It was one of my Presidential predecessors, Jenny Owen, who first, publicly raised the alarm, writes Ray James. In the run-up to the 2010 general election, pre-austerity, before the unprecedented budget reductions that followed. Even before integration became the growingly common language of the care and health sector rather than one whispered in quiet corridors between consenting adults, Jenny had spoken the unspeakable.
“IT IS EXTREMELY important,” she warned Gordon Brown, Andy Burnham and their Conservative and Lib-Dem challengers in 2010, “that the initiatives that have been set running in the past few weeks … are not left to gather dust once the election is past. Those same services will still be there, unsatisfactory, underfunded, and unfit for purpose, as will be the ever-growing armies of people who, one way or another, will be depending on them for their care and support.”
Sandie Keene repeated the message three years later when she warned that a bleak outlook was getting bleaker – a message reiterated and intensified last year when David Pearson warned that social care services in England were becoming `unsustainable’. In March this year he issued a stark warning to politicians of each and every party: “the next two years following May’s General Election will make or break adult social care.”
As Wilfred Owen might have written : “All an ADASS president can do today is warn. That is why the true ADASS president must be truthful.” So, as the Association publishes its annual budget survey for 2015, we have to issue our siren call again, but this time louder, and with even greater fervour and concern.
We know that some 420,000 fewer people today are not receiving the social care services they would have done four years ago - this at a time when demographic pressures suggest that more and more older and vulnerable people are growing, or ageing, into need. Why? We do not know precisely, although the further £1.1 billion being taken out of social care in 205/16 alone might point towards an answer.
Some are genuinely independent. Some rely more on family carers at the cost of their own health, employment and wellbeing. There’s some small evidence that charities are taking up some of the strain. But as to who is caring for them all? We don’t know. Is anyone caring for them? Ditto again. We simply do not know. But we ought to be devoting more time to finding out.
We know that large tranches of our 1.5 million-plus workforce are poorly trained and poorly remunerated. They are the very bedrock upon which the quality of the residential or home care experience of so many of our citizens depends. Despite the work of many exceptional social care workers, it is only too often liable to be found wanting…
Survey after survey is now pointing to the same truth: fewer people are getting the care they need. And many of those who do get a service are having the quantity reduced. We are at risk of a slow, grinding, salami-sliced route to isolation and whatever we call the opposite of dignity.
We know, too, that parts of the market which we rely on to deliver care are under pressure. There are impending sales of residential care homes and home care companies. Many councils have kept provider fees frozen for a number of years. But this year directors report that only £32m of efficiencies will be found through this route, and though we have taken all the (limited) steps we can to protect them, maintaining a caring and trained workforce in a sustainable provider market is now a key concern. 56 per cent of directors report that providers are facing financial difficulties now. This anxiety has to be seen in the context of staff turnover, quality, the National Minimum Wage, and the need for another million extra social care workers in the future.
Meanwhile spending on prevention has been reduced by six per cent from the previous year. Yet directors see increased prevention and integration as their top two areas for savings for this year, next and beyond, all in a year when the Care Act exhorts us to pay greater attention to it!
Put simply councils have tried to protect social care spending at the cost of other services. But we are running out of ability to do this in the future. And bear in mind that health funding has increased from £97.5 billion in 201-11 to £116.4 billion in 2015-16, while over the same period, social care funding has decreased from £14.9 billion to £13.3 billion - more in real terms when demography is taken into account. It is palpably absurd to believe that the money being transferred from the NHS via the BCF is anywhere near sufficient to mitigate these spending disparities.
Over the last several years we’ve heard many warnings that the NHS has only weeks left in which to be saved. We have been less alarmist in social care. But the evidence now makes us duty bound to sound that alarm indicating imminent danger unless the government acts in the coming budget and Spending Review