Older couple in Cutty Sark Gardens

SPECIAL INVESTIGATION: Controversial cuts to adult social care in Greenwich have left some of the borough’s most vulnerable people worried about their futures – and raised questions about where government money is going. YOHANNES LOWE reports.

As a former fitness instructor, exercise has always been important to Sarah*, but her daily walking routine gained special significance during the coronavirus lockdowns.

Leaving her house every day at 8.30am, she would head towards Eltham High Street, relishing the fresh air as she paced beside the passing traffic.

Two recent falls, however, have reminded the 78-year-old great-grandmother of the limits of her body, and of the reality of growing older away from her immediate family.

Back problems are making her movement increasingly difficult and rheumatoid arthritis compounds the sudden joint pains that come in bursts.

“Both accidents were around May. One time I fell over in the bathroom when I lifted my foot up to wash myself but lost my balance and fell over,” said Sarah. Her two children, aged 56 and 63, live outside London.

“The other one was when I went towards the bed and fell over after I caught my toe. I have really bad back problems, so I just lay there and thought, ‘Oh my God, what am I going to do?’ I was frightened more than anything.”

“Even though I am often in a lot of pain, I try to do as much as I can for myself because I do not want to burden other people,” she added.

Fearing her health is deteriorating, Sarah wishes she could afford Telecare, a remote support system for elderly or vulnerable adults which enables them to continue living independently at home.

It offers intercom systems and personal alarms, which can be activated if the wearer suffers a fall, feels unwell or just needs some friendly reassurance. Sarah used to use it until last year.

“When you have Telecare, you feel safer. There is always someone on the end of the phone who you can get in touch with if you fall or can give you advice. It makes you feel better,” she explained.

Social care cuts protest
There were protests against the cuts last February

‘£30 is a lot of money when you have a pension’

The service used to be free for Sarah. But last September she became unable to afford a new weekly £6 charge brought in under a package of controversial adult social care changes by Greenwich council.

Before the charges were introduced, residents who claimed housing benefit were not charged at all for the Telecare alarm and pendant, or for bed or chair sensors. Now many of these people say they can’t afford the fee.

“All of a sudden, the charges came in – about £30 a month. That is a lot of money when you have a pension. I have had to give it back,” Sarah said. She already has to pay for a carer to help with heavy lifting.

Sarah’s comments chime with the experiences of other service users who feel their needs were not considered when Greenwich introduced higher fees for Telecare and other adult social care support.

Other changes included the removal of the cap on weekly care charges for those living at home, new charges for tenants in supported accommodation, and the end of “meals on wheels” deliveries.

New charges for community support – such as to help users attend daytime activities – were also brought in.

At the start of January 2020 – weeks before the changes were unanimously voted through by the council’s cabinet – activists warned that the cuts would drive some of the borough’s most vulnerable residents to depression and potentially suicide.

One resident, Fred Williams, said in a statement read to the cabinet before the vote: “How does it feel like being a murderer? The stress will lead to some people killing themselves. The responsibility for that lies firmly on your doorstep, whether you like it or not, that in my eyes makes you all murderers.”

Council leader Danny Thorpe insisted that having a panel of councillors scrutinise the extra charges before they went to cabinet would help lessen their impact.

But there has been confusion over the whole process, both inside and outside the town hall.

Older woman looking out of a window

‘Some have huge bills they can’t afford’

Some 18 months after the vote, following a Freedom of Information (FOI) request by Greenwich Disabled People Against Cuts (Greenwich DPAC), the council said it had not carried out an equality impact assessment (EIA) of the Telecare changes – a check designed to ensure certain groups are not discriminated against.

Two months later, when asked by 853 about why an assessment was not carried out, the council said that one was actually undertaken.

853 has now seen the assessment, which was carried out as part of a broader study into social care charges. There are numerous recommendations – such as making policy information more accessible and ensuring there is greater support for financial assessment.

Campaigners, however, say that Telecare staff are unaware of these suggestions, leaving vulnerable residents with patchy service provision.

“No staff in Telecare seem to know about implementing the EIA,” said Anne Novis, a disability rights advocate from Greenwich DPAC. She has worked with vulnerable service users affected by the cuts and surveyed Telecare users about their experiences.

“This has led to an unequal service with no monitoring or clear information for clients. It has left some people getting the service for free and others with huge bills they cannot afford.”

As of July 2021, some 15 percent of the 3,513 Telecare users had asked for their service to be withdrawn, according to information received by Greenwich DPAC under FOI laws.

Charges ‘came as a shock’

Patricia Newson, from Woolwich, is one of those who asked the council to end her Telecare service.

The 67-year-old is a full-time carer to her husband Michael, who suffers from a range of health problems, including osteoarthritis and spondylitis – an inflammation of the spine which causes him severe back pain.

Michael, a former builder, has had two hip replacements and spine operations, so needs a frame to help him around their ground-floor council flat.

Before the charge was brought in, the couple say they had free access to Telecare, with an emergency call button attached to Michael’s wristband so he could ring for help if Patricia was out. The charges seemingly came out of the blue.

“We got a letter from the council stating they wanted £176.30 from us for Telecare charges billed between September 7, 2020 and March 31, 2021,” Patricia said.

“This was a shock to us because we were not notified of any of the changes to Telecare. Not a warning, nothing.”

“We are two old age pensioners with only a state pension to support us. How can we afford this?”

Greenwich Council said it had written to all Telecare recipients to tell them that the fees were being introduced and that it had offered financial support to those in need.

The Labour-run council had raised £276,537 from additional Telecare invoices between September 2020 and May 2021, a 50 per cent increase from an estimated £183,215 in the same period the previous year under the old charging system.

It insisted that the changes were not introduced to make a profit, saying the additional charges cover the cost of running the service and bring Greenwich into line with other local authorities.

Greenwich cabinet meeting, October 2019
Activists tried in vain to stop the council from implementing the cuts

‘They are an easy target’

Greenwich is not alone in cutting care packages while increasing charges, having suffered from government austerity cuts over the past decade.

As an ageing population drives up demand, councils have increasingly had to ration care with fewer resources, leaving many people relying on unpaid help from family and friends instead.

The additional costs of the Covid-19 pandemic – personal protective equipment, covering staff absences and supporting shielding residents – made the situation worse.

In March, a National Audit Office report found that 41 per cent of councils with social care responsibility said they needed to make “substantial” savings to their budgets.

“Councils have a tough political choice whether to charge disabled people and older people – many of whom are on low incomes – for social care services or not,” said Jon Abrams, the campaign co-ordinator at Inclusion London, a charity promoting deaf and disabled people’s rights.

“But apart from Hammersmith and Fulham – who scrapped charges – councils across England have taken up the option to charge them. Moreover, in recent months, evidence has emerged that councils are increasing them.

“The groups of people who are paying charges are often politically voiceless. Many may not be able to campaign for various reasons. Politically, they are an easy target.”

Couple with walking frame

‘I feel like I have no choice’

Users of Greenwich Telecare contacted by 853 felt powerless to challenge the new charges. Some felt as if they had no choice but to cut costs in other areas in order to continue paying for a potentially life-saving service.

Bettie* and her son, Andrew*, both heavily rely on Telecare.

During the summer, Bettie, who has mobility issues, fell down the stairs. Not too long before that, Andrew broke his foot when he stepped into the garden from the kitchen. Due to their vulnerability, the key safe outside their home – which contains keys to the house in case Telecare staff or paramedics need them – is vital.

“I have to pay £28.99 per month for me and my son for the actual alarm to be answered. By the grace of God, I am lucky to have not ended up in hospital because of my falls,” Bettie said.

“I can’t guarantee how long I will be able to afford it for. There is no other competition or cheaper options so I feel like I have no choice at the moment.”

Despite now having to pay for the service, Bettie says that responses from the council’s Telecare team have worsened since the charges were introduced, as she frequently experiences long waits.

Greenwich Council said: “Our Telecare service continues to exceed industry-standard response rates. We currently answer 98.5% of all alarm activations within one minute (industry standard is 97.5%) and – where a physical response is needed – we attend 94.3% of all visits within 45 minutes (industry standard is 80%).

“Despite difficulties posed by the Covid-19 pandemic, we have continued to surpass these key performance indicators.”

Anne Novis
Anne Novis was given an MBE for her work representing disabled people

‘Stop treating us like accountants’

Campaigners say that staff cutbacks are contributing to a poorer service that users are paying more to use.

They have also raised concerns that the increasingly complex social care system, coupled with sluggish council responses, has meant many service users are becoming more reliant on groups like Greenwich DPAC to inform them of their rights.

Groups picking up this work say that the assessments social care users have to endure every year can be overwhelming, confusing and can further isolate those with limited digital skills or internet access.

“The council is putting these onerous procedures on us and increasing costs. They need to have a more realistic expectation of us as service users, instead of treating us like accountants,” Novis said.

“When they increased the charges, many people said they did not receive information about how much they would have to pay and when the payments would start.

“They informed users on the website, but not everyone uses the internet like that.”

A case in point, she argues, is the care charges hardship policy, which allows residents who fear they will suffer under increased charges to ask for a review of their financial assessment – which could result in a cut in fees.

Novis, who received an MBE ten years ago in recognition of her work, says the hardship policy has not been sent out or properly publicised, meaning some people could be paying more for care then they should be.

“The council has said it is not keeping records of how they use the hardship fund, or how many people it is being supplied to,” she said.

“One staff member could decide one day the person has to pay for care charges, but then another day a different member of staff could decide something else.

“What sort of discrimination is going on- who is and who is not getting it for free? They are not giving us any policy details, so we don’t know.”

A spokesperson for Greenwich Council told 853 the process was outlined on its website but that it hadn’t “provided residents with the full hardship policy simply because it is very long”.

The council said it carried out an EIA on social care charging, wrote to all Telecare recipients individually to advise them on how the fees were going to be implemented and offered financial support to those in need.

“Telecare clients who asked for their service to be withdrawn have had an assessment carried out to ensure that they are not at risk due to having the service removed,” the spokesperson added.

Greenwich CCG letter
Greenwich CCG raised concerns in January 2019

‘This is a very serious situation’

There are also questions over how the council handled money handed over by central government specifically for social care.

The Better Care Fund (BCF) was set up in 2015 to encourage collaboration between councils and clinical commissioning groups (CCGs), who plan and commission local health services. The legislation requires health budgets to be shared between them.

Two years later, the Improved Better Care Fund (iBCF) was added to the BCF. This was paid directly to councils with the provision that it must be spent on adult social care.

This money – which totalled £25m in 2019/20 for Greenwich – was intended to support vulnerable adults.

But council documents, seen by 853, suggest that in 2019/20, and going against explicit government guidance, about £21.3m out of the £25m was not allocated to adult social care. Instead, it was taken into the council’s general fund.

Greenwich CCG raised concerns about the handling of the BCF and iBCF contributions in January 2019. It said it was worried the council was using some of the ring-fenced money to support cuts.

“This is a very serious situation, and we may invite our auditors to review this,” a letter addressed to the council’s director of finance read.

The following month, another letter – also seen by 853 – claimed that funds had been “nominally ‘put in’ and then ‘taken out’ as savings”.

Letter from Greenwich CCG
Greenwich CCG restated its concerns in February 2019

Appearing increasingly anxious about possible grant misallocations, the CCG sought assurances that the savings had not temporarily been put into the adult social care pot, only to then be transferred to a central fund to address what it called a “perceived” council overspend.

‘Savings target’

The CCG’s accusation has been supported by a source with knowledge of council decision-making at the time, who pointed to a four-year council financial strategy published in January 2016, which shows “new funding for adult social care” – including £11.7m from the iBCF – being offset against items such as street cleaning and cuts in other government funding.

Funding for adult social care (ASC) can be seeing going into the general fund in this extract from the 2016 medium-term financial strategy

In December 2018, a meeting of the council’s budget recovery board – a group of senior councillors and council officers – discussed how £21.3m of BCF and iBCF money was not being made available for adult social care.

Despite the budget recovery board meeting involving significant public spending decisions, the council refused to release the minutes when Greenwich DPAC submitted an FOI request in January 2020. It claimed that disclosure would hinder councillors’ ability to have frank conversations about the information contained in the minutes.

But 853 has now seen the minutes of this meeting. They show that Debbie Warren, the council’s chief executive, gave a presentation which said that “in practice, the £13m iBCF was used to cover this savings target”.

Budget Recovery Board minutes

Greenwich Council told 853 that this £13m figure related to a “transformation” programme in the adult social care department which dated from 2015, before the iBCF was introduced. A response to an earlier FOI request stated that no BCF or iBCF money had been used to meet adult social care savings targets.

A spokesperson added: “While adult social care funding is spent from the general fund, both BCF and iBCF funding are applied to adults’ resources for use on adult social care. Use of funding grants are signed off jointly, with integrated commissioning across the council and the CCG.

“The Royal Borough of Greenwich and Greenwich CCG have worked, and continue to work, closely together in the delivery of services to residents. The CCG is content with arrangements and the council’s accounts are signed off by the independent external auditor.” (See the full response from Greenwich Council.)

NHS South East London CCG, which took over Greenwich CCG in April 2020, said: “The concerns regarding the Better Care Fund were resolved in April 2019.”

It declined to elaborate on how the concerns were resolved.

The Department for Levelling Up, Housing and Communities, which distributes the grants to councils, declined to comment when approached by 853.

Older lady walking in the street

‘Smoke and mirrors hide the truth’

Campaigners are angered that money meant for social care could have been allocated elsewhere, and accuse the council of dodging questions about the hardship policy and what has happened to the money. They say it is just another example of the poor treatment of care recipients.

“I feel a great betrayal of trust by Greenwich Council about the way funding which was meant for social care has gone into the general pot,” Novis said.

“The whole reason and justification for increasing care charges was lack of funds.

“How can we trust people when smoke and mirrors hide the truth? Yet these are the people our very lives depend upon.”

All of Greenwich’s council tax payers have been hit by the crisis in social care funding.

Council tax bill
All council tax payers contribute towards a social care precept

In April, to compensate for falls in government funding, Greenwich imposed a 5 per cent council tax rise, which included a 3 per cent increase for adult social care. This element appears as a separate item on Greenwich council tax bills – something campaigners say leads to residents blaming disabled people for the increase.

Campaigners warn that, along with the tax hit, further misery could be heaped on the most vulnerable this winter with soaring energy bills and universal credit cuts.

“Care charging policies already severely restrict the amount that people are able to spend on basic costs – the rocketing costs of food, energy and transport multiplies the hardship,” said Jenny Hurst, a Greenwich DPAC steering committee member.

“Disabled people are again contacting our organisation saying they are being targeted as the cause of the country’s financial problems.”

Eleanor Lisney, one of the group’s co-founders, added: “I don’t think many of us look forward to the future when the threat of continuing harsh cuts remains.”

5.10pm update: A Greenwich Council spokesperson added after this story was published: “The council reaffirms its previous response on this matter which was supplied to 853 on 15 October 2021.

“It would not be appropriate for the council to make any further comment as this matter is the subject of ongoing court proceedings in the Employment Tribunal. The same applies to any other party involved in the proceedings.”

*Some names have been changed to protect people’s identities.

Original reporting by YOHANNES LOWE, illustrations by DANNY NOBLE.

This special investigation into adult social care in Greenwich has been funded by Trust for London, in conjunction with The Centre for Investigative Journalism.

This story is © 2021 Flyover Media. No reuse without our express permission.