Agenda item

Care Charges

This item will look at Care Charges and the impact on people with Learning & Physical Disabilities and their families.


The following will attend:


·  Adult social care officers

·  Carers

·  Southwark Disablement Association – David Stock


The following is provided:


·  A report of meeting between carers and councillors convened by Bede House.

·  A briefing on Care Charges provided by Bede House for councillors

·  An officer briefing / presentation

·  An email from Southwark Disablement Association (SDA)



The chair introduced the Care Charges item by explaining the intention was to particularly look at the impact on people with Learning & Physical Disabilities and their families. 


The background to this item was a meeting between carers and councillors convened by Bede House, and paperwork relating to this event is provided as back ground information


The chair explained that the following will contribute:


·  Pauline O’Hare , Director Adult Social Care


·  Carers, who have received moral support from Mencap to tell their stories.  Alan Burnham will present. He is the brother of a client that has attended Bede House for some years.  Mary Kumar has provided a written statement, which was tabled. She is full-time carer for her adult daughter.


·  Southwark Disablement Association – David Stock, CEO


Pauline O’Hare, Director Adult Social Care


A presentation on Care Charges, provided in advance, was given.


The chair invited questions and the following points were made: 



·  Certain disability related expenditure can be considered, examples of this are  heating if additional warmth needed, scooter charging, extra laundry costs to cover incontinence etc. 


·  Southwark Council adopted a Fairer Contributions Policy in 2015, which outlines the way the Council financially assess recipients of social care services. This was amended by cabinet in early 2020. 


·  Minimum Income Guarantee (MIG) was set prior to the present cost of living crisis and members queried if this is sufficient now.


·  The council spends close to £130m on Adult Social Care of which the budgeted income from charging for service is £8.4m. Members asked if the £8.4 million figure can be broken down to look at the proportion that goes to people of working age and pension age. This officer advised  that she had not been able to do this in preparation for this meeting and she did not know if it was possible but would look into it.


·  Many disabled people are not able to work throughout their adult lives, and therefore do not accrue assets or savings.


·  Some older people have been able to acquire assets, although not all. In some cases income is low, despite assets accumulated. Some people have worked in jobs with no or inadequate pensions. Wealth and income among pensioners is very variable.


·  In response to a question on why some people are charged and others are not the officer clarified this can be a combination of factors including income, if a placement is educational and if the threshold of care is high enough to be funded under the NHS Continuing Care. Social workers do not undertake the financial assessments, this is done by officers tasked with financial assessments.  People can discuss charging with the social worker when being assessed for services, for more detailed information the client affairs finance team will be able to help.


·  There has been a recent increase in resident concerns about Care Charges but it is unclear why this may be so since charges track back to 2015 and later changes made in 2020.  Individuals can be unexpectedly impacted by charges due to changes in their personal circumstances, for example earned income from a job is disregarded, but a pension is not. A small increase in income over the threshold, say of only £5, can lead to a significant  increase in charges.  It is also possible that the cost of living is causing hardship as households have insufficient room to make savings.


·   The Director of Adult Care said that the current focus of government funding streams are to aid hospital discharge, rather than preventative work. The funding window is also very short.  A member referred to recent research from Nuffield which said that less than half of delayed discharge cases are to do with social care, and asked about the local situation. The Director of Social Care agreed that discharge problems are often wrongly assumed to be a social care issue, whereas many relate to  delays within the NHS system. A recent local exercise found only 3-5 out of 33 delayed discharge cases from hospital, related to waiting for a care home placement or double  handed care.  She added that often the acuity of people on discharge is very high,.  People requiring a care home placement now have higher care needs,  are transferred to care homes in ambulances and on stretchers and people  rarely walk in these days.


·  The focus on hospital discharge, diverts resources away from community referrals and across South East London there are over  8000 people waiting for a Community Care assessment.


David Stock CEO, Southwark Disablement Association (SDA)


A verbal presentation was made with reference to an email circulated in advance and the following points made:


The SDA CEO explained that SDA is a user led organisation for deaf people, people with a physical disability, and to a lesser extent some people with mental health and learning disability.  SDA also provide home care.


He explained that Care Charges are often perceived as a form of additional tax by disabled people, nevertheless he understood the financial pressures the council were under. He suggested that the council consider raising additional money through the social care precept on council tax.


Just prior to the pandemic there was a lot of consultation on changes to Fairer Contributions Policy, which he reported went to cabinet in 2020. The assessments were done based on the living costs at that time, prior to the cost of living crisis and large rises in energy and food prices, which have hit disabled people particularly hard. He said Southwark already add 25% to the Minimum Income Guarantee and proposed that this was now increased to 50%.


There was recent a Equality Impact Assessment done as part of the budget process and this showed that disabled people were very negatively impacted by the cost of living crisis and he suggested this is  examined.


The government had proposed to raise the capital saving limit on pensioners to £100,000, however this has been postponed to 2025 , and he asked if it would be possible for Southwark to implement  this locally as it would offer some protection to pensioners who are capital rich but income poor.


He reinforced the positive impact of money earned from paid employment being disregarded during the financial assessment but income from employment related pensions being unfairly included.


The chair then invited comments and the following points were made:


·  The Director of Social Care was asked about the possibility of raising the Minimum Income Guarantee by 50% and if there had been an impact assessment. She reported that the finance team look at the individual needs and circumstances of each case as part of the financial assessment process. 


·  Regarding pressure on social care providers, the SDA CEO said that home carers are paid London Living Wage plus transport costs by SDA but employees can still decide they are financially better off working on supermarket checkouts, even if this is less rewarding work, so he said that it is important to look after the staff both financially as well as through good management.


Alan Burnham, a carer for his brother, presented


Alan spoke about his brother, Lesley. He said since the passing of their mother the family rallied around. The sister provides most day to day support. His brother had a personal care package but this has been gradually withdrawn. As part of package he attends Bede House and Surrey Docks Farm, which get him out of home.


His sister is getting older, she is 76, and so travelling from a neighbouring borough and providing regular care is becoming increasingly difficult. 


When Lesley received his pension he got a bill in excess of £470 per month, which has to be found from his pension and disability living allowance.  The charges went from £0 to £470 per month. The family do not know how to meet these expenses, and are disappointed and frustrated with the situation.


The sister does all the cooking, cleaning and check-ups.  He explained that because of his brothers learning disability foods which are easy to prepare are provided, and these have extra costs. The additional costs associated with his care have not been considered.


The chair thanked Alan for his presentation and invited questions. The following points were made: 



·  Members asked about financial assessment process and Alan said he was unable to speak with officers in the council about this. The family provided lots of information but have not heard back. His sister as the main carer was told she cannot claim back costs related to her expenses as carer, such as transport and providing a special diet.


·  Members queried if the expenses, such as diet were Disability Related Expenditure. Director of Adult Social explained that specific dietary requirements are considered as part of  offered to look into this and double check the assessment process.


·  Members asked if the sister had had a carer assessment, and clarified that here assessment would be done by the borough the person she cared for resided, rather than the borough she resided.




The commission resolved to write a short report to cabinet with the following recommendations:


·  Raise the Minimum Income Guarantee to 50% from 25%, and provide an impact assessment to understand cost to the council and benefit to disabled people and carers.


·  Take steps to reduce the adverse impact of care contributions on the incomes of people reaching pension age, both disabled people and their carers. In particular take action to mitigate the steep increases that can be incurred once a) a disabled person reaches pension age and their employment related pension becomes assessed b) carers facing reductions in income as they reach pension age and lose Care Allowances and income from paid work.


·  Cabinet revisit the Fairer Contributions Policy Cabinet agreed in 2015, and revised in 2020.

Officers to provide:


·  A breakdown of the £8.4 million received through care charges by cohort, including working age and pension age, including a breakdown of the amount of money received in income for each year between 2015 and 2022


·  Information and support available to enable disabled people and carers to understand Care Charges and Disability Related Expenditure.



Supporting documents: