June saw yet another barrage of criticism against the social care sector with the publication of CQC’s report into learning disability services. The report was published at a time of growing conventional wisdom that people will be better off when they are moved out of large residential settings to smaller supported housing settings. This is the product of a range of factors. Partly, it is the commendable notion that people should be treated as individuals and should be helped towards living as dignified and independent lives as possible.
There are, however, less laudable reasons for the trend. There is a general assumption among policy makers that separating accommodation and care is a cheaper option because it allows for greater competition. It is fair to say that in many (but by no means all) cases, that is a fair assumption. It is unsurprising, therefore, that local authorities have had explicit targets to meet on moving people from residential care to supported housing which influences their grant. Social Services departments have also been incentivised by the allocation of Supporting People funding and the fact that the accommodation element is not paid by the Social Services and is often paid by housing benefit, most of which derives from central funding. Residential providers have therefore faced pressures to de-register their services for some time.
Contrary to the conventional wisdom, however, the trend is not always in the interests of service users.
It is easy to forget that the Panorama documentary came about in the first place only because of a whistle-blower’s frustration at his concerns being ignored by CQC itself. With that in mind, it is worth taking a moment to consider what protection service users would be afforded if there was no regulation at all. That will often be the case where service users are moved from moderate sized care homes (which will be subject to registration if personal care is provided to just one person) to smaller, supported living units. In supported living, if the service user does not receive personal care, the community services received will be entirely unregulated. Even if personal care is provided, the accommodation is regarded as the person’s own home and so is not subject to CQC regulation. The personal care offered will be subject to registration, but it is rather more difficult to assess quality when there is no right of access to the premises where it is being provided. If service users cannot be protected in heavily regulated residential homes, it is doubtful in the extreme that they would fare better in the far less regulated supported housing sector.
Moreover, many service users will receive nowhere near as much care and support is supported housing as they will in residential care, and the move is made in the interests of meeting targets and reducing costs rather than considering the best interests of service users.
Providers who face such pressures can help their residents to challenge any such decisions. Service users have the right to choose their accommodation and have statutory rights under the Human Rights Act and the Mental Capacity Act 2005. It is easy for local authorities to ignore service providers when they object to their residents being moved. It is rather harder for local authorities to ignore residents supported by their own independent lawyers. We have worked with a range of law firms who have successfully acted for residents on such occasions, financed by legal aid. Providers who are concerned that ‘person-centred care’ is being paid lip service to and that residents are being bullied into inappropriate services should not hesitate to help them.