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Disabled people in care homes and DLA mobility cuts
3 June 2011
The Guardian’s Amelia Gentleman recently probed the Minister for Disabled People, Maria Miller MP, on the issue of Government plans to cut mobility support for disabled care home residents.
The Minister’s ‘explanation’ of plans is below in the transcript of the interview. But what the Minister neglects to mention is that, under clause 83 of the Welfare Reform Bill currently in Parliament, disabled people living in care homes will not be eligible for the DLA replacement benefit (the Personal Independence Payment; PIP). The current Bill prevents care home residents accessing the PIP.
AG is Amelia Gentleman and MM is Maria Miller:
AG: On the mobility component, I know you've made some reassuring noises on this, but I know there is still considerable anxiety on this.
MM: We had a really important consultation process on DLA, and we had more than 5,500 responses. There was a significant level of concern about how our proposals on the support that was available for people who are residents in care homes and in receipt of DLA, how that would work in the future. As a result of that, I undertook a lot of work to see how we would implement the policy that we had put forward, and that involved going out, speaking to disabled people themselves, and their families. What I found on the ground, was a huge amount of confusion, a lot of overlapping responsibilities, between local authorities, between care homes, between social services, frankly a mess in terms of who was responsible for delivering the support that disabled people rightly expect in terms of their ability to be able to get out and about. What I have made clear from the start is that out policy was never to remove disabled people's ability to get out and about. So we decided to look at how this would work in practice and we are continuing to look at that. What we have decided is that because we are taking extra time to consider that we will not implement the reform measure to remove the disability payment for care home residents in 2012. We will look at care home residents in exactly the same we will look at other recipients of DLA for the reform in 2013.
AG: So it has been postponed by a year?
MM: Well we are going to look at care home residents in exactly the same way as we look at everybody else in terms of what their mobility needs are and then we will take a view from there. What we only ever intended to do with this policy was to do remove the overlap?
AG: When they are assessed for the PIP, their disability will be assessed there, and if they are registered as immobile under the PIP criteria, then they will be eligible?
MM: We are still making sure that we understand what the responsibilities are on the ground for local authorities and for care homes. What I'm seeing quite consistently is perhaps the way this is being dealt with locally is not as it should be. It is not very clear.
It is not very consistent. So what I will not see is a situation where people living in care homes have their mobility removed.
AG: I don't quite understand what's going to happen in 2013.
MM: Well we will look at people who are living in care homes. We will assess whether... Because not everybody in a care home receives DLA, certainly not everybody receives DLA mobility.
AG: The people who are currently receiving DLA mobility...?
MM: Everybody will be dealt with together, so whether you are living in a care home, or not living in a care home, we will look at everybody's needs together. The outstanding issue here is whether or not local authorities and care homes are delivering what they should be delivering for care home residents. The findings that we have would suggest that it is a very inconsistent picture on the ground.
AG: So, I'm still struggling to understand... there will be the PIP payment, under the current system there is be the DLA special mobility payment for residents in care homes...
MM: No it's not separate. Residents in care homes get their funding through a variety of forms. One is through social care packages.
Within the package of support they receive for care homes, there is very clearly an accrual for mobility. Just in the same way some people receive DLA mobility, some people may not receive social services mobility. They may not need it. But there should be an accrual in there if they do need it.
What we have been looking at is how this has been working in each individual area in the country. Sorry this is too much detail... There is a great deal of inconsistency. Primarily, this came out in the Law Commission. Is it the Law Commission? The recent thing that looked at the very complex matrix of law, relating to adult social care. And what they found out is exactly what we found out that the way law has changed over time, it has been an iterative process, it has been layer, upon layer, of different requirements on local authorities for what they provide for people who are in receipt of social care, and this is again what we found with mobility. It's unclear, it's complex and it's inconsistent in the way that it is dealt with on the ground.
I have to say, Amelia, when I have gone out, and I have seen for myself exactly the way care home residents have had very inconsistent experiences of mobility support at a local level, I think there is a real need for that to be looked at, because we are dealing with some of the most vulnerable members of society.
AG: I understand that the situation needs to be looked at because of these inconsistencies. What I don't understand is what is the decision that you've come to.
MM: The decision is very clear – we are not going to change things for care home residents in 2012.
AG: But in 2013?
MM: In 2013 everybody who is in receipt of DLA will have their position reassessed, with a new objective framework, including people in residential care homes. At that point in time, we will make sure that residents who are in care homes continue to receive DLA support if they are not receiving it elsewhere, if they are not receiving support from some other source.
AG: Are you saying that come 2013, it really should be the local authority making these payments, and it really shouldn't be coming under DLA.
MM: I'm not saying that at all. I'm saying whatever the practical reality is at that point in time, that won't be removed. We're still look at what's going on on the ground.
AG: If you are saying that there are inconsistencies, do those inconsistencies relate to the fact that in some places the local authority is providing it, through payments to the care homes, and in other places people are relying on DLA?
MM: Yes
AG: Are you saying that actually the responsibility it the local authority? If you're saying...
MM: I think what I'm saying is that disabled people shouldn't be left experiencing this level of inconsistency, and that we need to make sure that they continue to receive the support if they are not receiving it from anywhere else. It has always been an overlap debate this. It has never been about reducing people's ability to get out and about.
AG: The question that is constantly being put to me, is 'will this payment continue as it is after 2013?' I suppose I don't understand what the answer is.
MM: I have just said, all people in receipt of DLA will be reassessed in 2013, to make sure that they have the right access to mobility support, whether they are care home residents or non-care home residents, that there is a clear and obvious requirement to provide mobility support from both local authorities and care homes, and at the moment we are still looking at how to resolve that issue. But my clear and transparent statement is that we will make sure that disabled people will continue to receive the support that they need, if it's not forthcoming from anywhere else.
The Law Commission said that this is a very very complex area. Well it is absolutely clear that actually DLA cannot be taken into account when you assess somebody's care needs, and it is legislatively dealt with, they can't take that into account. But what I don't want is disabled people being left without the support they need. So that's why I've always been absolutely plain that it's not so much about trying to point fingers as to who is responsible, it's trying to make sure that disabled people continue to get the support that they need.
AG: What's not clear to me is if the process is about ironing out inconsistencies, what you are saying is that after 2013, you think it should be clear to everybody that this is the responsibility of the care home and the local authority
MM: No, I'm not saying that. It is already the responsibility of them...
AG: It will continue to be?
MM: It will continue to be the prime responsibility of the local authority to make sure that there is a care package in place to support somebody. DLA has always been in addition to that. The point of the debate is how much there is overlap there. The theory is very clear, there should [not?] be an overlap. We have found on the ground in practice that the overlap may not be there in all cases.
That's why, what I am saying very clearly, is that it's all about making sure that disabled people continue to retain that ability to live an independent life.
AG: Everybody will be thrilled about that response, are you then saying that if there continue to be inconsistencies, we will just live with that, because that's how the real world is?
MM: I am not very happy at all about the inconsistencies in the way that people in care homes live. I find that really deeply concerning. My first priority is that disabled people continue to have the ability to get out and about and live an independent life.
AG: If someone is in a care home and is using their DLA mobility component to pay for a car that is available to them and them alone to drive to swimming, therapy, external activities.. their concern is that if this shifts to a situation where they have to share a coach, then they won't any longer have the same independence.
MM: the way that DLA is used by people living in care homes, on a day-to-day basis, is incredibly diverse. There will be some people who use it in that way. There are many care homes that make it a condition of being a resident there that you do pool the DLA money. It might be that it is perfectly sensible in certain circumstances that that happens, but my concern is to ensure that there is never any opportunity to make sure that the money is used in any other way than the way it was intended to be used, ie in support of someone assessed to receive it.
DA says: the Minister is right that DLA is used in different ways, by different people, in different care homes. This is viewed as a problem in the context of Government plans to cut DLA expenditure by over £2 billion. But it remains far from clear what the fair, simple and transparent process will be to ensure resources match need and that disabled people remain able to access support.
The Government aims to ‘simplify’ the welfare system but plans appear to include: DLA assessments and provisions for young people (under 16); PIP assessments for people 16-64; Attendance Allowance for people over 65 (as well as some disabled people retaining DLA); and now a new group of disabled care home residents who may be able to access PIP – despite the Bill preventing their eligibility. This is opaque and we will be lobbying for further clarifications as the Bill progresses.
