Despite the astonishing success social services have had in sustaining high quality services in the midst of a financial maelstrom, the Autumn Statement posed further challenges to DASSs everywhere. Could the additional demands placed on DoLS assessments jeopardise Care Act implementation for example? David Pearson looks at the issues in the round…
The Autumn Statement contained some fairly slick politics and some measured analysis of the country’s economic woes. But on the obvious link between health service pressures and those of cash strapped social care, the statement was silent. For directors - and those leading the many provider social care agencies and organisations representing users - the challenge of managing declining resources can seem quite overpowering when compared with the increasing need at the door.
It isn’t - it couldn’t be – all bad news. How could it be, when the proportion of people who say they are extremely or very satisfied with their care and support has gone up in the past 12 months; the proportion of people using social care who receive self-directed support continues to rise; the proportion of people using social care who receive direct payments has swollen, and the proportion of adults with a learning disability who live in their own home (or with their family) has continued to increase as well?
How could it be when in 2013-14, 66 per cent of people who used services felt as safe as they wanted, up from 65.1 per cent in 2012-13. And the proportion of service users saying that their services have made them feel safe and secure was 79.1 per cent in 2013-14, an increase from 78.1 per cent in 2012-13 and 75.5 per cent in 2011-12? (Figures from Health and Social care Information Centre).
The answer to the unlikely link between reducing resources and increasing satisfaction for those receiving them is probably to be found in the increasing personalisation of services. Now four out of five people receiving community-based services in England receive this through a personal budget.
In Control, Lancaster University, and Think Local Act Personal published a survey in October in which over 4,000 people shared their experiences of personal budgets. More than 80 per cent of those surveyed said that a personal budget had made things better or a lot better when it came to dignity in support, and the quality of life. More than two thirds of carers also said that as a result of the person they care for having a personal budget things had got a lot better when it came to remaining well and being able to continue caring, as well as in the quality of life for them and the person being cared for.
Beneath the froth about stamp duty, garden cities and Stonehenge tunnels, the harsh financial reality within the Autumn Statement should not obscure the enormous amount of positive developments and successes our services are capable of pursuing. Nor can we be complacent, there are obvious challenges; practices incompatible with high quality care - the concerns about the reducing number of people receiving services, the minimum wage, zero-hour contracts and ensuring that commissioning practices enable providers to ensure dignity and respect in the delivery of care services.
So, Government spending is set to fall from 41 per cent to 35 per cent of GDP over the next five years. As the Economist puts it, the fact that health, schools and international aid budgets are ring-fenced “would suggest a looming massacre of the unprotected budgets for welfare, local government and defence.”
It isn’t absolutely clear where the government believe social care funding comes from. In some of their literature – particularly the little pie charts tax payers are beginning to receive helpfully telling them how central government spends their money – it appears to come under the `welfare’ budget – a decision about which ADASS has complained. But we know where the bulk of our finance comes from other than charges even if the Treasury is having second thoughts: local government.
And their `unprotected’ budgets, the magazine says, are about to be `massacred’.
The burgeoning disparity between health and social care spending – a disparity which the autumn statement appears to have worsened – has a direct impact on one of the key issues facing health agencies in England: the lack of out-of-hospital care for the many thousands of older people who need and deserve it and as importantly community services for younger adults with disabilities, including those in health commissioned specialist hospitals about which there continues to be widespread concern.
Directors have unreservedly praised local councillors’ resolve to work closely with the NHS to support the increasing numbers of people who leave hospital every week. But despite that, the warning is that social care budgets cannot continue to be neglected and starved of the vital funding they need in order to make sure that people receive the care and support in the community they need as well as helping with the unsustainable pressure on accident and emergency and other hospital services. The cry is there is no more money and things have to be done differently. Well they have been. A read of the Local Government Association report on efficiency gives ample evidence of this.
Put simply: maintaining or increasing the current levels of spending on the NHS while simultaneously cutting spending on social care makes no sense.
Not only that: everyone knows it. Politicians know it. Local councillors know it. The NHS Confed knows it. The excellent Barker Commission knew it. Health service managers know it. You know it. And so does Health Secretary Jeremy Hunt. This is what he affirmed only two months ago at the National Adults and Children's Services Conference in Manchester when he told us that there can be no sustainable health service without a sustainable social care service.
Yes, they all know that responding to the increasing numbers of people who have long term illnesses, multiple conditions, or disability by investing in the NHS and ignoring the vital role of adult social services in providing essential care and support makes little or no sense. Our social care services are vital if we are to avoid inappropriate, expensive, hospital care. The issue with Jeremy Hunt’s speech, though, is that while its objectives are laudable, and the transfer element in it is welcome, the BCF does not deal with the very steep decline in social care budgets.
There is an urgent need to consider the important balance which has to be maintained between investment in care outside, as well as inside, hospital wards as we approach a winter which is already exposing weaknesses in this important and fundamental relationship. We are also approaching the implementation of the Care Act starting in April 2015, and distracting issues arising from the stratospheric rise in the number of DoLS assessments following the Supreme Court judgment earlier this year.
There is no doubt but that we must meet the legal requirements placed on us by the judgement. But to do this we will need to make further cuts elsewhere and reduce or stop services to other people. The Care Act rightly provides a national eligibility framework - given the current spending plans, the question is which disabled people should have their services further reduced?
Ministers have rightly said that the way in which we treat older people is a litmus test for the compassion and inherent values of our society. The time has come to test the commitment when there appears to be an increasing gap between the rhetoric and the reality.
The next couple of years will be years of choice for government and people in this country: whether we rise to the challenge – and cost – of caring for an ever growing number of frail older people and people with disabilities. Or fail them.