Sunday, 30 January 2011

Day Care part 2

It seems the writing is on the wall for Day Care in my area. A council document published on the website of a local paper projects a budget saving of £400 000 from 'reviewing' the service which reading between the lines involves reducing demand through a two pronged strategy of individual budgets and tightening up eligibility criteria.

This can probably be achieved as there are probably a fair few people going to Day Centre who strictly speaking wouldn't meet the eligibility criteria as it stands today. I remeber in my time assessing people for this service I had the unenviable task of explaining to a lady why she couldn't have a second day at the Day Centre despite the fact that other people had three days there. Quite simply the bar for the service has been raised year-on-year and Care Managers doing reviews don't like taking services away as this involves potential for conflict with the service user and the risk of getting things wrong not to mention more paperwork. This created a two-tier system where existing service users assessed in more lenient times had their privelages maintained whilst potential new ones had to meet much tougher criteria which often saw people with possibly greater levels of need being turned down for services.

This two-tier nature of the system is bad in itself, but also problematic is what happens to people who now don't now meet the eligibility criteria. Will they be able to obtain the service elsewhere? The answer is probably not, if a person isn't eligible for Day Care under FACS (Fair Access to Care Services)they won't be eligible for an Individual Budget either. Can they obtain the services from the voluntary sector? Possibly however, this depends where a person lives and whether they have the resources to access transport. Groups which do exist tend to meet on a fortnightly basis so will also be unlikely to meet demand. As the service in the area is also currently provided by the Voluntary Sector, but funded on a contract basis by the authourity it is much more likely that the Voluntary Sectors ability to provide good quality Day Care services will collapse.

A reason for the bar being set low for access to Day Care was that, as our senior managers were fond of saying, was what was termed a 'preventative service'. It was seen as a form of early-intervention which would prevent someone needing more services at a later stage. This was clearly logical whether it was giving a carer a break, extending a persons support network, improving someones mood, or just being able to tell when something is wrong Day Care did work in this respect.

Our Head of Service used to bemoan how we had so little to invest in such preventative services and how this undoubtedly increased the costs we had to pay now and in the future. A cycle occoured where less money on prevention meant higher costs and even less for prevention.

Reducing Day Care provision seems to be a leap along this cycle, but even more troubling later in the document is the following passage detailing a planned budget saving of £776 000 across the council. The passage reads:

All voluntary sector contracts which are identified as providing non
statutory preventative services are included and will be ended. The
loss of these services will impact on later costs where early
intervention would have reduced service need. Such cuts may
result in some organisations becoming unviable which will impact
on their use by other areas of the Council and partner

Which all leaves me wondering what happens in the future?

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