The social care system is on its knees: what is the Chancellor going to do?

This week's Spending Review and next week's Lords debate of the Care Bill provide the government with opportunities to start solving our care crisis.

On Wednesday millions of older and disabled people who rely on support from their council to get up, get washed and dressed and get out will be closely following the Chancellor’s Spending Review.

The social care system is on its knees.

Budget cuts to councils have seen them upping the bar for eligibility for support, with 83 per cent of councils now setting the threshold at a higher level. According to London School of Economics 69,000 disabled people have been pushed out of the system.

At the same time many are squeezing the support for those that are in the system. A Scope survey found almost 40 per cent of disabled people who continue to receive social care support are not having their basic needs met including eating properly, washing, dressing or being able to get out of the house.

The consequences are dire. Take away the preventative support and people fall into crisis.

It’s no surprise that there’s now a widening consensus that the crisis in local care is a factor in the pressures on A&E.

It’s also no surprise that there’s cross-sector and cross party backing for the Chancellor to use the Spending Review to invest in preventative social care.

Intriguingly on Friday there were strong hints that the Department for Communities and Local Government, while potentially taking a 10 per cent budget cut, could take responsibility for £3bn from other departments' budgets.

The momentum is there and social care looks set to be a crucial Spending Review issue.

But in case the Chancellor needs further convincing let me introduce Angela Murray.

Angela is an independent, sociable young woman who has a degree in psychology. She volunteers three days a week. She’s also disabled; she was hit by a car when she was two.

For the last ten years, she’s lived in her own home and has had support from her council to get up, get washed, get dressed, go to the toilet, cook, eat and shop.

But recently her social worker told her that her care was being cut from 20 hours-a-day to just three hours. Angela was given five days’ notice.

Angela described her new care routine as ‘depressing and undignified’. She had to be in bed at 9.30pm every night. She also lived off microwave meals because her 30 minute evening call didn’t give the carer enough time to cook for Angela as well as take her to the toilet.

Angela says if she has to live under that regime for the next 50 years, life would not be worth living. She’s fighting back: the local media have already covered Angela’s story and she has a solicitor on board fighting the changes.

The council, reluctantly, agreed to temporarily reinstate Angela’s old care package until a second reassessment, when her care package is likely to be cut again.

And while we’re at it, let me also introduce the 45,000 members of the public who have signed Angela’s petition calling on the Chancellor to invest in social care. It’s clear that Britain cares about social care.

Wednesday will be crucial. But it doesn’t stop there.

The following week the Government will publish its plans for deciding who is in and out of the social care system. This is critical.

The announcement will come as the Care Bill is debated in the Lords. The reforms seek to tackle the crisis in care by introducing a cap on costs, a new means-testing threshold and national eligibility to end the postcode lottery in care.

But the plans, as they are, will also raise the bar for eligibility to social care (see p32 of the White Paper). According to the London School of Economics (LSE) this will leave 105,000 disabled people outside of the system altogether.

If the Chancellor takes the opportunity to invest in social care, that cash needs to be channelled into a system in which disabled people are eligible for care before their situation has deteriorated into crisis.

Properly funded social care is now a ‘no brainer’.

Research by Deloitte has shown that investing in £1.2bn in social care for disabled people will result in a £700m return for central Government and £570m return for local Government and NHS, because it prevents disabled people falling into crisis and needing to access more costly support.

By acting decisively the Chancellor can go a long way to solving the social care crisis, protect A&Es, and save cash across government departments. It’s a triple win.

But the Government will only be able to claim that it’s solved the social care crisis once it has decided who is in and who is out of the system.

Richard Hawkes is chief executive of the disability charity Scope

Take away the preventative support and people fall into crisis. Photograph: Getty Images

Richard Hawkes is chief executive of the disability charity Scope.

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Scarred lands: visiting the villages Boko Haram left behind reveals the toxic legacy of terrorism

The progress and challenges of Nigerian communities rebuilding after Boko Haram’s insurgency begins to wane.

“Sometimes it’s when I go to bed that what happened comes back to me.” Two years ago, Boko Haram militants stormed into 23-year-old John Amida’s home late at night in a village in Gwoza, Borno State, northeast Nigeria. Shielding his eyes with his hands from the torchlight saved his life. He shows me the mark in the centre of his forearm where the bullet aimed for his head went instead.

“All my friends were either killed or abducted,” he says. “I don’t try to forget what happened because it’s not possible; it’s with you even when it is not in your mind. The best thing is just to keep on living every day.”

After a broadly effective 18-month military campaign, Boko Haram remains a deadly yet waning force. Many communities once occupied by Boko Haram are now liberated. In Adamawa, just south of Borno, over 630,000 people previously displaced by Boko Haram have returned home.

With them, over 170,000 internally displaced people (IDPs) now live in camps, or – like John and his family – in host communities. He and his family live in a home vacated and lent to them by a local. All over Adamawa, IDPs live in homes shared with residents or given to them temporarily in exchange for help, crops or token sums of rent.

Adamawa is a serene, largely rural, mountainous state. Even deep into the dry season, driving through the roads that cut between its vast countryside, its land is incredibly scenic. But within local communities, in more rural, isolated villages north of the state’s capital, Yola, the picture is more complicated.

Gombi, a small town a few hours’ drive from Yola, was recaptured from Boko Haram in late 2014. Much of what was destroyed in the insurgency – shops and small businesses – have been rebuilt or replaced. The local government buildings have been largely restored. The impact is still visible but, according to locals, decreasingly so.

But in less urban areas, like in Garaha, a village in Adamawa, rebuilt homes sit next to broken, abandoned houses, churches, mosques and buildings blackened by the fires that damaged them. Local government officials say the damage across Adamawa by the insurgency has set the state’s development back by a decade. Funding for rebuilding the state, which local governments complain is insufficient, is concentrated on urban areas.

According to Chief Suleimanu, a traditional ruler in Garaha, mental health issues are widespread but few are financially able to access support. While some people have been able to move on, others are still dealing with the consequences.

“Many couples and families have separated,” he tells me, detailing how in some couples one partner feels attached to their home while the other can’t face returning, or feel there is little to return to.

“The same with the children, some of the young people have gone to bigger cities like Kano or Abuja because of a lack of opportunities.”

Many returnees, who left camps in Cameroon to come back to Adamawa, are from families who have lived in their villages for generations. Their ancestral roots anchor them to their homes because their farmland is their main source of income. Non-agriculture-based industries provide few jobs. For many people, fleeing their homes meant abandoning their livelihoods.

As of 2015, 52 per cent of people in Nigeria lived in rural areas. Their relative isolation is a blessing and a curse. Larger rural spaces provide them with adequate land to cultivate their crops – but it also leaves them exposed.

During Boko Haram attacks on Garaha through to early 2015, there was minimal protection from security forces who often take hours to arrive.

For many people living in rural Adamawa, life is getting harder and easier at the same time. Armed herdsmen, mainly from the Fulani ethnicity have become a greater threat across Nigeria, partly due to tensions between land ownership and cattle grazing.

According to locals, killings by herdsmen have increased this year. But villages are addressing their vulnerability. Armed vigilantes, some of which formed due to the lack of military protection against Boko Haram, are increasing. The police services are often too far away or too under-resourced to protect them. But some vigilantes now have more weapons and vehicles due to help from state services and locals. It is not an ideal solution but it has made places like Garaha safer.

With this new-found relative safety, villagers have begun farming again. With cash grants and donated tools from charities like Tearfund, it has been easier for thousands of people to begin cultivating land. In many villages there are small, lively recreation centres where young people play snooker and watch sport. Many of their places of worship have been rebuilt.

But the situation is grimmer in communities where such charities are not present.  Without resources, state or non-government help, rebuilding is a real challenge.

Adamawa is a state maxing on its credit of hospitality, relative safety and appreciation of agriculture. A recession in Nigeria and a severe food crisis in the northeast have added pressures on returnees and IDPs. Liberated communities will need more help and attention before they truly feel free.

Emmanuel Akinwotu is a journalist based between Lagos and London who writes about Africa, migration, and specialises in Nigeria.