THIS month the King's Fund and Nuffield Trust published a report called 'Home Truths'.

The report comments on the state of social care for older people in England.

It is not very positive reading.

The headlines include: • Home care services are in a critical condition everywhere and large scale care provider failure is now a matter of 'when' not 'if'.

• Access to care depends increasingly on what people can afford, and where they live, rather than on what they need.

• Under-investment threatens to undermine the ability to keep people independent and out of residential care.

• The ability to achieve more within existing resources is very limited and Council’s will struggle to meet basic statutory duties.

The report states:

"If the government is unwilling to provide adequate public funding to support the current system it must be honest with the public about what they can expect from publicly funded services. This would mean establishing a fresh and more explicit policy framework, which makes it clear that primary responsibility for funding care sits with individuals and their families, creating incentives for people to plan ahead for their care needs and revisiting some of the new duties and rights created by the Care Act 2014 so that expectations are aligned more realistically with what the government is prepared to fund and local authorities can afford."

Over the last two years I have seen a change in the way people are assessed and in the way assistance is provided to meet their needs.

When the Care Act was introduced the expectation was that a consistent assessment process would be delivered and that people would receive personalised, integrated support.

We hoped that the importance of unpaid carers would be recognised.

Carers were promised help to perform the role and to balance it with a life independent of that responsibility.

Initiatives were taken to pool funds and ensure that the NHS and Local Authorities worked more closely together to generate more positive outcomes for families.

The clients I see across the South West suggest that reality matches the 'Home Truths' report rather than the aspirations we had in 2014.

What’s the Reality in the South West?

• It is more likely than not that you will not be assessed for Continuing Healthcare funding (CHC) when you leave hospital for another care setting. If you are eligible for CHC, the NHS should meet the costs of providing your care.

• You may receive short-term funding from the NHS to encourage you to leave the hospital setting. However, if you are self-funding that support can be withdrawn without a re-assessme

nt of needs and without any alternative arrangements being put in place.

• If you return home and have assets with a value of less than £14,250, the Local Authority is likely to offer a maximum of four visits from a carer per day. Those visits will usually last between 15 and 30 minutes.

• If you want to continue to live at home, the Local Authority may limit their contribution to the cost of residential care. You may be offered a 'Direct Payment' for the equivalent cost of a residential placement. You will be expected to arrange your own care and make up any funding shortfall. This may well force you into residential care.

• You may be discouraged from requesting a CHC assessment (via a 'Decision Support Tool' - DST). If a full assessment is performed there will probably be a long delay.

• You may not be given a copy of the DST and/or it may not reflect the discussion at the assessment meeting. Levels of need may have been reduced following the meeting. The assessment may focus on evidence of 'positives' and understate 'negatives'.

• There may be a long delay before the DST is put before the CCG for a decision. If the DST recommends eligibility the CCG may well substitute their own (reduced) ratings for the areas of need and refuse funding.

• You may die before eligibility for CHC is finalised. In the meantime you will have to fund/arrange your own care or cope with the support you can obtain from the Local Authority, relatives and friends. If you do not have a network of free support or the money to fund care while this process is conducted your needs may well be unmet.

These features demonstrate, in practical terms, how the problems surrounding funding are coming to affect the experience of people needing care and their families.

If they sound familiar then you should seek support to ensure that your needs are recognised, assessed and addressed in a way that is compliant with the statutory obligations placed upon Local Authorities and the NHS.

If you are unable to afford the services of a solicitor or other paid support you can contact 'Swan Advocacy' who are a free advocacy service supporting citizens of Somerset.

You can reach them on 0333 447928.