Resource Allocation Systems on Trial

How are direct payments, personal budgets and resources allocated in adult social care? I’ve been working in this field for many years at the front line and couldn’t tell you. Fortunately, the courts are shedding some light, albeit foggy, on the matter.

This morning I came across this blogpost on the Guardian website. It mentions the case of R(KM) v Cambridgeshire County Council which will be heard by the Supreme Court on appeal next week.

I read through the previous judgement which is being appealed and would recommend it to anyone involved in adult social care in England.

While the previous judgement found that according to the Kensington and Gloucestershire rulings, local authorities could take resources into account when extending services to those in need without their bounds and remain within the National Assistance Act (1948), the Chronically Sick and Disabled Persons Act (1970) and the NHS and Community Care Act (1990) to assess and provide services, the method of developing non-transparent ‘resource allocation systems’ (AKA RAS) was criticised heavily.

KM is a 26 year old man ‘with a range of serious physical and mental disabilities. He was born with no eyes or optic nerves, has learning difficulties and an autistic spectrum disorder’

KM in the case above was assessed by Cambridgeshire as needing direct payments to the value of £84,678 to meet his assessed needs. Eventually.

In 2009 KM was assessed under the RAS in place (plus discretionary ‘top up) as needing £67,206. The judgement well explains the torturous process of the the arrival at the figure.

The judgement tries to explain as succinctly as possible.

Points are attributed for various aspects of need and an amount for payment thus arrived at. The maximum number of points on the scale is 55 for which the maximum annual payment is £61,000. The synthesis does not include amounts paid to those few people in Cambridgeshire with very serious and therefore very expensive needs. If, as in KM’s case, an eligible person is assessed to have needs beyond the top of the scale, an addition to the £61,000 is assessed to reach the total. This assessed addition is referred to as an “Upper Banding Calculator”, which gives it a somewhat misleading impression of accuracy. As will be seen, the assessed addition is an accurate calculation of what it is, but the £61,000 to which it is added cannot be directly related mathematically to the assessed addition

The initial legal challenge was launched by KM’s family on his behalf when this £67,206 appeared to be ‘arbitrary’ as his needs had not changed since 2006 when he was assessed and received the higher payment.

An independent social worker was engaged to carry out an assessment. He concluded the total cost to support KM adequately was £157,060.

And so mediation was launched whereby the figure of £84, 678 was reached. KM’s solicitors wanted to clarify how this figure had been reached and Cambridgeshire had difficulty responding adequately until six months after first requested.

The court found in Cambridgeshire’s favour (hence the current appeal to the Supreme Court).  The figure of £84,678 was eventually explained by Cambridgeshire through a somewhat torturous and lengthy route and the established principle of local authorities having finite resources was accepted.

The court found that Cambridgeshire had a somewhat arbitrary was of establishing care costs above the ‘upper limit’ of their RAS however they were able to explain it.

It will be interesting to follow this case through the High Court. The RAS has not come out of it well and quite rightly.

The ethos behind personal budgets, whether delivered by direct payments or managed budgets was (in my understanding) supposed to be clarity but the RAS seems to be used to mask openness. This is an issue which must be addressed by those who push out personalisation. Everyone needs to know how budgets are arrived at.

The other concerning thing about this case is that the higher figure of £84, 678 for support of KM as opposed to the original offer of £67,206 was only reached because KM’s family took this to court and an independent assessment was requested.

What does this way about protections within our systems for people without family or strong advocacy support?  I worry that we are further moving down the path of allowing those who don’t complain or shout about the injustices in the systems to receive poorer care than those who are able to.

The appeal was won but the systems don’t come out showered in credit. We need to make these systems better. There is much talk in government about ‘fairness’. Let’s try and make social care fairer for everyone, not only those who are able to fight.

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One thought on “Resource Allocation Systems on Trial

  1. Pingback: Changing Adult Social Care – The Select Committee Reports « The Not So Big Society

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