Buried in the chancellor’s pre-budget report last week was a mention of social care. It came on page 137, a single, fragile reference which may not have meant much in the Treasury but meant a great deal in the Department of Health where champagne corks were heard to pop. Could it be that the hopes pinned on next summer’s comprehensive spending review might actually come to something, social care’s claims gaining recognition alongside those of security, health, education and the myriad other electorally sensitive issues which usually overshadow it? Well, it just could be.
However, the chancellor’s statement did spoil the party somewhat by suggesting that the money urgently needed to meet growing demand from older people would have to come from efficiency savings. Adult social services departments have worked hard to find the 2.5 per cent efficiency savings currently demanded by the government and have had a fair measure of success. But at the same time services have had to be rationed as never before with a number of departments forced to raise eligibility thresholds to “critical” for older people. The situation is much the same for mental health and disability services. It is now proposed that, from 2008, efficiency savings should rise to 3 per cent and it is hard to see how this is any more compatible with throwing open the door to services for more people.
Reversing the overall reduction in services for older people will be the greatest challenge facing the government, commissioners and providers over the next four years. Cost pressures from various sources are intense: the rising numbers and expectations of older people (by the time the CSR is published there will be more over-65s than under-16s), cuts in funding from primary care trusts, the increasing popularity of direct payments and the clamour from residential care homes for a better deal are just a few. In their finance report earlier this year the Local Government Association and Association of Directors of Social Services identified a £1.76bn black hole in funding for social services.
Yet there has been much to be positive about in social services over the past year. After Sir Derek Wanless’s report on the future of services for older people was published, the government signalled its good intentions by setting up a working group to make the best possible case to the Treasury as part of the CSR. The white paper Our Health, Our Care, Our Say held out the prospect of more choice and control for service users, gave more weight to prevention and promised the transfer of a sizeable chunk of NHS resources into the community. The welcome given to the looked-after children green paper and the disability equality duty on public bodies may have to be offset against the frosty reception given to the revived Mental Health Bill and the Options for Excellence report on the workforce. But all in all the foundations of social care look more secure now than they did at the start of the year.
Building on those foundations will require resolve of a wholly different order. Investment in social care will have to be such that it can shake off its poor law past at last, while the quality of services will have to be such that they are more often the first choice and less often the last resort. In other words the relaxed interplanetary speeds of the social care starship will have to shift up to interstellar warp factor 9. If the government and its service deliverers are shrewd in their use of resources, and the NHS can be cajoled or frogmarched towards the destination marked out for it in the white paper, that may yet happen. It is certainly what most professionals and their clients would wish for and there is now every reason to believe that the chancellor has heard their voices above the background noise of competing demands. So we, like the DH, are glad to drink to the pre-budget report, even if social care registers as a whimper when what is needed next summer is thunder.
Chancellor’s Pre-Budget Report
The Simon Heng Column