Devolving Care

The devolution of welfare benefits to Scotland, especially those relating to disabled people and carers, provides an opportunity to transform the way Scotland approaches welfare and care policy says Kirstein Rummery. 

Scotland has long maintained that a sense of social justice and fairness is woven deep into the nation’s political DNA. The forthcoming devolution of many welfare benefits for disabled people and carers offers an opportunity to demonstrate its commitment to those principles. If Scots are prepared to learn from the best practice in the world, there is an opportunity to develop an approach to welfare and support for disabled people and carers that is fair, universal, simple and sustainable.

Based on extensive international research, this is what we know about effective benefits that support disabled people and carers:

•       They are holistic and joined up from the perspective of the user;

•       They are designed and run according to a social model of disability, personalised, flexible, and administered by service users themselves;

•       They see long-term and social care services as an investment, not a spend;

•       They are simple, universal, fair – and with transparent criteria and the right to challenge access decisions, and well-supported advocacy services.

The current system of welfare benefits and social care support for disabled people is not fit for purpose. It is extremely complex because welfare benefits have been developed on an ad hoc basis rather than designed to support disabled people to live independently. For example, benefits are meant to meet the additional costs of impairment, not compensate for lost work earnings:  So why separate out benefits for the over and under 65s, and industrial injuries from other kinds of impairment? The costs to disabled people are the same regardless of age or reason for injury. Similarly why should the criteria for accessing services differ between each local authority, giving Scotland 32 different social care systems? This is obviously unfair.

Scotland has two main sources of funding for welfare and care. It already has devolved powers over health and social care and it does not have to follow established patterns of spending in either of these areas. With the Scotland Bill it also will receive new powers over welfare benefits: Attendance Allowance; Disability Living Allowance/Personal Independence Payments; Industrial Injuries Disablement Benefit; Severe Disablement Allowance; and the Regulated Social Fund. If you’re thinking that there must be a simpler, fairer way of doing things, you’d be absolutely right. 

Scotland Funding for Welfare and Care

The devolution of certain benefits offers an opportunity to simplify the existing system from the perspective of the user – in this case, the disabled person. There are two approaches that the Scottish Government might take. The first of these simply improves on the existing provision and might, among other changes, create joined up health and social care budgets for disabled people, older people, mental health service users and learning disabled adults. Scotland has lagged behind the rest of the UK in pulling down the ‘Berlin Wall’ between health and social care and this means the current system is wasting resources – for example by keeping older people in hospital because social care funding cannot be found to arrange support at home.
 
There is also some duplication between, for example, benefits such as Disability Living Allowance and Self-Directed Support (social care) particularly when the latter is taken as a cash sum to purchase support or equipment. The present system of Carers Allowances is also fragmented and unfair: it does not really allow choice and control to be exercised by either carers or disabled people, and it certainly does not adequately support carers who are providing intensive support.
 
At present Scotland is already trying to move funding from acute NHS services into community health services, which can help support people with chronic illnesses and impairments more effectively. Ending the division between health and social care would make it is possible to invest more in preventative social care services. Scotland could use the opportunity offered by the devolution of welfare benefits to combine existing disability benefits and social care budgets into one simple, three-tiered user-controlled benefit reflecting the World Health Organisation’s Instrumental Activities of Daily Living Scale – mild, moderate and severe – which would apply across Scotland and to every disabled person regardless of age. 
 
Users could then chose to take this as a weekly direct payment – to spend on services, support, personal care, informal care, aids etc. – and be assisted by user-run advocacy services both to apply for and manage the payment, or chose to have the payment managed for them by social services departments. This would build on existing best practice in self-directed support whilst making a simpler, fairer, more accessible universal system. It would also open up choice and control to both disabled people and carers and allow them to create flexible systems of support that met their needs and enabled them to participate in society rather than being trapped in poverty and isolation.
 
It sounds fairly simple and the international evidence suggest it could work. But there would be hurdles to be overcome. There would be a need to develop consensus between groups currently using the services effected, carers, and the staff involved.  The approach would also make more sense if the existing devolved payments were supplementary to a Citizens Universal Basic Income comprising other benefits which are currently reserved to Westminster. 
 
However, there is a second, bolder approach. The benefits system has been tweaked, prodded, pushed, pulled, sub-divided and reunited into something so complex as to be burdensome for all concerned, most especially those who depend on it the most. By uniting our approach to welfare and care policy, and placing the user at the heart of an overhauled welfare and care system, Scotland could build a model that places human value rather than bureaucratic inertia uppermost on the political agenda. It could build a care infrastructure that cares. 
 
There is no point having additional powers over welfare if Scotland is not prepared to risk doing things differently. There is compelling international evidence that systems developed from the perspective of the user achieve better health and social care outcomes. By reducing the need for expensive acute services and reducing the bureaucratic cost of managing apparently endless complexity, they are also more cost effective. 
 
Scotland’s political leadership has made much of the idea that it is prepared to do things differently to create a society that is not only more just, but that delivers services in a smart and effective way. If this becomes an exercise in covering over the exiting cracks in the system with a Saltire, it will be a missed opportunity. If, however, Scotland’s political leadership can demonstrate that it is a small country with big ideas, then there is an opportunity to both learn from the rest of the world and act as an example to it.
 

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University of Stirling
10th September 2015

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