights the fact that, under the current system, those with modest levels of wealth stand to lose the most as a proportion of their assets. As an area of relatively low house prices and high levels of deprivation, Bradford District would benefit significantly from the Commissions funding proposals. 9.2.3 Treasury figures show that an elderly person owning an average priced home in Bradford (currently 94,180) who receives roughly eight years of residential care16 at the local authority standard rate would stand to lose 81% of their assets under the current system17. If the means-test threshold were to be increased to 100,000 and a lifetime cap of 50,000 introduced, the same individual would lose just 37% of their total assets. 9.2.4 The Dilnot funding proposals would mean that many more individuals in Bradford will become eligible for Council commissioned care services. Bradfords relatively high levels of deprivation and low house prices will mean that a higher proportion of people than now will be brought into the new capping system, and therefore have their care costs paid for, than in less deprived authorities. 9.2.5 In an area like Bradford, lower house prices mean lower potential assets. With a higher means test of 100,000, this means that under the Dilnot proposals fewer people will have to sell their house in order to pay for long term care. 9.2.6 A number of constituents who approached us, as well as those interviewed, highlighted issues around financial difficulties associated with care costs. They expressed a feeling that the proposed range for a cap on the lifetime cost of care, even set at Dilnots 35,000, was too high possibly reflecting the lower levels of wealth in the area. Mr Cameron talks about 35,000 as if everybody has it. Doesnt he realise that amounts like that are lottery winnings to working people. Most people have never seen 35,000 let alone have it to spend. Summer Survey respondent.

15 16

http://www.landregistry.gov.uk/__data/assets/file/0009/28728/october-hpi-report.pdf This assumes total spending of 150,000 on residential care, plus additional hotel costs of 10,000 per annum. In Bradford the current standard rate for residential care is 384 per week, so 150,000 would buy approximately 7.5 years of care at current prices. 17 Hansard, 17 Dec 2012: Column 631W www.publications.parliament.uk/pa/cm201213/cmhansrd/cm121217/text/121217w0005.htm

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9.2.7 In addition to concerns on the amount of the cap, there is uncertainty in Bradford about exactly what the hotel costs will cover and how additional costs will be met. Bradford Council have raised concerns that a contribution within the proposed range of 7,000 to 10,000 would be unlikely to meet all the costs that an individual would incur and questioned how any excess costs would be funded. Finding: the consensus view in Bradford was that the Dilnot funding reforms should be implemented as soon as possible including a cap on the lifetime cost of care. 9.3 Paying for Dilnot in Bradford

9.3.1 Respondents to our survey were asked where they thought that extra money to pay for social care funding reform should be raised. The most popular response by far was to reduce spending on universal benefits for wealthier pensioners. 46% of respondents ranked this as their first or second most preferred option, suggesting that there is significant public support to shift public spending from within the total Government budget for older people. This is all the more surprising given that the average age of our respondents was 63. Figure 5 - Where do you think extra money should be raised?18

Where do you think extra money should be raised?

% ranked 1st or 2nd most important
4% Cut benefits to wealthy (eg free TV license) 46% Higher general taxation

15%

35%

Tax the estates of those who receive care after they have passed away

9.3.2 Such a proposal to fund the cap on care costs would adhere to one of Dilnots overarching principles where paying for the cap should linked to intergenerational fairness and thus footing the bill of the cap must come from those that would benefit from it the most, the elderly.

18

David Ward Summer Survey 2012

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9.3.3 Suggestions on how to pay for the cap have been proposed by both the Institute of Fiscal Studies19 and the former Care Minister Rt Hon. Paul Burstow MP20, through targeting the universality of elderly benefits such as the winter fuel allowance, free bus passes or free TV licenses. This would mean that such benefits would be taken away from wealthy pensioners through some form of means test. 9.3.4 However, in discussion groups organised by the Bradford Alzheimers Society, a number of participants expressed caution about shifting spending away from universal benefits. Concern was expressed around the level of income that would be considered wealthy. One participant said it came down to who they class as really rich. Its usually people who own their own home and work and another participant disapproved of the impact this could have on savers: It all seems to mean that if youve got savings or youve worked, you pay.... 9.3.5 With regards other options to pay for the cap, there was a general feeling that those who are in care should not bear a greater burden, either through higher charges or from their estates after death. Increasing charges on care users was particularly unpopular and nearly half of respondents ranked this 4th out of 4 options as a way of raising extra money. 9.3.6 In discussion groups, respondents were strongly opposed to any increase in care costs. A participant in the Social Care summit commented that the costs have already gone up, if they go up any more no one will be able to afford it and its penalising those who are already paying again. Finding: there is strong support in Bradford for funding social care reforms from within Government spending on older people.

9.4

Governments Response to Dilnot

9.4.1 On Monday 11th February, the Government published their response to the recommendations put forward by the Dilnot Commission. 9.4.2 The Government will be introducing a cap on care costs from April 2017, set at 75,000. This is equivalent to a 61,000 cap set in the 2010/2011 prices which the Dilnot proposals were based on.

9.4.3 The Government has also agreed to Dilnots recommendation to increase the asset means test threshold at which you start paying for care from 23,250 to 100,000 in 2011 prices. However due to the effects of inflation, by the time of its introduction in 2017, the Government have committed to introduce the same real terms level of the means test which will be set at 123,000.

19 20

Institute of Fiscal Studies, Pensioners and the tax and benefits system, IFS Briefing Note Billion130, 2012 Centre Forum (2013) Delivering on Dilnot: paying for elderly care edited by Paul Burstow http://www.centreforum.org/assets/pubs/delivering-dilnot.pdf

21

9.4.4 Along with Dilnots commendations, the Government will also be introducing a cap on hotel costs of 10,000 (equivalent to around 12,000 in 2017/18) which is more welcome news. Whilst this is again at the higher range of Dilnots recommendations, the establishment of a cap will insure against unlimited residential costs. 9.4.5 It is understood that the legislative framework for implementing the lifetime cap on care will be introduced within the current Draft Care and Support Bill. 9.5 A Regional Cap for Dilnot?

9.5.1 The introduction of a means test set at 123,000 by 2017 will be welcome news to many people in Bradford East, with average house prices of 94,180 in October 2012; this means that many people will not be forced to sell their homes to pay for long term care. 9.5.2 Whilst this addresses what the former Care Minister, Paul Burstow MP, describes as the meanest of means tests by increasing the threshold to 123,000, the cap on care costs, no matter what it is set at, does not account for the substantial difference in peoples ability to pay this across the country. 9.5.3 Whilst Dilnot recognised that there would be a regional differentiation of the price of care and the effects that a cap would have by region, he did not propose any solution and instead proposed a national cap which the government has chosen to implement. 9.5.4 According to the Office on National Statistics in April 2012, the average weekly wage in Yorkshire & Humber for both men and women was 457 (23,756 annually) compared to 649.50 (33,774 annually) in London21. Therefore, with the care cap set at 61,000 in 2010/2011 prices, (rather than the 75k at 2017 as its more comparable) as a proportion of annual salary, people in Bradford would have to pay 2.6 times their annual salary to pay for care whilst people in London would only have to contribute 1.8 times their salary. This is an extremely unfair and unequal system. 9.5.5 According to Laing & Buisson 201222, Yorkshire & Humber has the lowest care home fees in the country averaging at 24,076 per year, whilst London has the highest average fee of 31,096. Nursing home fees in Yorkshire & Humber are the third lowest in the country averaging at 32,448, whilst in London it is 42,692. 9.5.6 However, if we take the home care fees in Laing & Buisson and cross reference it with the wage data according to the Office of National Statistics, a resident of Bradford earning an average income paying home care fees would have to pay a
21

22

Office of National Statistics (2012), Annual Survey of Hours and Earnings, 2012 Provisional Results Laing & Buisson, 2012 Care of Elderly People Report 2012/13

22

larger portion of their income on these fees compared to a equivalent person in London (101% of income in Bradford compared to 92% in London). 9.5.7 Therefore, with current care costs and with the implementation of a care cap set at the Governments rate, people in Yorkshire & Humber not only have to pay more for the care cap as a proportion of their income but they have to pay more for care as a percentage of their annual salary. 9.5.8 With lower average house prices at 94,180, whilst Bradford residents will of course significantly benefit from the introduction of a means test set at 123,000, with lower average incomes; those residents in Bradford who will be obliged to contribute up to the care cap, will have to pay a larger proportion of their income on fees than many other parts of the county. In an already deprived region, it seems that in this respect Bradford gets a bad deal out of the care cap. 9.5.9 Such regional disparity in the positive effects of a cap cannot be welcome which has led the Local Government Association (LGA) and Bradford Council to call for further investigation into the potential regional differences in the impact of social care funding reform. 9.5.10 As demonstrated with the results of our survey, people in Bradford thought that the proposed limit of the cap was unaffordable and we would welcome further research and analysis into the implementation and feasibility of introducing a regional care cost cap. Finding: further research is needed on the impact of the Dilnot funding proposals in more deprived local authorities such as Bradford with particular emphasis on the establishment of regional care cost caps. 9.6 Additional Financial Reforms in Draft Care and Support Bill

9.6.1 The Draft Care and Support Bill will also introduce a universal deferred payment scheme which would allow individuals to fund their care costs by borrowing against their property. The loan would be repaid only after that person had died and their home is sold. Like some Councils, Bradford already has such a scheme in place, but it is often an underutilised mechanism due to the costs incurred by Councils as they are not currently allowed to charge interest on the loan arrangements. 9.6.2 At the moment, in order to qualify for a deferred payment scheme, an individual has to have less than 23,250 of liquid assets in addition to property. Currently 213 deferred payment arrangements are in place in Bradford. 9.6.3 Section 16 of the Draft Care Bill will introduce provisions to allow Councils to charge interest on loans undertaken as a deferred payment as well as charging an administrative fee for this. Whilst it is hoped that such measures will enable
23

more people to stay in their homes rather than having to sell them, the exact details and clarification of the deferred payment scheme will be introduced in the future as part of the Regulations to the Care and Support Act. 9.6.4 Section 17 of the Draft Care and Support Bill will place a duty on local authorities to broker services on behalf of people with eligible needs regardless of their financial circumstances, which would include self-funders23. 9.6.5 This is significant as many people have reported to us that the local authority do not offer any support once it is clear they will be self-funding. 9.6.6 A number of constituents have also contacted us about the difference in fees charged to self funders compared with local authority funded care users. This is explained further by the story of Mrs G below. Mrs G The daughters of Mrs G complained that as self funders, they paid a lot more for exactly the same service as provided to residents by the local authority. When they questioned this, they were unable to get an adequate answer but only told because thats how it is. For two families, whose relatives received the same meals, rooms and being cared for by the same person, because of how they paid, they were charged at significantly different rates. 9.6.7 Whilst the draft Bill does place a legal duty on local authorities to engage with selffunders and assist in providing information about care and support services, the draft bill does not place a duty, should the person wish it, to purchase services at local authority levels or prices. 9.6.8 With the purchasing power of Councils, in the form of economies of scale, they are able to negotiate a much lower price than self-funders are able to negotiate independently and therefore inflating the price of services for self-funders. This discrepancy is unfair regardless of someones ability to pay for these services. We would welcome further investigation or the insertion of sections within the draft Care and Support Bill in order to compel local authorities such as Bradford Council to allow self-funders to purchase services at the local authority funded rate. Finding: there is a strong argument that Bradford Council and Councils more generally should ensure that self funders can take advantage of a Councils buying power to access services at local authority funded rates.

23

The Draft Care and Support Bill, Part 1, Sections 17-18

24

10.0 10.1

Access to information Access to information was an issue raised by nearly everyone we contacted in the course of our research. Many people said that they found it difficult to access information and advice on care and support, particularly when they first tried to engage with the system. Several of the groups we consulted expressed a strong preference for receiving information face to face. A number of respondents suggested that GPs could play a greater role in signposting services for care users. A recent study by the Joseph Rowntree Foundation24, focusing on the needs of ethnic minority communities, found that many find it difficult to access timely information about services in Bradford, often leading to participants not receiving services or benefits that they are entitled to. This point will be expanding on in a later section. Bradford Alzheimers Society found that some carers are frustrated by a difficulty in obtaining information on behalf of a relative with dementia and below is an extract from an interview.

10.2

10.3

I was on the phone to [...] DWP for 2 hours. I said: Im not coming off this phone until somebody tells me what I need to know. Bradford Alzheimers Society consultee. Often they want to talk to him and he cant answer. They wont talk to me but he cant do it. Bradford Alzheimers Society consultee. 10.4 To try and combat this, access to key information and advice is an important component of both the Care and Support White Paper and the draft Care and Support Bill. The Bill enshrines a duty on local authorities to provide appropriate access to independent advice and information about care, the services available and the support people are entitled to. The White Paper also proposes providing information which can be used for comparison websites about the quality of local care providers, which will facilitate decision making in choosing appropriate care services as well as allowing for the development of a market based on quality. It also proposes the development of feedback websites so that individuals can comment on providers. The Government has allocated 32million to local authorities to improve access to information and to set up a national online information tool covering both health and care.

10.5

10.6

24

Cattan, M & Giuntoli, G (2010) Care and support for older people and carers in Bradford: Their perspectives, aspirations and experiences.

25

10.7

Bradford Council itself is running a one year pilot of Slivers of Time25, a webbased platform for booking paid care and respite care. There is already a Yorkshire and Humber trial underway of a social care emarketplace. Bradford Council is adapting to the Connect to Support emarket, which is based on the Shop4Support platform, and already in use in a number of other Yorkshire and Humber local authorities. However respondents to a Bradford Council consultation expressed concern about the emphasis that has been placed on the online provision of information within the draft Care and Support Bill. Many people may be unable to access online information due to language, disability, culture or poverty. Such concerns were raised by the Joint Committee on the Draft Care and Support Bill to Jeremy Hunt, the Secretary of State for Health, on Thursday 7 th February. The Secretary of State assured the committee that he will ensure that provision is made for people to access suitable information who are not IT literate.

10.8

10.9

10.10 To assist in access to information and care, in 2010 Bradford Council introduced the Adult Service Access Point telephone service as a single gateway to social care services in Bradford. This service carries out a pre-screening of those who are seeking care assessments so that fewer ineligible people are assessed. 10.11 This has meant that while the number of assessments carried out fell from 5,790 in 2010/11 to 4,437 in 2011/12 the number of people who were assessed as eligible for local authority care increased from 3,763 to 3,802 over the same period. 10.12 Whilst the Governments reform agenda ensuring independent access to information, in addition to the Councils own improvements in access to care via the telephone, are both noteworthy and welcome, people we surveyed and interviewed significantly demonstrated that they preferred face-to-face contact both when accessing care information for the first time or on a continuing basis. Finding: People in Bradford stated that they preferred face to face contact when accessing information on care and support services and much more needs to be done both nationally and within Bradford to ensure that this vital service continues despite strains on budgets.

25

http://www.slivers.com/public-sector/

26

11.0 11.1

Loneliness According to a survey carried out by Age UK, on average around 10 per cent of people over-65 believe that they are lonely or are very lonely26. Given the Office of National Statistics estimate of 79,41027 people aged over 65 living in Bradford, approximately 8000 older people in the District are likely to be lonely or very lonely most of the time. Figure 6 - How can we best support older people who are living in social isolation?
Greater access to public buildings for social events Home visits from National Citizen Service volunteers 27% Online support networks

8% 19%

28% 2%

Partnerships between care homes and community organisations (eg schools) 16% Peer Support Networks

% ranked 1st or 2nd most important

11.2

Research suggests that loneliness can have severe long-term health effects. For example, a recent study found that loneliness can increase the risk of death amongst the over-65s by almost 10 per cent28. 95% of respondents to our survey indicated to us that they believed loneliness to be a major health issue among older people in Bradford. This demonstrates that there is an urgent need in Bradford to tackle the issue of loneliness in older people. Some researchers have also found that feelings of loneliness may actually be more prevalent among certain ethnic minority populations, particularly those of South Asian origin29. This was echoed by the Consortia of Ethnic Minority Organisations (COEMO) based in Bradford, whose research cites loneliness as a particular issue among elderly South Asian people.

11.3

26

Victor, C. Loneliness in older age: the UK perspective in Age UK Oxfordshire (2011) Safeguarding the Convoy: a call to action from the Campaign to End Loneliness 27 2011 Census Population and Household Estimates for England and Wales, March 2011 28 http://health.universityofcalifornia.edu/2012/06/18/loneliness-linked-to-serious-health-problems-deathamong-elderly/ 29 http://www.campaigntoendloneliness.org.uk/wp-content/uploads/downloads/2012/07/Victor-Loneliness-PlenaryJuly2012.pdf

27

11.4

As figure 6 demonstrates, 28% of respondents to our survey ranked peer support networks as either the first or second best method of combating loneliness among older people. Julie Lintern, who coordinates the mutual and support networks group at Keigley and Ilkley Voluntary and Community Action estimated that there are currently over 100 peer support and befriending networks in Bradford District. The main challenges these groups face are obtaining funding and volunteers. With such support for peer groups, this raises a question about what more could be done to introduce and sustain peer support networks in Bradford. Another popular idea to come from our research was to institute home visits from the National Citizens Service, which 27% of respondents ranked first or second most important. This year 50 young people from Bradford took part in the National Citizen Service and there are plans to expand the scheme in subsequent years30. The benefits of such a scheme correlates with our survey where 16% of respondents thought that facilitating better relations between elderly people and community groups, particularly bringing young people into more contact with older people living in social isolation, was a key objective in combating loneliness. Further partnership building between schools and care homes is something that should be explored further in Bradford. As highlighted by the Joseph Rowntree Foundation, Essex County Council has developed an Inclusion and Outreach project aimed at supporting better community engagement and brokering relationships across care homes and the wider community support31. One of these projects involved joint work between schools and care homes and involved speaking to older people via a local radio station, organising music and art workshops and bringing children and local choirs into care homes. 19% of people ranked support from neighbours as the 1 st or 2nd best solution to deal with loneliness. The Know Your Neighbour campaign32 helps communities to set up neighbourhood events such as coffee mornings, local classes and area tidy-ups to allow people to get to know their neighbours. This campaign may provide a model that could be adopted in Bradford.

11.5

11.6

11.7

11.8

Finding: Loneliness is a huge problem both in Bradford and nationally. Finding: Given their effectiveness, Bradford Council and the Government more generally need to work in partnership with community organisations and schools to encourage and develop innovative schemes to support older people living in social isolation.

30

http://www.thetelegraphandargus.co.uk/news/news_behind/9633574.Scheme_to_help_Bradford_youngsters_feel_part _of_their_communities/ 31 Joseph Rowntree Foundation, (2012), My Home Life: Promoting Quality Of Life In Care Homes, http://www.jrf.org.uk/sites/files/jrf/care-home-quality-of-life-full.pdf 32 http://www.knowyourneighbour.ie/

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12.0 12.1

Quality A number of Bradford residents have raised concerns about the quality of care and particularly about the attitude and competence of a minority of some care staff. In particular, amongst those consulted by BACC and Bradford Alzheimers Society, there was a general feeling that the standard of care in most residential care homes is poor and leaves room for improvement. This is illustrated by an attendee at our Social Care Summit.

As a user of some of the care services recently, I was appalled at the funding that goes on. The poor girls that come and visit me dont get a living wage. This is because they are paid on the basis of how many patients they see which can vary greatly. I would also like to have the same carer coming to see me regularly that I know and can build up a relationship with. Social Care Summit attendee. 12.2 This is despite the Care Quality Commission finding that out of the 37 different independent providers of domiciliary care procured by Bradford Council, 7 providers are rated excellent, 28 good and 2 adequate33. Furthermore, the 8 local authority-run care homes in Bradford have been assessed as Good or Excellent by the Care Quality Commission (CQC) in the last three years.

Figure 7 Question: What would most improve the standard of social care in the UK?34

12% 36% 16%

An insurance system to allow people to meet unexpected costs More taxpayer funding for social care Tougher standards for providers and improved inspections

36%

Universal legal entitlement to social care

% ranked 1st or 2nd most important

12.3

A random sample of independent sector residential care placements was assessed by Bradford Councils commissioning team in 2010. The team rated the placements on a five point scale (1 = very poor; 2 = poor; 3= average; 4 = very

33

The review score is a subjective judgement by the Bradford Adult Services department commissioning team based on reading the documentation in each review. The scores can be found in Bradford MDC (2010) Long Term Support For Older People The Future Of The Councils Residential Care Homes and Day Care Services. Report of the Strategic Director of Adult and Community Services to the meeting of Executive Committee to be held on 3rd December 2010. 34 David Ward Summer Survey 2012

29

good; 5 = excellent). They found that 54% of private sector placements were either good or very good. 10% of placements were found to be poor although none were rated as very poor. Some of the concerns that led to homes being rated as below average included staffing levels and staff training. 12.4 There was overwhelming support in our survey for the imposition of stricter quality standards on care homes and residential care providers. As demonstrated by figure 7, 36% of respondents ranked this first or second on a list of four possible measures to improve standards in social care. Bradford District Council have recently introduced a new Bradford Quality Assessment Framework (BQAF), incorporating the CQC standards. The Council aims to link this to a local directory of care homes and to the Council website to provide each home with a certificate to display on their premises. Bradford & District Age UK and attendees at our Social Care Summit raised concerns about the time pressures placed on local authority funded home care workers. Age UK are concerned that strictly timed visits allow very little flexibility in the tasks they can perform. They report one instance in which a carer had no time to put [a] curtain back on its track, so for weeks it just hung off. The government White Paper proposes a new code of conduct and minimum training standards for care workers. Bradford Adult and Community Services Department currently offers council-employed care workers training on how to treat people with dignity and respect. This could potentially be extended to independent sector care workers. The White Paper reaffirms the Governments ambition to end contracting by the minute the practice of commissioning home care in very small time increments. It is suggested that this will be done by encouraging councils to commission care based on outcomes in collaboration with the Think Local, Act Personal partnership. Bradford Council currently contracts care on an hourly basis, typically at a price of 12.50 per hour. However, as a result of national policy shifts announced in the White Paper, from summer 2013 the Council are moving to a tendering system predicated on an outcomes based framework. Care services will be purchased in bulk and a range will be specified for the number of users who need to be seen in a given year. Services will then be commissioned within the purchased hours of care based on outcomes rather than specific time increments.

12.5

12.6

12.7

12.8

12.9

12.10 The outcomes based framework is intended to free up carers to spend more time with the people they care for and to give them greater flexibility around the times they attend and the tasks they perform. This may address several of the concerns that were raised in the course of our research. In particular, many care users felt that they did not have control over the times at which carers attended, an issue which Bradford Council argued would be addressed by the
30

new framework. In addition, carers should also have more time to build relationships with those they care for and to carry out other tasks if needed, which may address concerns about impersonal or rushed service care workers. 12.11 We welcome further solutions Bradford Council has introduced to free up more of care workers time. The Commissioning Service Manager described how service providers had been organised to be concentrated in small geographical areas. The Adult Services Department have also developed the Plot and Place system using Google Earth which will help to ensure that carers appointments are in close proximity to each other. Together these measures are designed to minimise travelling times to free up carers to spend more time with their clients. 12.12 Bradford currently pays a fee of 370 per week for a standard care home place, which is average for the region, and 514 per week for a nursing home place which is above average. No quality premium is currently provided. 12.13 The Director of Ideal Care Homes, Mark Greaves, which owns Mill View Care Home in Bradford argued that higher quality care should be incentivised through differential fee levels paid to care providers. He also argued that setting minimum legal entitlements to care will only address one aspect of the current postcode lottery in care services. He suggested that in order to have a more uniform standard of service there needed to be greater consistency in fee levels paid to providers across the county. 12.14 Bradford Council raised the issue of competing demands on social workers time, which may prevent them from providing greater interpersonal support. They identified particular pressures around paperwork including assessments, safeguarding issues, mental capacity assessments, positive risk-taking assessment, medication check lists and check list for continuing care. Finding: Whilst they have already introduced some welcome measures to increase the quality of care, there is a strong argument for Bradford Council to take a greater role in driving up standards among independent sector care providers.

31

13.0 13.1

Minority provision in Bradford Bradfords population is notable for its ethnic and religious diversity. Just 63% of the population identified themselves as being White British in the 2011 census, compared with a figure of 80.5% for England and Wales35. Bradford has the highest proportion of residents with a Pakistani ethnic origin of any local authority in England (20.4%) and nearly a quarter (24.7%) of the population identified themselves as being Muslim. The number of older people of Asian origin will double in the next 15 years from around 5,000 to 10,000 in the Bradford District. The number aged over 85 will also double from around 300 to 75036. The Consortia of Ethnic Minority Organisations report Social Care Needs of Muslim Elders in the Bradford District37 highlights residential care as a particular area of difficulty. Their research indicates a lack of awareness or acceptance of residential care in a community in which there is a strong expectation that family members will care for their parents into old age. They also reported widespread fears about a lack of cultural sensitivity toward Muslims by care home staff. Their report also indicates a lack of awareness of other care services, largely due to language barriers. A recent Joseph Rowntree Foundation report38 identifies a strong desire for individually tailored services among ethnic minority communities in Bradford. Existing services are perceived to be provided in a way that is not sensitive to cultural differences. A small number of respondents also highlighted the potential discrimination faced by older lesbians, gay men and transsexuals in relation to care services. Organisations such as the Equity Partnership and Age UKs Opening Doors project39 has shown how OLGBT people miss out on services which they need because of fear of encountering discrimination. Services such as domiciliary and residential care need to be appropriate for OLGBT community in Bradford. The closure of day care services was identified as a particular issue among South Asian communities by The Consortia of Ethnic Minority Organisation (COEMO).

13.2

13.3

13.4

13.5

13.6

35

http://www.ons.gov.uk/ons/rel/census/2011-census/key-statistics-for-local-authorities-in-england-and-wales/rft-tableks201ew.xls 36 Bradford MDC (2011) Meeting Changing Expectations: a joint commissioning strategy for health, social care and housing related support services for older people in the Bradford district. 37 Consortia of Ethnic Minority Organisations (COEMO) (May 2012) Social-care needs of Muslim Elders in the Bradford District 38 Cattan, M & Giuntoli, G (2010) Care and support for older people and carers in Bradford: Their perspectives, aspirations and experiences. 39 Phillips, M. and Knocker, S. Opening Doors Evaluation: the story so far London: Age Concern Camden, Hackney, Islington, Kensington and Chelsea, Westminster. http://www.openingdoorslondon.org.uk/resources/Opening%20Doors%20Evaluation%20Report%20-%20FINAL%20%2022%2002%2010%20(2).pdf.

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Their report40, The Social Care Needs of Muslim Elders in the Bradford District, states that many South Asian Elders groups have stopped running due to lack of funding. The participants in their research reported great satisfaction with day care services and the report suggests that day care may be regarded more acceptable than other forms of care by the South Asian Community. 13.7 Section 3 of the draft Care and Support Bill will introduce a new duty on Councils to promote diversity and quality in the provision of services. In preparation for this part of the Bill, the department of Health set up The Developing Care Markets for Quality and Choice (DCMQC)41 programme which is designed to help drive up quality and diversity of choice in care services locally. Through this programme, Councils will also receive support in developing their capability to build strategic relationships with local providers, to work in partnership to ensure peoples needs are met ensuring high quality of services that meet local needs. With its new diversity duties and given the size and diversity of the minority ethnic population in Bradford, Bradford Council must do more to ensure that all its residence with particular emphasis on BME communities, can access the appropriate services that they need.

13.8

13.9

Finding: Evidence suggests that Bradford Council should increase efforts to raise awareness of care services among ethnic minority communities. Finding: Commissioners and providers need to look at how services are developed and delivered to adhere to cultural needs in addition to how those services are accessed by the OLGBT and BME communities. Finding: Bradford Council needs to do more to engage with and enable harder to reach communities to access the support services that they need and to ensure appropriate support services are available within the area.

40 41

Consortia of Ethnic Minority Organisations (2012) Social Care Needs of Muslim Elders in the Bradford District. http://socialcarebulletin.dh.gov.uk/2012/09/28/driving-quality-through-diversity-and-choice/

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14.0 14.1

Prevention and integration Prevention work in Bradford

14.1.1 A focus on prevention and integration is one of the key themes running through the Coalitions proposed reforms. Bradford Councils Adult Services Department welcomed the aim to shift funding from the acute sector to preventative work and the community services sector, but expressed reservations about how achievable this is in practice. They acknowledged that the recent transfer of public health responsibilities to local government and the setting up of Health and Wellbeing Boards has the potential to deliver a more integrated health and care system. However, the Council highlighted the fact that achieving a more joined-up health and social care system will require Bradfords Clinical Commissioning Groups (CCGs) to work proactively with the Council. 14.1.2 Bradford Council has rapidly expanded its provision of Telecare over recent years. Telecare is a service offering remote care of elderly and physically less able people, providing care and reassurance often used to enable people to remain living in their own homes. The use of sensors may also be part of a package which can provide support for people with illnesses such as dementia, or people at risk of falling. 14.1.3 The number of users has increased from 800 in 2009/10 to 2,697 in 2011/12, as well as a monitoring service for 6,500 care users in housing associations properties. 14.1.4 A recent postal survey in Bradford carried out by the Think Local Act Personal Partnership suggested that the number of people receiving home care who were self-funders was lower than average among the local authorities studied, at 22% of all home care recipients42. In most cases, home care is provided by an agency, although the Council has retained some home care services in house, with a specialist focus on providing short-term care to prevent people from developing more expensive acute care or long term care needs. 14.1.5 Most home care services in Bradford are being progressively transferred to the independent sector to reduce costs. Bradford Council are focusing their remaining in-house domiciliary care service to focus on providing a specialist enablement service, BEST. This service is orientated toward reducing costs by removing the need for long term care. All new service users receive six weeks of enablement support. Following the enablement period, 25% of users require no ongoing care and 30% have had a reduction in the number of hours.

42

http://www.thinklocalactpersonal.org.uk/_library/Selffunders/Follow_on_study_Older_people_who_pay_for_care.pdf

34

14.2

Housing

14.2.1 Availability of specialist accommodation is an issue frequently raised by disabled people in Bradford. A number of constituents have been left in unsuitable accommodation that does not enable them to carry out even basic tasks such as washing and toileting. Below are two examples (Mr C and Mr D) that reflect this issue in a very real way. Mr C has diabetes and has had both legs amputated. Since being discharged from hospital, Mr and Mrs C have been trying to find a more suitable home. The current home has steep steps to the door, no downstairs toilet, no room for a stair lift and the doors are not wide enough for Mr C to pass through in his wheelchair. As a result he is confined to one room whenever he is released from hospital and has to eat, sleep, shower and go to the toilet in a small room. Mr and Mrs C have been trying to sell their home but have not been able to do so. They have applied for social housing but the only potentially suitable unit is in Thorpe Edge, which is very hilly and so is unsuitable. Private houses which are specially adapted are not available to rent. Mr D cares for his adult son who is in and out of hospital with mental health problems. After one period of hospitalisation, he had to wait over 4 months for a discharge in order for a suitable home to be found. He was told that he could not go back to the private supported accommodation which he was in previous to his hospitalisation as the company claimed that they could no longer manage Mr Ds sons needs, despite little change in his care requirements. Furthermore, the company who owned the private accommodation would not end his tenancy and therefore not freeing him up to be able to seek suitable alternative accommodation. Mr Ds son was therefore stuck on a hospital ward. Mr Ds son was offered an opportunity to return to the supported accommodation with support from the hospital staff. However, this was rejected by the private provider of the supported accommodation. An agreement for Mr Ds son to return was only reached when a new company took over the supported accommodation. 14.2.2 Bradford Council have identified a need to increase extra care housing for frail elderly people43. The local authority received 2.4 million of capital funds for specialist housing from the Department of Health in 2011/12. Of this, 1.3 million is being used to fund a 52 bed extra care housing scheme in Thackley with construction due to start in March this year. However, a reduction in Central Government funding via the Homes and Community Agency is adversely affecting the opportunities for Registered Social Landlords (RSLs) to develop further schemes. 14.2.3 With public funding for social housing increasingly scarce, local authority housing departments and social landlords have been exploring alternative sources of funding for social housing of all kinds. Pension funds and Real Estate Investment Trusts (REITs) may be suitable vehicles through which to deliver greater investment in specialist housing in Bradford. There are also
43 Bradford MDC (2010) Long Term Support For Older People The Future Of The Councils Residential Care Homes and Day Care Services. Report of the Strategic Director of Adult and Community Services to the meeting of Executive Committee to be held on 3rd December 2010.

35

opportunities to make greater use of publicly-owned brown field land for specialised housing projects, such as sites on the fringes of Thorpe Edge and Fagley. 14.2.4 The White Paper Caring for our future: reforming care and support announced 240m of additional capital funding for specialised housing. This will be administered by the Homes and Communities Agency and will initially focus on affordable housing44. Bradford Council is preparing a bid for funding for additional extra care housing. 14.2.5 Housing is a crucial part of the independence and prevention agenda and as such the local authority housing department and registered social landlords should have representation on the Bradford and Airedale Health and Wellbeing Board. Finding: Our research suggests that Bradford Councils housing department should have representation on the Bradford and Airedale Health and Wellbeing Board. Finding: Bradford Council and Registered Social Landlords should make greater use of alternative funding mechanisms for specialised housing such as pension fund investment and REITs.

14.3

Boundary between Health and Social Care

14.3.1 In our research, we found that there was a strong feeling of unfairness about the boundaries between health and social care. For example the Bradford Alzheimers Society reported a feeling among their members that Dementia is an illness and that care should therefore be covered by the NHS. 14.3.2 Bradford and District Age UK have raised major concerns about hospital discharges in the District. They brought several cases to our attention in which vulnerable patients were discharged under circumstances that would have posed severe risks to those individuals. In all cases their carers were not properly informed, highlighting the need for better communication between health and social care services. One example (Mr H) whose case is described below. The Chief Executive told us that: we are getting instances of vulnerable people discharged from the Bradford Royal Infirmary in the early hours of the morning with no warning or preparation with their carers. Mr H is an 83 year old man who suffers from Dementia. He was discharged from in the middle of the night. The hospital contacted his daughter-in-law just half an hour before discharging him but did not contact the court manager. He was taken home wearing no shoes. He had wet himself and all his possessions were thrown into a bag.
44

http://www.homesandcommunities.co.uk/news/bidding-%C2%A3240m-care-support-housing-fund

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14.3.3 The Care Services Minister, Norman Lamb MP, has often said that the lack of integration between health and social care is one of the last bastions of reform within the necessary health reforms. In a joint submission to the Communities and Local Government Select Committee in November 2012, the Department of Health and the Department of Communities and Local Government stated that integrated health and social care should become the norm in the next five years and pledged to remove the barriers to integrated care. 14.3.4 Bradford itself has made good progress in trying to integrate health and social care. Established in November 2010, the Integrated Care Management Board was set up to shape the future of integration of care and health support in Bradford, Airedale, Wharfedale and Craven. 14.3.5 Reporting in December 2012, the Board stated that four of the pilot/test sites in Bradford set up in Bradford are now operational with each having identified a small number of patients around which services are integrated45. Cath Doman, Head of Community Health Services at NHS Airedale, Bradford and Leeds confirmed that these integrated pilots are linked to groups of GP practices and will test out integrated community teams made up of community health services, social care services and voluntary and community services, and will be organised by one team, with one manager46. 14.3.6 However, the progress report in December noted the pace of these reforms and stated that the board understands the operational challenges that the executive team is currently addressing in respect of the Bradford ICAP (Integrated Care for Adults Programme). Therefore the pace of reform in Bradford in addressing the problems of a split health and social care system has been slow. Finding: We found that there is a strong demand in Bradford for an integrated health and social care system. Whilst progress has been made in this area, more must be done by the Council and the NHS to speed up reform to ensure that residents of Bradford can enjoy the benefits of an integrated health and care system.

14.4

Adaptations

14.4.1 We have received a large number of complaints about adaptations. Two of the worst examples (Mr A & Mrs B) are enclosed on the next page.

45

http://www.bdct.nhs.uk/wp-content/uploads/Implementation-of-the-Integrated-Care-for-Adults-Programme-inBradford-Airedale-Wharfedale-Craven.pdf 46 http://www.thetelegraphandargus.co.uk/news/local/localbrad/9523398.Elderly_health_care_in_Bradford_set_to_be_si mplified/

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Mr A was blind and had bladder cancer. Several health professionals made referrals for his house to be adapted to include a downstairs toilet. Mr A waited for months before anyone from the Council got in touch, and this only happened after we (David Wards office) got involved. There was a phone call and an initial visit two weeks later. Shortly after this, Mr A died. During his final few weeks he had been confined to just one room in the home and required constant assistance. Mrs B was being cared for at home by her daughter. In order to be moved she required a hoist, however the hoist installed by the Council required two people to operate. The only other person in the home was her daughter, who the council would not train to use the hoist. This meant that in order for Mrs B to use the toilet, two carers had to attend. The carers visit at irregular times (never the same time each day and at their discretion rather than when they are needed), which effectively means that Mrs B cannot use the toilet or do anything until they show up. It also means that if she is sleeping when they arrive, she has to either be woken up or go without using the toilet or moving until the next visit. Mrs Bs daughter and several neighbours offered to do the required training to operate the hoist. After Mrs Bs daughter informed the Council of this offer they immediately removed the hoist. Since this time, Mrs Bs daughter has been providing care for her mother alone and with very limited assistance. She has asked the Council for assistance in the form of financial support, or equipment and materials (such as comfort pads and nappies etc) but has had no response despite repeated efforts. 14.4.2 Some constituents have faced very long delays before the necessary adaptations are made to enable them to continue living in their home, in at least one case this delay was longer than six months. This left them and their carers in an unmanageable situation with severe consequences for their wellbeing. In at least one case the person being cared for died before adaptations were made. In another case the Council were unwilling to provide appropriate training to enable relatives to use the installed adaptations independently. Finding: There is clearly a need for Bradford Council to review the delivery of adaptation services and find ways to drive down waiting times.

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15.0 15.1

Personalisation Numerous examples of a lack of control over domiciliary care services were raised by in the Caring For Our Future discussion event organised by Bradford and District Disabled Peoples Forum suggesting that this change is badly needed. A common complaint was that people do not have control over the times when carers attend and that this has an impact on their independence and quality of life. One lady wasnt able to arrange for a carer to help her to wash before going out and as a result felt unable to leave the house. The Governments current reforms and impetus on carer choice should alleviate some of these problems. The Government announced a target to have all Council-funded service users and carers on personal budgets by April 2013. Due to complaints about the realistic nature of this target, this target was downgraded to 70% of people should be on personal budgets by April 2013. The draft Care and Support Bill would make personal budgets a legal requirement as part of all Care and Support Plans. In addition, the White Paper sets out measures to improve access to independent advice and to help people to obtain support from their local Council to develop a care and support plan. The Bill also makes direct payments available to people in residential care. A Council officer, speaking in a personal capacity, argued that take up of direct payments was likely to be poor, and that setting up the infrastructure for this may be a distraction at a time of intense pressure on resources. Recipients of direct payments report being sent lengthy legalistic letters demanding that they submit information on their spending to be audited by the Council. Many care users may find such letters intimidating and difficult to process. Easy read versions are not currently available. Bradford Council has made some progress in introducing personal budgets, with 44% of care users receiving support via a personal budget in 2012. All new care users and those in need of reassessment are placed on a personal budget and the Council claim that existing users are being progressively transferred to the new system. However, the Council concede that they are certain to miss the Government target to give all care users a personal budget by April 2013. Bradford Council raised the issue of value for money in decentralised service provision. They have historically been able to secure significant volume discounts on the block purchase of care services. As a result, self funders in Bradford can find themselves paying significantly more than local authority funded care users for exactly the same service, which is an issue already highlighted.
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15.2

15.3

15.4

15.5

15.6

15.7

15.8

15.9

A number of care users raised concerns about the implementation of the personalisation agenda in Bradford. In particular, it seems that care users are finding themselves severely restricted in how they must spend their allocated personal budget. In addition, where service users wish to change the care service that they commission, they often face a lengthy and arduous reassessment process. This clearly does not reflect the aims of the personalisation agenda as set out in the Care and Support White Paper and in various Bradford Council documents.

15.10 This problem seems to arise from both a cultural aversion to risk within Bradford Council and a shortage of qualified social workers. One senior social worker with a focus on housing and supported living told us that there was currently an 8 month waiting list to be allocated a social worker for adult social care. While high priority cases presenting to Access Point are dealt with more quickly this leaves those with more moderate needs facing very long waits before they can be assessed, during which time their needs may not be adequately met and they could develop more serious disabilities. Finding: Bradford Council will not meet the Governments target for all Council service users to have a personal budget by April 2013. More must be done to implement this. Finding: The Council should ensure that correspondence with care users managing personal budgets is accessible and clearly written. Easy read versions should be made available to those with learning disabilities.

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16.0 16.1

Summary of Conclusions Access to care

16.1.1 Whilst the setting of a national minimum standard of care within the Draft Care and Support Bill was welcomed, there was concern that this may lead to some local authorities levelling down. Our survey found overwhelming support for maintaining the FACS threshold in Bradford at the moderate level. 16.1.2 There was widespread approval for the introduction of specific Carers Assessments in Bradford especially given the often enormous pressures borne by carers in supporting relatives but proposals were put forward to rename Carers Assessments to Carers Needs Assessments so as to remove perceptions that the assessment is designed to test a carers ability to care. Finding: There is overwhelming support for maintaining Bradfords home care eligibility threshold at moderate and the Government should look to set the new National Minimum Standards of Care at the moderate level. Finding: That Carers Assessments should be rebadged as Carers Needs Assessments.

16.2

Local Government Spending and Care funding Reform

16.2.1 The local authority has faced steep reductions in its grant funding at the same time as a growing demand for care services from adults with learning difficulties and Bradfords ageing population. In light of these pressures, it is unlikely that the Government will be able to achieve the objectives set out in the White Paper and draft Bill without additional funding for local authorities to deliver changes on the ground. 16.2.2 A Bradford Council review of residential homes47 estimated that approximately 65% of care homes in Bradford charge top-up fees. With 21% of residents in Bradford receiving third party top up fees from family or friends, higher than the national average, this reflects the high levels of deprivation in Bradford. With so many people in Bradford having to pay top-up fees, the Council needs to investigate the suitability and sustainability of its current rates. 16.2.3 Our research uncovered very strong demand for the implementation of the Dilnot Commissions funding proposals. Survey responses suggest that older people are generally supportive of proposals to fund this from within Government spending on older people.

47

Bradford MDC (2010) Long Term Support For Older People The Future Of The Councils Residential Care Homes and Day Care Services. Report of the Strategic Director of Adult and Community Services to the meeting of Executive Committee to be held on 3rd December 2010.

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16.2.4 As an area of relatively low house prices and high levels of deprivation, with a means test set at 123,00 by 2017, Bradford District would benefit significantly from the this proposal. 16.2.5 However, with a national cap on care costs set at 61,000 (75,000 by 2017) significantly more than the 35,000 recommended by the Dilnot Commission set at 2010/2011 prices, given Bradfords average salary levels and deprivation, residents in Bradford will be forced to pay a higher proportion of their income than many parts of the Country. This is an extremely unfair and unbalanced system and it is imperative that further research is undertaken to study the regional effects of the care cap with a view to the introduction of regional care caps. 16.2.6 Our research also found considerable dissatisfaction with the difference in fees charged to self funders compared with local authority funded care users. The Draft Care and Support Bill will place a duty on local authorities to broker services on behalf of people with eligible needs, regardless of the financial circumstances48. Bradford Council should use this opportunity to ensure that self-funders can access care at the local authority funded rate. Finding: With the projected growth in the Bradford population, coupled with budget cuts in social care funding, this results in a higher proportion of care residents having to pay top up fees for their care. Finding: With the number of top-up fees paid in Bradford, the Council could investigate increasing the current local authority rate for residential fees. Finding: the consensus view in Bradford was that the Dilnot funding reforms should be implemented as soon as possible including a cap on the lifetime cost of care. Finding: there is strong support in Bradford for funding social care reforms from within Government spending on older people. Finding: further research is needed on the impact of the Dilnot funding proposals in more deprived local authorities such as Bradford with particular emphasis on the establishment of regional care cost caps. Finding: there is a strong argument that Bradford Council and Councils more generally should ensure that self funders can take advantage of a Councils buying power to access services at local authority funded rates.

16.3 16.3.1

Access to Information Access to information was an issue raised by nearly everyone we contacted in the course of our research. Many people said that they found it difficult to access information and advice on care and support.

48

The Draft Care and Support Bill, Part 1, Clauses 17-18

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16.3.2

Several of the groups we consulted expressed a strong preference for receiving information through face to face contact and were concerned that there was an over reliance on online provision. Whilst the Draft Care and Support Bill places a duty on local authorities to further facilitate access to information about care and support services, more must be done to ensure approachable and personable access to information.

16.3.3

Finding: People in Bradford stated that they preferred face to face contact when accessing information on care and support services and much more needs to be done both nationally and within Bradford to ensure that this vital service continues despite strains on budgets.

16.4 16.4.1

Loneliness We have found that loneliness is a major issue among elderly people in Bradford, which needs to be addressed. Our research suggests that as many as 8000 older people in the district are likely to be lonely all or most of the time. We found particular support for building up links between schools and care homes as well as for building support networks within communities. A local campaign to encourage people to meet elderly neighbours may be a step in the right direction.

16.4.2

Finding: Loneliness is a huge problem both in Bradford and nationally. Finding: Given their effectiveness, Bradford Council and the Government more generally need to work in partnership with community organisations and schools to encourage and develop innovative schemes to support older people living in social isolation.

16.5 16.5.1

Quality A number of Bradford residents have raised concerns about the quality of care and particularly about the attitude and competence of a minority of care workers. In particular, there was a general feeling that the standard of care in most residential care homes leaves room for improvement. There was overwhelming support in our survey for the imposition of stricter quality standards on care homes and residential care providers. With the introduction of the Bradford Quality Assessment Framework (BQAF), we believe that the council should use this opportunity to take a greater role in

16.5.2

43

assessing the quality of independent sector care providers and should use the newly introduced framework to impose stricter standards where possible. Finding: Whilst they have already introduced some welcome measures to increase the quality of care, there is a strong argument for Bradford Council to take a greater role in driving up standards among independent sector care providers. 16.6 16.6.1 Minority provision The Consortia of Ethnic Minority Organisations (COEMO) has highlighted a lack of awareness and acceptance of residential care in the South Asian community and widespread fears about a lack of cultural sensitivity toward Muslims by care home staff. A small number of respondents also highlighted the potential discrimination faced by members of the OLGBT community in relation to care services. With the Councils new duty to promote diversity and quality in the provision of services, the Council must do more to raise awareness of care services and the appropriate provision of services to ethnic minority communities.

16.6.2 16.6.3

Finding: Evidence suggests that Bradford Council should increase efforts to raise awareness of care services among ethnic minority communities. Finding: Commissioners and providers need to look at how services are developed and delivered to adhere to cultural needs in addition to how those services are accessed by the OLGBT and BME communities. Finding: Bradford Council needs to do more to engage with and enable harder to reach communities to access the support services that they need and to ensure appropriate support services are available within the area.

16.7 16.7.1

Prevention and integration We found strong support for improving prevention to keep people out of the care system, but this was tempered with concern that this agenda may be undermined by budget pressures. Some Bradford residents have experienced serious difficulty in obtaining suitable adaptations and sheltered accommodation to enable them to live independently. We found that the availability of specialist accommodation is an issue that is frequently raised by disabled people in Bradford with a number of constituents having been left in unsuitable accommodation. Whilst Bradford Council have acknowledged the current lack of more suitable accommodation for frail elderly people, while reduced HCA funding limits RSLs ability to develop further schemes, we recommend that alternative funding
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16.7.2

16.7.3

mechanisms for extra care housing are trialled in Bradford. As housing is such a crucial part of the independence and prevention agenda, we believe that the local authority housing department should have representation on the Bradford and Airedale Health and Wellbeing Board. 16.7.4 We found that there was a strong feeling of unfairness about the boundaries between health and social care. Whilst the Council and Health Authorities have made some good progress in this area, this has been slow and more impetus must be given to the programme.

Finding: There is clearly a need for Bradford Council to review the delivery of adaptation services and find ways to drive down waiting times. Finding: Our research suggests that Bradford Councils housing department should have representation on the Bradford and Airedale Health and Wellbeing Board. Finding: Bradford Council and Registered Social Landlord should make greater use of alternative funding mechanisms for specialised housing such as pension fund investment and REITs. Finding: We found that there is a strong demand in Bradford for an integrated health and social care system. Whilst progress has been made in this area, more must be done by the Council and the NHS to speed up reform to ensure that residents of Bradford can enjoy the benefits of an integrated health and care system.

16.8 16.8.1

Personalisation We found strong support for proposals to give people greater control over their care, and for the concept of personalisation. Many people participating in our research said that they were frustrated by a lack of say over the times that carers attended and the tasks they performed. However, there were reservations about how personalisation would work in practice and particularly about direct payments. Bradford Council has made some progress in introducing personal budgets but the Council will miss their 2013 target set by the government. Our research uncovered concerns about the implementation of the personalisation agenda in Bradford. In particular, a number of care users found the allocation of personal budgets to be overly prescriptive and inflexible. There also appear to be severe delays in allocating social workers to assess low priority cases and care users with a personal budget who wish to change their package of services.

16.8.2

Finding: Bradford Council will not meet the Governments target for all Council service users to have a personal budget by April 2013. More must be done to implement this. Finding: The Council should ensure that correspondence with care users managing personal budgets is accessible and clearly written. Easy read versions should be made available to those with learning disabilities.
45