Over the Christmas period, I missed the government consultation on bereavement benefits, but you’ve got until 12^th March to reply. And there’s lots of useful info in the consultation document.

There are three bereavement benefits currently payable:

Bereavement Payment – a one-off tax-free payment of £2,000 payable to someone after their wife, husband or civil partner has died.

Bereavement Allowance – a taxable weekly benefit which can be paid to someone for up to 52 weeks from the date of death of their wife, husband or civil partner if they are over 45 and under State Pension age.

Widowed Parent’s Allowance – a taxable weekly benefit which may be payable to a parent whose husband, wife or civil partner has died if they have at least one child for whom they receive Child Benefit. It is payable until the claimant reaches State Pension age or upon cohabiting or remarriage/formation of civil partnership.

So that’s basically a cash sum to pay for the funeral and other expenses at the time, a weekly allowance for re-adjustment immediately after the death of a partner and then an extra payment if you are responsible for a child. The government’s position is that it’s too complicated and, playing their current relooping Mpeg (this is the new form of a cracked record – who has records any longer? Do young people know that they could get cracks?), it disconnects people from the employment market, so bereaved people are not incentivised to get back into work (which of course would be good for them and save the government money).

The first aim of their proposed reforms are that people should be supported by normal income support, rather than special measures for bereaved people, so they want to have a bigger up-front  bereavement payment for the transitional period. This of course will push all bereaved people sooner rather than later into the standard ‘get work or else’ approach of the present government. There is a whole paragraph about the ‘lack of conditionality’, which means there’s no requirement to seek employment as a condition of getting the benefit. I imagine people did not think about that back in the 20s when widows benefits were first thought of. I don’t know how I feel about it now: on the one hand I recognise that most women as well as men who are bereaved now do go out to work and want to do so, and tying them into help and encouragement to move forward into work is useful. On the other hand, making it a condition of a benefit has a harsh feeling about it that naïf old me sort of feels I don’t want to be part of our welfare state.

They want to remove the age criterion (civil servants are now so illiterate, they don’t know the singular of criteria, but I do) and comment that the combination of the age limit and different contribution requirements for the longer-term benefits means…

that around 80 per cent of Bereavement Allowance recipients and 46 per cent of Widowed Parent’s Allowance recipients do not receive the maximum payment.

As a result they suffer from greater uncertainty, which is bad when they are already suffering from the ‘loss of control’ in bereavement and emotional turmoil which means they don’t take in how the benefits are calculated. Alongside the ‘conditionality’ approach, I find this claimed concern with people’s feelings a bit hard to believe; it feels out of place in the generally callous style of the text. Perhaps they should give their consultations to social workers to vet for niceness, as well as the Plain English people for readability. Or perhaps they don’t feel social workers are nice enough nowadays to make a difference.

Then, as we know, there is a plan to have a universal benefit the same for everyone, to simplify the system, and the aim will be to have bereavement benefits alongside this. So most regular provision will be from the universal benefit, if you are eligible for it. However, they did research which shows that most people suffer a period of disruption in the immediate aftermath of bereavement and are proposing to target these benefits there.

There are two options they are consulting on:

1                    Pay an increased lump sum payment in the region of £6,000 for all claimants without dependent children and £10,000 for claimants with dependent children

2                    Pay a lump sum in the region of £3,000 and a monthly allowance of £250 for a period of 1 year for recipients without dependent children; and a lump sum in the region of £5,000 and a monthly allowance of £400 for a period of 1 year for recipients with dependent children.

Obviously option 1 would be quick and easy, while option two would maintain the security of a sense of support for a longer (but not too long) period. The sums proposed seem decent and realistic.

They are also consulting about whether to simplify the contribution requirements to whether the deceased partner contributed for the tax year before the death; the problem with this is that if they were palliative care patients they would have been ill, so they might well not have made those contributions so close to the date. Another option is to remove the remarriage disentitlement, on the grounds that they would not be paying the benefits for very long and it is unlikely that most people will be ready to partner up again, so they simplify the arrangements (and reduce civil servant time and the length of application forms) – always a good thing. This of course would generally be true, although I’m sure any palliative care social worker can tell you about the widows, or more often widowers, who have lined up the replacement partner well before the death. Perhaps even the DWP doesn’t have the life experience to be aware of that sort of thing.

Department of Work and Pensions (2011) Public consultation: Bereavement Benefit for the 21st Century. (Cm 8221) London: TSO.

The consultation document on the web: http://www.dwp.gov.uk/docs/bereavement-benefit.pdf

A little while ago I posted about a evening experience with an organisation for homeless people in Bratislava, Slovakia. One of the young men I went out with that evening recently emailed a comment about homeless people dying on the streets: how little you can do, and how someone may die unexpectedly. Even though you provide all the care you can, people are still at a high risk of ill-health and death if they are homeless.

The National End-of-life Care Programme in the UK publishes a very good guide to good quality end-of-life care for homeless people; it mainly refers to hostels, but covers broader issues as well. You can get this on the internet:

http://www.endoflifecareforadults.nhs.uk/assets/downloads/RTS_Homeless___Final_draft___20101211.pdf

National End of Life Care Programme (2010) End of Life Care: Achieving Quality in Hostels and for Homeless People – a route to success. London: Department of Health.

Among the suggestions are getting homeless people to do some advance care planning, so that their wishes are known if they are found dead, and finding a way of memorialising their lives in a place that was important to them. A memorial event may allow people who knew them and staff in hostels or homelessness projects to deal with some of the upset they feel, having often tried so hard to help.

Volunteers working in homeless need training in helping people who are affected by families and friends of homeless people who die.

Projects also need to think about how they deal with reactions to people dying: openness if usually the best policy.

I said a couple of days ago that we need to think about palliative care for homeless people, and now see in the recent NCPC magazine Inside Palliative Care a feature about a St Mungos/ Marie Curie collaboration to do just that. Power to their elbow.

You’ll have seen all the flurry about the housing benefit changes, which may well lead to heavy losses in benefit for people occupying housing in expensive areas of the country, and average losses of £12.00 a week.  Palliative care and other social care colleagues might, however, have missed an element of the changes announced by the DWP. Here is its statement:

The Government is also responding to concerns that the criteria used to determine the size of property a customer requires only take account of people who live in the customer’s dwelling as their home. Therefore a paid carer who resides with the customer is reflected in the size criteria but no allowance is made for carers who provide overnight care but who normally live elsewhere.

In recent years, local authorities have increasingly been asking for advice as they have come under pressure to include an extra room for the use of non-resident carers. This has led to inconsistency in treatment of non-resident carers. In some areas, the additional cost of a sleep-over room has been met by social services. Elsewhere the local authority has met the cost through a Discretionary Housing Payment but, on other occasions, the customer has had to meet the shortfall themselves. The Budget measure to fund an additional bedroom for non-resident carers puts right this unacceptable position.

What a nice positive way of putting this change. It means that if your carer is a live-in carer, you are likely to lose money, especially in a high housing cost area, but if they only sleep over, an extra room is paid for under the housing benefit. So there is potentially a small goody here for patients and clients who have carers not living with them.

But…

Remembering the effects of the cohabitation rule on my clients in the past, I can’t help thinking that it won’t be long before the DWP is taking someone to court for fraud because they have made a (larger) claim for a sleeping-over carer when it should have been a (smaller) claim for a live-in carer. I look forward to the DWP definition of when you’re living in rather than sleeping over. Will it be like Blackpool landladies: you have to go out after breakfast and not come back until the evening? Or perhaps your bedroom will be examined to make sure it doesn’t have the appurtenances of living in (no home comforts, perhaps, no telly, book, kettle in evidence)? Or perhaps sleeping-over carers will not be allowed in the living room with other people in the household.

You can look at the DWP impact statement on who will be affected by size of house, area etc; it is instructive about the sums of money individuals will lose (although not necessarily a high proportion of the population), at least outside London:

http://www.dwp.gov.uk/local-authority-staff/housing-benefit/claims-processing/local-housing-allowance/impact-of-changes.shtml

Scroll down to click on the impact statement. People have criticised the DWP assessment, so don’t take it as gospel. You can look for how it will affect your area.

The Daily Telegraph is warning that gas and electricity usage has shot up in the last few days. I for one am not surprised, since I’m at home burning gas because they’ve suspended rail travel on my journey to work for the last two days, when normally I’d be relying on St Christopher’s to keep me warm. Apparently demand for gas was up 25% yesterday in last year’s levels. Because gas and electricity prices are also shooting up (electricity up two-thirds since the beginning of winter according to the Telegraph), social care clients generally will be paying much more for keeping warm this quarter than they were paying last year at the same time (up perhaps 47% on last year if the cold weather continues – the Telegraph again). And palliative care clients even more, because a major illness, staying in and probably being fairly immobile almost certainly means you need higher heating. This is particularly significant because it will be an extra factor, and will have happened unexpectedly for many people.

So WARNING, be ready to make the case for sympathy from the fuel suppliers (and get MPs and Ofgem to bully them if they’re not sympathetic), keep the info about the cold now from the papers available for when you need to make the arguments in a few months time, and make sure medical and nursing colleagues give you the info about how important warmth is to combat immobility and illness. This will also help to get them onside, and make them realise the value of another of the jobs that social workers and their welfare rights teams do.

The Telegraph article: http://www.telegraph.co.uk/finance/personalfinance/consumertips/8174586/Fears-over-record-gas-bills-in-cold-weather.html

A Twitter conversation about how the proposed legal aid changes (which largely exclude legal aid for social care/social security matters) and the social care vision might impact upon one another. If you’re not used to Twitter, the first heading is the person speaking and if it connects to something someone else has said, you say @their Twittername first. I have edited this exchange to take out a typo that was corrected in a later tweet; the correction is just inserted in its place in the first tweet.

nickiyou Nicola Youern First legal aid reform now new vision for adult social care – I need to spend a day in bed reading- no time for work anymore.. 16 Nov

MalcolmPayne Malcolm Payne @nickiyou Govt’s legal aid reform may enforce a renewed vision for welfare rights and legal support as part of adult social care. 16 Nov

nickiyou Nicola Youern @MalcolmPayne I don’t disagree with that at all. I have long thought that social welfare issues are misplaced in the legal justice system 16 Nov

MalcolmPayne Malcolm Payne @nickiyou A weakness of govt social care vision is no robust appeals against care decisions; local councils/social workers will resist it.16 Nov

nickiyou Nicola Youern @MalcolmPayne I raised the issue of a joined up vision when Labour were in power but the DOH and MOJ seem to be worlds apart. 16 Nov

MalcolmPayne Malcolm Payne @nickiyou Altho if adult social care users cannot go to law under govt’s legal aid proposals, we need a more robust appeal mechanism. 16 Nov

nickiyou Nicola Youern @MalcolmPayne we do and is it in their interest to provide it? 16 Nov

MalcolmPayne Malcolm Payne @nickiyou: Govt social care vision means care decisions are also about finance; therefore, appeals processes are more vital than ever.

Much of the comment on the comprehensive spending review is political comment. Accountancy firms and small business websites tell you about changes relevant to them, and each pressure group has its own comments. How can you find out useful general information? Here are some websites that focus on the social security changes:

The best brief summary I have seen, telling you about benefits affected by both the May budget and October comprehensive spending review and organised by year of implementation, is on a local CAB website:

Summary of May 2010 Budget and October 2010 Comprehensive Spending Review announcements concerning benefits

http://www.reigate-bansteadcabx.org.uk/files/Budget%20and%20CSR%20summary%202010.pdf

This seems very comprehensive, but only gives you headlines: you have to know what the benefits mean. I have also seen this from the Surrey Welfare Rights Service, but I don’t know who has prepared it, because it’s not apparently on the Surrey WRS website or on the national CAB website.

The Turn2Us website has an Elizabeth Finn Care summary, which also has a good brief account of the effects of the comprehensive spending review on social security provisions. It’s also organised year-by-year, according to when the changes take effect. There is a bit more commentary and explanation here, but the listing seems less full:

http://www.turn2us.org.uk/PDF/Benefits%20Changes%20and%20FAQs%20Oct%2021st%20%285%29.pdf

Among the first-half drones at this conference was a duo talking about something called ‘connected care’. It turned out that someone in healthcare has found about about community audits (a technique widely used in community work for forty years or more): you train a few people to carry out and analyse a survey of their local community to find out what you already know, but the results have more credibility because they’ve found it out themselves by participating (ie doing what they’re told would be a good idea by the professionals – this is my new definition of participating in the NHS).

Someone on their film identified the main concern about people presented with another survey from the NHS, that they can’t be bothered to respond because they know nothing is going to happen as a result. This of course is why getting someone from the local community to do it is an ace, because it’s harder for people to say ‘no’ to an earnest neighbour, preferably young or old, so they’re harder to abuse.

Apparently, though, the latest management-speak for dealing with people who don’t believe you’re going to do anything is to tell respondents in advance that you cannot afford anything, and then they won’t be disappointed afterwards. This way of getting people more connected to the NHS was hailed as a new project development insight. I was always taught to see it as ‘not raising expectations’ – it’s been a standard social work technique for at least the forty years I’ve been using it; it’s always been vital in social work, because it’s really hard to get anything for anyone from a deprived community, so it’s best not to raise their hopes.

The survey apparently found out useful things: for example, local people would like more social activities, especially for older people. Unfortunately, the presentation did not go so far as to say anything that they’ve actually done as a result of their community audit; we were invited to accept that this ‘industry best practice case study’ is going to lead to wonderful things if we do the same, only they haven’t quite got there yet.

And probably won’t, if normal life and the economy is anything to go by.

The EU has published a strategy for global health policy, with  focus on maternal and child care, responding to climate change and talking about support for issues such as malaria prevention. Obviously major problems of ill-health and health inequalities remain. Buit this is very much a policy about achieving the Millennium Development Goals, and ignores that element of health and social care which is about care, not just about widespread changes will prevent or treat diease, which tend to focsu on the young. Inequalities affecting older peopleand dying people because they are not our future are ageist and in the end uncaring.

On the web: http://ec.europa.eu/development/icenter/files/europa_only/EU_role_global_health_issue_paper_en.pdf