International Development Select Committee inquiry: Definition and Administration of ODA - Hft Response

Compiled by Billy Davis- Public Affairs & Policy Manager – April 2018

About Hft

1. Hft is a national charity that provides specialist care and support to over 2,500 adults with learning disabilities in order to live with as much independence, choice and control as possible.

2. We were founded in 1962 by a group of families who believed that, with the right support, their relatives were capable of more than society expected of them.

Today, we still share that same vision. We support people to live independently in their homes through our Supported Living services, alongside  Residential Care, and Short Break services. We empower people to make their own choices, including finding a job, building friendships and relationships and taking part in activities.

3. We operate in sites across England – from Newcastle to Newquay.

About the Fusion Model of Support

4. Hft’s Fusion Model of Support is a different way of supporting someone with a learning disability. The model puts the emphasis on how we provide support, not what support we provide. It contains all of our strengths and all of the elements that we believe are essential to providing high quality, person-centered services. When all of these elements come together, a ‘fusion’ is created – this is when Hft is working at its best.

5. At the centre of our model, and because they are at the centre of everything we do, are the people we support. Surrounding them are eight segments that reflect all of the specialist skills that we believe are necessary to provide excellent support. These segments also include some of the ethical and moral considerations we take into account when providing services.

6. Surrounding these segments are three supporting themes: ‘care about’ runs through everything we do, ensuring we provide ‘quality’ services that are ‘continually improving’.

i)                    Person-Centred Active Support (PCAS)

7. PCAS is a way of supporting people so that they are engaged in meaningful activity and relationships as active participants, exercising more control over their lives and experiencing greater levels of inclusion, independence and choice.

ii)                 Specialist Skills

8. Specialist Skills means using proven expert knowledge and best practice to support people.

9. This includes providing support with physical, mental, emotional and social needs and also meeting syndrome and time of life specific needs.

iii)               Creative Solutions

10. Creative Solutions means thinking openly and using imaginative and original ideas to find practical solutions to enhance the lives of the people we support.

iv)               Families and Other Partnerships

11. This means helping the people we support to develop and maintain positive relationships with families, friends and other partners involved in their lives.

12. It means having the skills and understanding of how important it is to work in partnership with the people we support and those involved in their lives. This includes welcoming and valuing what families contribute to giving the best support.

v)                 Choice

13. Choice means enabling the people we support to have a greater awareness of the range of options available to them, so they can make the choice or decision that is uniquely right for them. This means people are more empowered to make informed decisions, even if these decisions may be considered ‘unwise’ by others.

vi)               Total Communication

14. Total Communication means that all forms of verbal and non-verbal communication are thoroughly explored and embraced for each individual. This includes all body language, facial expressions, gestures, signing, verbalisation, intonation, photographs, drawings and symbols, written words, objects of reference and access to appropriate technology.

vii)             Personalised Technology

15. Personalised technology means any technology which enhances the lives of the people we support. This includes specialist technology such as telecare, environmental controls and prompting devices, as well as mainstream technology such as quick cooling hobs and mobile phone technology.

viii)           Healthy, Safe and Well

16. Healthy, Safe and Well involves all aspects of a person’s life including their physical, mental, emotional, social, cultural and spiritual needs. It is a positive concept and means we will proactively work with each individual to find out what this means for them so we can help them to live more fulfilled lives.

17. This also means that, when necessary, we will support them to take risks to get the lifestyle they want, while also safeguarding them from harm.

ix)               Personal Growth

18. Personal growth means the people we support will be helped to take control of their lives so they can continue to develop as individuals. This includes embracing new skills and knowledge, widening interests and having new experiences. Everyone we support will have the confidence to express their thoughts and ideas, increasing their self-esteem.

Executive Summary

• 19. Social care has become one of the most pressing political issues since the Snap Election of 2017.

• 20. Learning disabilities accounts for over one –third of the total adult social care spend in England. Hft believes that the current government position of fragmenting social care will not result in a sustainable funding solution for the whole sector.

• 21. With the government’s proposed Green Paper and “parallel process of work” on the future funding of social care is designed to open the debate on the future of social care funding

• 22. At the same time, organisations – included several tabloid newspapers – are calling for the abolition of the overseas aid budget, with the NHS and social care being cited as “worthy” recipients of the social care budget.

• 23. However, Hft does not believe that axing the overseas aid budget will help to solve the financial crisis in the social care sector.

• 24. In this submission we outline practical and moral arguments against the axing of the overseas budget to fund social care; including the nuance of the tabloids’ campaigns, the practicalities of axing whole Whitehall departments, the UK Government’s commitment to disabilities, and its continuing obligations under the UN Convention on the Rights of Persons with Disabilities. 

Written Submission

25. This submission to the International Development Committee is based upon a blog post written by Billy Davis, Public Affairs and Policy Manager, published on 28th November 2017[1], and later shared by the Guardian Social Care Network on 6th April 2018[2].

26. The Snap Election of 2017 brought issues relating to the funding of social care to the mainstream. Largely seen as the “single issue which cost Theresa May her majority”[3], issues relating to Conservative Party’s social care policy dominated the news agenda from the fortnight between the policy announcements and Theresa May’s so-called U-Turn on these policies dominating the news agenda until the London Bridge terrorist attacks wiped them from the front pages[4]. An analysis of social media during the general election found that 154,007 tweets containing #DementiaTax or #SocialCare were sent during the election period, making it the eighteenth most discussed topic of the campaign[5].

27. The subject of social care funding even recently found its way into the celebrity glossies; with comedian Ian Lee revealing he was facing the “evil, cruel and nasty….Bushtucker Trials[6]” of I’m A Celebrity: Get Me Out of Here! in order to fund social care support for his mother[7] and actress Amanda Barry claiming she took part in “Britain’s national obsession[8]” Celebrity Big Brother in order to pay for a care home[9].

28. This increased dominance of the issue in the media does not seem to have been met with decisive political action.  It has widely been noted that rather than legislation, the past twenty years has seen plethora of investigations and studies into the sector. This includes two independent commissions, three consultations, two green papers (excluding the planned 2018 green paper), three white papers

and countless reports from the civil sector[10]. We hope that this planned Green Paper and ‘parallel body of work’ on the future funding of the social care sector is the end of consultation and the beginning of concrete action to address the long-term funding of social care.  

29. Although the government’s green paper will focus on elderly care – with the rest of adult social care forming a ‘parallel body of work’ - learning disabilities accounts for approximately one-third of adult social care spend in England[11]. We are the fastest-growing sector in councils’ adult social care spend, with only six of the 151 local authorities in England spent more on care for working-age adults than they did on care for the elderly in 2005, compared to 57 in 2017[12]. Support for adults with learning disabilities is also more costly than elderly care, with CQC noting that in 2014/15 the average cost for nursing care was £552 per week for adults aged 65 and over with physical support needs, compared to £1,119 per week to support adults aged 18 to 64 with a learning disability[13].

30. Given this substantial difference in growth and cost, it is perhaps unsurprising to read that the learning disability sector is operating within a challenging financial climate. According to analysis of a survey conducted by Hft, the number of organisations in the learning disability sector reporting that they are operating at a loss has more than trebled since 2016-17, rising from 11% to 34%[14]. In order to alleviate these cost pressures, 54% have curbed investment in the future of their services (up from 48% in 2016)[15] and 74% will need to do so “in the near future” (up from 50% in 2016)[16].

31. With organisations within the sector stemming losses today by not investing in tomorrow, there are grave concerns over the financial sustainability of the sector.  Social Care is often described as “the classic definition of a monopsony – a market with one buyer and many sellers”[17], with local authorities being the predominant commissioner of care packages within a locality. The Care Act 2014 gives local authorities powers to “encourage quality, choice and sufficiency of provision” within the social care marketplace. The Taxpayer’s Alliance has highlighted how, between 1997-98 and 2017-18, there has been 5514 individual council tax cuts, compared

to 1379 freezes and 366 cuts[18]. CIPFA have warned that 2018-19 will see the highest council tax rises for 14 years[19].

32. Despite these tax rises, and with 80% of councils declaring their intention to make use of the social care precept[20], social care still faces a funding gap of £5bn by 2020. The Local Government Association has also warned that, despite the social care precept set to raise £548m in 2018-19, this will be “wiped out” by the increased costs of paying a rising National Living Wage rate[21].

33. Against such a backdrop, it is unsurprising to see several organisations, and most notably the tabloid press[22][23], launching campaigns calling for either the dropping of the ringfenced commitment of 0.7% of GDP to be spent on Official Development Assistance (ODA), or for the scrapping of the Department for International Development (DfID) altogether. The premise of such campaigns is a fairly simple one; that the foreign aid budget is bloated, ineffectual and safeguarded, and that the money sent abroad would be better spent addressing problems at home. To many, this would be an emotive and compelling argument and, indeed, such campaigns have attracted high-profile support[24] both inside and outside of Westminster.

34. Since February 2016, Hft has run the It Doesn’t Add Up campaign[25], which aims to raise awareness of financial pressures facing the learning disability sector, primarily through unfunded increases in the (otherwise welcome) National Living Wage. With this is mind, it is assumed that we would support such campaigns to increase funding to the sector. However, there are several flaws in these arguments, which we would like to highlight for the committee’s consideration.

35. Firstly, many of these campaigns associate ‘social care’ purely with support for the elderly[26]. In a way, this makes sense: the UK has an ageing population[27], and

so many of these tabloids’ readers will have relatives or loved ones who are elderly and, some day, may themselves need to access support services for the elderly.

Unless one has a learning disability oneself, or knows somebody who has a learning disability, there is sadly not the same ‘human interest’ angle. However, as mentioned previously, learning disabilities accounts for one third of the total adult social care expenditure in England. The sector is also seeing a substantial rise in demand, and increasingly supporting individuals with complex needs and behaviours that challenge[28]. If all of this proposed additional revenue went purely to elderly care, then some of the most vulnerable adults in society would lose the essential support that they need. Any future funding must look holistically at the whole of social care, without grace or favour to any particular sector.

36. Secondly, Hft does not accept the argument that scrapping Department X will instantly solve all of the problems in Department Y. As it stands, all Whitehall Departments are responsible for managing their own budgets, so underspend in one department would not necessarily mean additional money for other departments. Social Care is a portfolio split primarily between two Whitehall Departments – the Ministry for Housing, Communities & Local Government (MHCLG) and the Department of Health and Social Care (DHSC).

37. MHCLG is responsible for managing local authorities, who are the main commissioners of social care in England. Local authority budget cuts and the monopsonic nature of the social care market has led to a decline in the rates being given to organisations to provide social care support.  With margins being squeezed, there is little incentive for organisations to make cost efficiencies, as the savings are not shared between local authorities and providers. Hft believes that a move towards outcomes-based commissioning in social care would help remedy this, incentivising organisations to make cost efficiencies by allowing them to share in the benefits, and invest in future services, resulting in improved health and life outcomes for people supported by the sector.

38. DHSC is responsible for the government’s social care policy. Patchwork integration of health and social care services across the country, along with delays in closing Assessment & Treatment Units, keeps money in the health sector, despite government policies imploring local authorities and NHS Trusts to move people with learning disabilities into a supported living setting. By advancing both the integration of health and social care, and committing to closing the remaining

ATUs, more money would be freed up to invest in social care, rather than ring-fenced in health expenditure.

39. Clearly, then, there are innovations and efficiencies that can be made within the relevant Ministries which could see increased funding routed to the social care sector, and which could be achieved with far greater ease and substantially less upheaval than the complete dismantling and closure of large parts of the Whitehall machinery that would come with closing DfID.

40. Finally, there is a moral argument to be made here. In August 2017 Hft staff members and members of Hft’s Voices to be Heard group, went to Geneva to give evidence to the United Nations [29][30][31] over our concerns that the UK government was failing to fulfil their obligations under the Charter of the Rights of Persons with Disabilities (CRPD). Although Hft was in Geneva to talk about the government’s domestic policies; going forward it is essential that civil society hold the government to account on all of its policies – including foreign aid – if it is to become the “world leader” on disability rights that it claims to be[32]. It would be something of a pyrrhic victory if we secured a better life for adults with learning disabilities in England that came at the expense of the life outcomes for those with learning disabilities overseas.

41. The rights contained within the CRPD are universal. DfID and UK aid have a long history of funding disability projects. In December 2016, Priti Patel, the then Minister for International Development, stated that disability would be a priority for UK Development Aid[33]. Ms Patel’s successor, Penny Mourdant, was previously the Minister for Disabled People, Work and Health[34]. We are pleased to note Ms. Mourdant has continued her predecessor’s commitment to the funding of international disability projects and, most notably, hosting the first ever Global Disability Summit, which will be held in London in July 2018[35]. 

42. Certain swathes of the British media have always portrayed foreign aid in a negative light[36], and we are sure that, for as long as the social care sector remains

at what CQC describes as “at full stretch”[37], certain voices will call for funds from UK Aid to be diverted to social care. Hft will continue to build the case for a sustainable funding future for the social care sector, and we will champion positive solutions. This will, on occasion, mean throwing our weight behind other organisations – as we did by encouraging our supporters to participate in Mencap’s #StopTheSleepInCrisis campaign.  But to throw our weight behind calls to fund social care by scrapping the foreign aid budget? It doesn’t add up!

www.hft.org.uk

Company registered in England No. 734984  Registered charity No. 313069  Patron HRH The Princess Royal             

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