COMBINED HOSPITALS CABx SALFORD & MANCHESTER

Transcription

1 COMBINED HOSPITALS CABx SALFORD & MANCHESTER The Problem With Social Fund And Sickness Benefits Administration: Suggestions For Improving The Experience Of The Hospital Community Prepared by Caroline Ellicott Page 1 of 12

2 Executive Summary This report presents the evidence of problems experienced by CAB clients between February 2007 and July The evidence was collected by the services of Combined Hospitals CAB, which serves the patient and staff communities at Hope Hospital, Royal Manchester Children s Hospital and Booth Hall Children s Hospital. The problems raised include Delay and inadequacy of Community Care Grant decisions and problems contacting the Social Fund helpline In relation to the above, some eligible families visiting sick children in hospital choose not to apply for Community care grants for travel costs Income Support /Incapacity Benefit 0800 phone number - trouble with clerical claims for hard to reach groups e.g. hospital in patients and families visiting sick children. Delays to Income Support /Incapacity Benefit claims Wrong advice/decision by Department For Work and Pensions (DWP) Community Care Grants are designed to offer financial support to the poorest families and individuals in the UK. To be eligible the claimant has to be in receipt of Income Support, Guarantee Pension Credit or Income-based Job Seekers Allowance (the minimum allowance as set by the Government). As Community Care Grants are discretionary from the Social Fund, usually only the claimants with the highest priority need, for example acute health problems, as a carer or disabled person, or families under exceptional pressure, will be awarded any grant. Community Care Grants are an extremely important resource for clients who face additional expenditure either due to a health problem or because of unavoidable need to travel to hospital to visit a sick relative. Parents are required by law to give consent for treatment on behalf of their child. It is recognised that parental contact whilst in hospital is beneficial to a child s recovery alleviating the psychological stress to a child who is artificially separated from parents. Parents with more than one child often need to juggle visits at least twice daily to sick children while still providing a caring role for other children at home. For children in hospital, there is the immense added pressure on parents of simply not being able to afford the additional outlay of petrol, or having to pay taxi fare when public transport is not available or would prove too time consuming. Unfortunately however under Social Fund Direction 4 b families who have a child accommodated in hospital are expected to have Home savings. The principle is that if a benefit/allowance/tax credit is being paid in respect of someone in hospital, a significant proportion of that money is not being spent on normal day to day expenses for that person. 1 In practice this limits the amount of travel costs awarded (if any) because it is assumed parents will have unused Income Support/tax credits. In reality parents 1 Social Fund guide, Para 323 Direction 4 (b) i Page 2 of 12

3 expenditure increases as they need to pay for car parking, for food at hospital restaurant/ canteen prices for themselves and other children visiting, and for things to needed to occupy the child whilst in hospital. Being a hospital in-patient can seriously reduce that person s income. Parents visiting children in hospital on a longer term basis will also experience a reduction in income if their employer only allows unpaid parental leave. For this period, some clients are eligible to claim Income Support. Other parents make the more long term decision to quit work to care for a sick child. In patients facing the payment of Statutory Sick Pay ( weekly in 2008/09 benefit year) only for themselves and family also face the same predicament. Therefore those claiming Income Support for the first time need a system that can quickly provide a replacement for lost earnings to avoid the high risk of falling into debt. It is hoped that by presenting this evidence some progress will be made towards reforming the law governing Community Care Grants for hospital travel costs. For example, this could become either part of the regulated Social Fund such as Maternity Grants, Funeral Grant, Cold Weather payment, and Winter Fuel payments. There would also be a welcome for improvement and clearance times for Income Support and Incapacity Benefit. Introduction The bureau services The Combined Hospitals CAB is based at Hope Library in Salford, with further outlets at Royal Manchester Children s Hospital and Booth Hall Children s Hospital. The CAB assists anyone with a connection to the hospitals, or those with a connection to Salford Primary Care Trust. In practice this means many of the users of the service are local Salford residents, but our clients represent the whole North West region. General advice is available at each of the hospitals, though the clients at Royal Manchester Children s Hospital and Booth Hall Children s Hospital are in many cases the relatives of children receiving treatment at the hospital, as reflected in enquiries. In addition to general advice Combined Hospitals CAB has a number of specialist outlets. The Expectant Families Advice Service is based in the maternity unit at Hope Hospital, serving young families, typically local residents. It provides a wide range of services including benefits. The Legal Services Commission funded team of two full time and two part time caseworkers offers specialist advice in welfare benefits and Community Care for clients financially eligible for Legal Help who live in Salford, have a connection to the Hope hospital, or live in Greater Manchester, for community care enquires. Page 3 of 12

4 The Palliative Care Advice Service provides advice and assistance for terminally ill patients and their families, with a range of advice including welfare benefits. This service is available across the CAB sites. There are three Financial Inclusion Fund workers dealing with all aspects of money advice. Two who specialise in visual and hearing impaired patients, families with disabled children, and clients with learning difficulties. Social Policy work One of the aims of the CAB service is a preventative role namely 'to improve the policies and practices that affect people s lives and this is what is known as social policy work. Whilst advice may benefit an individual client, it is more effective in the long run to tackle the root cause of a problem and persuade the policy maker to make a change. We do this at a local, regional and national level. Evidence is reported to our national body Citizens Advice via completion of a Bureau Evidence Form (BEF). The contents of a BEF should quickly summarise the nature of the clients problem, how this has impacted on the client, the underlying cause, and any attempts to resolve the problem by CAB service or client. All the evidence in this report is based on contents of evidence forms our bureau services have submitted. DWP Modernisation background Between there has been a roll-out and completion of re-structuring of Department for Work and Pension (DWP) offices and administration of most claims for benefits. The Jobcentre plus (JCP) now has a network of 800 modern Jobcentres, Contact Centres and Benefit Delivery Centres. Originally this was 50 pathfinder offices. 2 This was completed for 314 million less than the original 2.2 billion budget, according to the National Audit Office. Eighty offices were delivered in an additional fifth year of construction. The National Audit Office found that this delay had an impact on the speed of improvements to customer services locally, in some other respects the quality of customer service may initially have deteriorated, particularly for customers unable to reach contact centres by telephone. 3 In July 2007, local district discretionary Social Fund budgets were being merged to create 23 larger area budgets for the centres to administer across 20 benefit delivery centres. 4 Members of the Public and Commercial Services Union who work for Department for Work and Pensions staff took strike action on 6 and 7 th Dec 2007, 17 and 18 March 2 JCP in touch April 08i 3 National audit office press release Feb Social fund annual report 2006/07(presented July 07) Page 4 of 12

5 2008 and 24 th April This affected the 0845 and 0800 helpline numbers and administration of benefits. Those members who voted for strike action in the ballots at that time are also committed to participate in any future action as decided by the union. 6 To compound the operational issues around office re-structuring, there was a Royal Mail strike between 30 July 2007 and 8 August Local implementation Social Fund For clients we serve, this has meant changes to which office they apply for the benefit, and huge changes to demands/geographical area that particular office serves. The Job Centre Plus in Chorlton before October 2006 was confined to its central Manchester base. From October 2006 it took on the whole of the Social Fund benefit administration including Budgeting Loans, Community Care grants, Crisis Loans, Maternity Grants, Funeral Grant, Cold Weather payment, and Winter Fuel payments, and this was across the whole of Salford, Trafford, Bolton, Bury, Tameside. In August 2007 this area expanded to the whole North West, to include Wigan, Blackburn, St Helens, parts of Warrington, the whole of Lancashire and Cumbria. It was inevitable that there would be operational issues. Demand for, and problems with, the new 0800 helpline number for Crisis loans affected the centralised 0845 Social Fund helpline and administration of other sections of Social Fund benefits. The backlog of claims was spread out to other offices e.g. Oldham where previous Social Fund staff were located. Recently there has been a new telephone system and reduced attempts at contacting clients for telephone reviews for Community Care Grants to increase efficiency. Income Support/Incapacity Benefit Since June 2007 there has been one dedicated tele-claim number ( ) for new Income Support applications. 7 The Job Centre Plus in Bolton took on administration of both benefits for all of Greater Manchester area Evidence of problems DELAY TO COMMUNITY CARE GRANTS (CCG) DECISIONS 5 The public and commercial services union helpline Sept 08 6 John Murphy, Chorlton BDC, Sept 08 7 Touch base June 07 Page 5 of 12

6 Targets A performance target called Average Actual Clearance Time (AACT) is the DWP way of measuring how long it takes to process people's benefits. The latest national figures for New claim targets for Community Care grant decisions is 9 days, and for local review is 10 working days. Performance average was 9.2 for new claims; national standard achieved was 9.8 working days on average for review. 141 million had been allocated to the national grants budget for 2006/07 after taking district boundary changes into account. 1 million was retained centrally to provide a contingency reserve to support any Jobcentre Plus district budget that comes under pressure. 8 However, actual clearance times locally 1 st April to 19 September 2008 for Community Care Grant new claims averaged 6 weeks. As of Sept 2008, this is 4 weeks, and reviews 7 weeks. 9 The children s Palliative Care Advice Service (PCAS) reported in February 2007 That a lone parent client applied to the social fund for a Community Care Grant (CCG) for household items as he was due to move home to more suitable accommodation for his disabled daughter. Delays to the CCG made the client suffer with additional stress and anxiety as he has signed for a property but could not move into it. Children s PCAS reported in July 2007: That a single mother with 5 children claimed a CCG to help with travel and sustenance costs while she visited her poorly child aged 7 in hospital. She did not live local to the hospital nor did she live on a suitable bus route. She travelled both day time and night time. The Community Care Grant was applied for giving full detail of her circumstances and submitted 22/06/07. She explained she had to get taxis to and from hospital to support her child in hospital and provide care for the children at home. An award of 15 was processed on 4/10/07 paid into clients Post Office account without receipt of a decision letter. This did not reflect her out goings and the client was further left in financial hardship. Review was applied for and, on 6/12/07 CAB was contacted by Social Fund Reviewing Officer as original claim had been lost and further information was wanted. Original estimate was 200 costs. Our attempts to achieve an outcome were hampered by trouble getting through on Social Fund helpline. The Legal services Commission (LSC) service reported - That a hospital in-patient claimed a CCG 19/12/2007 for household items which was decided on 24/1/2008 (taking 5 weeks). The claim was to facilitate her imminent discharge form hospital. The award was a fraction of the claim value. The client was without essential bedding and clothing at her discharge and quickly ended up as an in-patient again, partly due to lack of those items. Despite requesting fast turnover and full detail of client circumstances, the decision still took 5 weeks. The client was too poorly and was put off a review process due to apathy about the original decision 8 Social fund annual report 2006/07(presented July 07) 9 John Murphy JCP Chorlton Page 6 of 12

7 The LSC service reported in Oct 2007 That a client applied for CCG on the 5th Oct. The claim was received seven days later. A decision was made to award 140, three weeks after the claim received. A review took a further 6 weeks (decided 10th Jan 2008) and was out sourced to a decision maker in another JCP area. The decision was doubled at internal review. Although this wasn't the full amount, the highest priority items were awarded. In total the client had to wait for further essential items, 3 months after first claim. The LSC service reported in May 2008: That a client claimed a CCG in early February 08. The decision was expected in a further 5 weeks (as advised by Job Centre Plus staff). The client stated that she had been refused, but due to strike action during the week of 17 th March and persistent attempts thereafter, neither the adviser nor the client could get through to the social fund helpline. English was not the first language of client who needed help interpreting the letter. As a result, the review was requested late, meaning extra work to explain the grounds for lateness. The review decision was finally made 27th May in the client s favour 12 weeks after the first claim. The LSC service reported in May 2008: That a disabled single client applied for a CCG in May, the decision took 7 weeks and the client was awarded 1/3 of the total claim value. The adviser tried several times to contact the helpline, but there was a persistent message to call back later and the then line was cut off. COMMUNITY CARE GRANT NOT SOUGHT BY SOME FAMILIES FOR TRAVEL COSTS The Bureau Evidence Forms above show the underlying cause of the client's problem was Delays to Community Care Grant decisions which then did not reflect the true costs and the impact on hospital in patients and parents having to travel to visit sick children, especially while still caring for other children at home Difficulty contacting Social Fund helpline to find out how claim is progressing A trend was quickly identified by children s hospitals services at Booth Hall and Royal Manchester Children s Hospital and by the children s Palliative Care Advice Service. Families who would otherwise be eligible for Community Care Grant (those in receipt of Income Support) chose to rely on charitable application to the Family Fund rather than face the perceived problems above i.e., delays to accessing financial help. The Family Fund is a registered charity that gives grants to households with a disabled child under 16 who have an annual earned income before tax, excluding overtime of less than 23,000, or families whose only income is benefits. Funding for the charity across the whole of the UK for 2007/08 was 30 million of which 28.7 million was spent on grant awards. This is in stark contrast with 141 million allocated in 2006/07 for social fund grants. The budget for 2007/08 was not published at the time of writing. Page 7 of 12

8 The Family Fund awarded 1,697 grants for Hospital visiting costs totalling 624,000 for the year 2007/08. The average travel cost award is There was a 24% rise in 2007/08 in the number of grants awarded in 2006/ Parents eligible for Community Care Grants by choosing the Family Fund instead, have an impact on the limited budget available to families whose only option may be to apply to the Family Fund. It is worth noting that the Family Fund provides grants not claimable under Social Fund Directions such as for holidays, computers and driving lessons. Evidence reported included: Parents with 4 children, frequently making hospital visits were given the option of Community Care Grant or the Family Fund. The client chose to avoid repeat claim for CCG travel costs and included in her Family Fund claim for household items and clothing. This was made on 13/09/07 on a non urgent form. The client received financial help from the Family Fund before 3 months due to a high volume of claims at this time. Another BEF reported: That a single mother travelling from Blackpool to visit her daughter, who receives Disability Living Allowance, chose to apply to Family Fund on 7/11/07. An award was made to the client within 4 weeks. She received 500 towards actual travel costs and 500 voucher for Washer/Dryer. As a consequence she was able to afford to travel over the Christmas holiday period and eat at the hospital Another BEF reported: That a client applied on 05/03/08 for help with travel cost as the son had been an inpatient for several weeks and transferred to Bolton Hospital. Upon contact by the Family Fund CAB adviser was able to discuss in more detail needs/requirements of client and by 31/03/08 client was awarded travel costs and grant towards a family holiday of It is not unusual for urgent applications to The Family Fund to be processed in a matter of hours with the money being in the clients account almost immediately. INCOME SUPPORT /INCAPACITY BENEFIT CLAIMS PROBLEMS RELATED TO CLERICAL CLAIMS FOR HARD TO REACH GROUPS- HOSPITAL IN PATIENTS AND FAMILIES VISITING SICK CHILDREN. Since June 2007 there has been one dedicated tele-claim number ( ) for new Income Support and Incapacity Benefit applications. Claimants are required to provide all income/personal circumstances in a call centre scripted application process which can take minutes to complete. This is the new approach to claim processing in line with office reorganisation and modernisation of Job centre plus. Whilst an 0800 number is free to those calling from a landline, hospital in-patients or their relatives would always face paying the usual mobile phone call rate, or Patient Line (bedside phone service) rate of 40p per minute. They would find the process of needing all information to hand very difficult. 10 Claire White business director, Family Fund, Sept 2008 Page 8 of 12

9 Within the modernisation programme, there is provision for clerical claims (paper claim pack) when it is not effective to use a contact centre. However awareness of this by JCP staff and their willingness to comply with requests for paper claims was challenging to our staff/services. In April 2007 Ward Visiting Service reported: That a client was admitted to hospital with intestinal failure. The claiming procedure was very difficult for both client and CAB acting as a third party contacting on clients behalf. It was very difficult explaining that the client was in bed on a ward and he was not with the adviser, and he could not get to a telephone himself. Eventually, after consulting with their supervisor, the Incapacity Benefit Contact centre agreed to send the form to the client. At first they wanted to send the form to his home address but again after pressure they agreed to send the claim form to the hospital. In May 2007 the Ward Visiting Service reported: That a client was unable to get out of the hospital bed, so CAB ordered clerical forms for him, to be sent to the bureau as he lived alone and would not be able to get the forms from home. These were ordered , the client was discharged and the forms had not still arrived meaning client had to ring 0800 central number as soon as possible to avoid losing out on any back dating of Income Support. In April 2007 Royal Manchester Children s Hospitals service reported: That a client's Statutory Sick Pay was due to end and she needed to claim Incapacity Benefit. The client spent her time in hospital with her terminally ill child. Client was too distressed to sit by the phone and answer multiple questions about her circumstances. She had no access to a private telephone on the ward for any length of time so could not claim the normal way. Client required a paper form to complete in her own time. The CAB requested this via official claim number (0800) but the representative was very defensive when asked and repeated that paper claims are only issued if the system is down. The CAB had to state that they could not refuse to issue a claim pack. DELAYS TO INCOME SUPPORT /INCAPACITY BENEFIT CLAIMS The specified Average Actual Clearance Times, for Incapacity Benefit is 18 days, and for Income Support 11 days /8 full year figures show that Income Support average clearance now stands at 9.2 days, Incapacity Benefit is currently 13.1 days. 12 Our evidence below however shows that not all cases locally were dealt with so efficiently. Legal services Commission in March 2008: The client had his final payment from work in May He had been in and out of hospital but managed to claim Income support in July 2007 via the tele-claim 11 DWP Business Plan 2007/08 12 JCP In Touch may 08iin Page 9 of 12

10 process. He was refused Income Support in July, due to a computation error in the final salary calculation. He claimed again in October 2007, asked for backdating and was paid from date of second claim. The decision was appealed and despite persistent attempts to glean an explanation of the first decision, the client case still had not been decided in March Since May 2007 the clients only income was Disability Living Allowance highest rate care and mobility components. He was then later awarded lowest rate Incapacity Benefit. Lack of explanation and wait for an award of Income Support backdated to July 2007 had caused considerable distress. The client had found it hard to cope with the added expense of hospital trips without Income Support between May and Oct 2007 for which he should have been reimbursed. Legal services commission reported in July 2007 and June 2008: That a client finished work on ill health grounds 26 April She claimed via the 0800 helpline in early May. When she received the claim correspondence shortly afterwards, she attended Baskerville House (JCP) where the staff verified documents to send to the re-located JCP processing office in Bolton. The claim was not received until 27th May and was not processed until the end of June 08. In July 2007 Royal Manchester Children s Hospitals service reported: That a client was without weekly benefit money for 4 months, the CAB submitted an appeal and chased a response 6 weeks later. CAB staff member was informed by the appeals section representative in a hostile tone that it can take many months and when we asked if this meant 3 or 4 months she said 'it might do'. WRONG ADVICE/DECISION BY DWP Not all decisions can be right first time, though we would expect the majority of straight forward cases to be decided correctly. Job Centre Plus contact staff now have a greater role in the claims process. Staff should not adopt a screening process to phone based interviews/assessments, which means that a client s claim is not processed, based on wrong advice/assumption of entitlement. In May 2008 Legal Services Commission reported: That a client claimed Income Support and Incapacity benefit on 02/03/2008 making it clear this was because of blindness. The client was awarded Incapacity Benefit only in error as the decision maker neglected to award a Disability Premium even though the client automatically qualified because of being registered blind and provided evidence of this. The client was having to live at between addresses of several family members due to having to adapt to recently becoming blind. She had not been paid for eight weeks the per week owed to her due to basic error. As a consequence she also missed out on passport benefits for example travel costs to/from hospital and prescriptions. In May 2007 Royal Manchester Children s Hospitals service reported That a client single with no income, and living with her parents, was the main carer for her younger brother who had cancer. Disability Living Allowance had been claimed for him and the client had also submitted a linked Carers Allowance claim. Page 10 of 12

11 Client was identified as being eligible for Income Support and contacted Job Centre Plus to make a claim. She was told that as she wasn t yet getting any Carers Allowance she wouldn't be entitled to claim it. This was not true, as people caring for someone prior to a DLA outcome can claim for up to 6 months. In April 2008 the adult Palliative Care Advice Service reported. That a client made a new claim for Income Support and Child Tax Credit following the death of his wife. The client received a decision notice for the Income Support that included the Carers Premium for the wrong dates and that the CTC counted as weekly income. This resulted in the client being paid the wrong amount of Income Support for that period. The client was underpaid and this resulted in him receiving nothing for that period except housing costs. Conclusion The modernisation programme has been a momentous undertaking which has resulted in streamlining of services and clearer identification of points of contact for example, one helpline number for each benefit. For the majority of claimants the changes may have had a positive impact, but the aim of this report is to show the additional problems faced by our clients who are either hospital patients or parents of children undergoing hospital treatment. The evidence shows that local delivery on Social fund new claim and review, and Incapacity and Income Support is not performing anywhere near to national average targets. For CCG new claims average 42 days (as of Sept 08, this is 28 weeks) and reviews 7 weeks. (National targets are 9 and 10 days respectively) 11 Actual clearance targets for Incapacity Benefit is 18 days), Income Support 11days. We welcome the news that clerical claims will continue to be a feature of the new Employment Support allowance which replaces Income Support and Incapacity Benefit from 28 th Oct 2008, but wait to see how clerical data will be transferred into the new national computer system (CAMS), how this will perform and how clients are supported through the new claims and medical system. Recommendations Whilst there is now an escalation point/person for delays to social fund applications at Chorlton BDC, a welcome change would be a priority system for CCG applications for Travel Costs claims and for hospital in patients whose discharge/ move to new property would be adversely affected by CCG delay. Overall it is felt that there is much scope for an improvement of services for those in hard to reach groups for example hospital in-patients and their visiting relatives. There would be a welcome for a campaign to change the system to make hospital travel cost claims part of the regulated Social Fund, just like the current provision for payments for Maternity Grants, Funeral Grant, Cold Weather payment, and Winter Fuel payments. These too provide essential financial support to people in specific life event circumstances. Page 11 of 12

12 A further recommendation would be the abolition of the Home savings rule when deciding on the amount of Travel cost claims, as the experience of many families clearly belies this concept. By prioritising the making of and paying for multiple hospital visits and the additional costs whilst there, parents without the financial assistance of a CCG award are unavoidably becoming in debt or extending their debts. For more information about this report or Combined Hospitals CABx, contact Operations Manager Caroline Ellicott on Page 12 of 12