THE NATIONAL CHILDREN'S and Adults Social care Conference happens at a critical time for this country. Major decisions about the relationships between the countries within the UK have been closely followed by the political parties as they seek to make their pitch for the privilege of governing us from next May.
If my personal experience, as I seek to fulfil the enormously privilege of being president of ADASS is anything to go by, then the interest in social care continues to increase for reasons which are troubling and encouraging in equal measure. Personally I have completed over 40 media interviews and articles and spoken at over 20 conferences and events as the issues in social care appear to be of greater interest than they have ever been.
Why is there more interest in adult social care?
The somewhat obvious answers include the concerns about quality in regulated settings with some well publicised, poor examples; the concern raised that the number of people receiving social care has reduced significantly as needs are rising; how some people experience a fragmented response between health and social care; a persistent debate about how social care is, or is not, supporting the increasing pressures in the health service, and general concerns about whether local authority commissioning has led to underfunded services with an impact on quality and the care workers in the service.
A recent YouGov poll of over 4,500 people, commissioned by the Care and Support Alliance, has indicated that one in three people rely on, or have a close family member who relies on, the care system. This helps dispel the myth that social care impacts on a very small proportion of the population. There is no doubt that this is set to increase as the number of older people over the age of 85 is set to double over the next two decades while there will be a significant increase in the number of working age adults with disabilities who will be eligible for adult social care services.
Little wonder, then, that after the NHS, social care support is the biggest priority for where the electorate want the government to increase expenditure. Credit to the Care and Support Alliance for commissioning this independent poll.
Of course the implementation of the first consolidated legislation for adult social care in 60 years in the form of the Care Act occupies centre stage as we move from the enactment in May, then the publication of over 1000 pages of regulations and statutory guidance in June for consultation. By the time the conference begins the final versions should be in place and it will require that same commitment and goodwill we have seen to date to ensure that April 1 arrives with all the necessary ingredients for success in all areas of the country.
The major changes in the Act for 15/16 will be the provision of advice and information; new assessment and eligibility criteria; the extension of rights to services to carers; deferred payments; social care in prisons; safeguarding; rights to personal budgets; increased responsibilities on local authority commissioners, and the provision of early assessments in lieu of the cap on care costs beginning in 2016/17 to name but a few.
A preoccupation of course has been whether there will be enough money available given the scale in the reductions in funding over recent years. The answer lies as much in anticipating behaviour as in a scientific process of modelling the need, demand and costs. The difficulty is that we can predict how people might respond to new entitlements and opportunities, but never be completely sure,
The response of very many authorities to what must seem like an endless request for surveys this year has been nothing short of remarkable and I would like to thank members and colleagues for the enormous contribution there has been to a better national understanding of the likely costs.
As I write this, the conversations between the Department of Health, and the LGA/ADASS programme board are characterised by a genuine desire on all parties to understand the evidence - however uncomfortable - in order to come to a reasonable position on the 2015/16 costs. In terms of money there is the immediate and specific issue as to whether the new responsibilities are funded in the short term. And the longer term issue of whether the future funding settlement for adult social care arrests the decline in funding in order to provide the basis upon which the overall aspirations of the Act can be fulfilled in future years. These are both important issues and, understandably, can become conflated.
For me there are two features of this work that signify just how outstanding the social care sector can be. Firstly, the consensus and commitment across the sector: commissioners, providers, politicians, senior colleagues, service users and carers and the myriad of partners to the principles of the Act. Each will have seen its potential to change and improve lives. This has led to what must be one of the most collaborative ventures in design and implementation we have ever seen along with the contributions from a very large number of organisations.
Secondly, in the
areas of change and complexity in challenging financial times we welcome the
contribution of others to testing aspects of the legislation as implementation
proceeds apace. The implementation of the Care Act will be a significant piece
of work and ADASS is jointly responsible for implementation along with the
Department of Health and the Local Government Association. As I write there is
a flurry of activity taking place with government in trying to ensure there is
sufficient funding to cover the likely costs of the Care Act next year.
Of course the work of understanding the paying for care reforms (or Dilnot reforms as they are often referred to) which are to be introduced in April 2016 continues, and will become clearer in the next couple of months. This will be coupled with the publication of the draft regulations.
The NHS has
already featured significantly as one of the key areas of debate in the
election and alongside this will go adult social care. However this connection
- although entirely appropriate in the quest to coordinate commissioning and
services around people who need them - can belie the rather different courses
for health and social care in recent years.
Local Government has not undergone large scale restructuring. But the flatlining of NHS expenditure is much in the news in the face of rising demand. The course for social care has been a 26 per cent savings - a mix of 12 per cent cash reductions and !4 per cent increasing need due to demographic changes. The political parties seem aligned in supporting the principles of increasing the person-centred approach (up to and including integrated personal budgets in health and care) based on the principle of wellbeing.
integration is seen as a way of ensuring that the needs of an increasing number
of older people with long term conditions are met more effectively, and that
the necessary savings to pay for future growth in the need for health and care
will be funded through this process.
The contribution of the Barker Commission is very persuasive, too, in identifying the fact that integration is absolutely the right thing to do. But Barker also insists that any greater levels of cost effectiveness which may result cannot meet the growing need that will be experienced in the future. Dame Kate Barker makes the very measured observation that a trajectory of social care spend declining as a percentage of GDP is `implausible’.
preventing 30 per cent of older people with significant needs but who do not
need to be in hospital at any one time from being in hospital is likely to be
less expensive as well as being far better for their wellbeing. But to what
extent? The idea that this would enable the protection of services or even the
development of new ones that would completely replace the old ones is something
that is not likely from the evidence. A part of a solution without a doubt, but
not the solution.
A number of directors have spoken to me about the experience of the Better Care Fund as one whose intentions we can entirely support notwithstanding the complexity of its formulas. But they also reckon that bringing forward three per cent of health and care spend to the table is probably not enough as a basis for planning the scale of changes required and being able to balance priorities.
Meanwhile, councils are planning their budgets on the basis of the next phase of a 43 per cent reduction in government grant seeing adults and children's services taking an ever-increasing share of the cake. The increasing use of health and care can belie their radically different financial profiles over recent years. The level of creativity, ingenuity and risk-taking rises, while for a masterclass in making every local authority penny count I recommend John Bolton's work for the LGA on adult social care efficiency.
It is right that we seek to use all the tools and best ideas from up and down the country to use money better. The questions raised by the ADASS budget survey give rise to very real worry that despite this commitment, there is real concern about the sustainability of the funding position in the future. Local government has taken every conceivable step to save money in ways that are principled in ensuring that, as far as possible, the offer to citizens is the best possible for achieving the outcomes desired. As John Bolton’s work identifies, there is more to do to enable all councils to implement as many of the initiatives as possible. But don’t forget that there has been some fantastic work up and down the country.
Over the last six months I have constantly been reminded as to why these issues are important. It is necessary to remind ourselves constantly of the purpose of our endeavour. Firstly, in amidst the process of negotiating the Better Care Fund there are some tremendous initiatives up and down the country of things such as multidisciplinary working in primary care where colleagues from different disciplines, including the voluntary sector, are seeking to provide proactive support to people most at risk of being admitted to hospital or residential care settings.
The second is that the announcement of the Integrated Personal Commissioning initiative included some joint work across TLAP to contribute a paper on the history of personalisation in social care including an analysis of its impact. This paper includes a review of progress in this country and powerful examples of how it has made a difference.
The energy of local political leaders; senior colleagues from across the country; advocacy organisations; users and carers and providers, will be directed as ever towards making this work for the local communities we serve. We must as a nation make sure that national policy and deployment of resources creates the right levers for the delivery of excellent, cost effective services at a local level.