Some are seeing the run up to the 2007 comprehensive spending review as the last chance saloon for social care. With long-term social and demographic changes and allegations of cost shunting from the NHS, many in social care are arguing that the current situation is unsustainable and that we need even greater increases in spending than we have enjoyed in the past few years.
Certainly, it is true that things are extremely tight financially, and that the situation is likely to get worse rather than better if the review delivers a “no growth” result, as many predict. With a triple whammy of rising demand, rising costs and rising public expectations, it seems increasingly difficult to keep up with existing responsibilities and requirements, let alone continue to modernise and develop services. In older people’s services, for example, some estimates suggest that the number of people aged 80 and over could double or even triple during the first half of this century. In contrast, there is unlikely to be two or three times the money or two or three times the staff.
On the one hand there are some reasons for optimism. With a new director general of social care, David Behan, at the helm, we have a strong and experienced national advocate who is well placed to champion social care. Added to this is the Wanless review of the funding of older people’s services, which provides a crucial and compelling analysis of current and future spending.
At the same time, the wider economic situation is such that there is a much smaller pot for which to compete than in the past. After massive (and ultimately unsustainable) investment in public services, the money is now running out, and the reality is likely to be a very difficult financial settlement. Also, the Wanless review was not funded by the government, but by the King’s Fund – thus, the detailed financial data we have going into the review process came not from government but from an independent charitable foundation.
In practice, this could well leave social care with considerable problems, and it is hard to see how many of the white paper aspirations can be delivered if the funding isn’t there to make them happen. For example, how do you invest in longer-term prevention while also meeting the needs of people currently in crisis? How do you balance individual choice and control with economies of scale and efficiency targets? How do you work in partnership with an equally hard-pressed NHS without arguments over money getting in the way?
However, to use these questions as an excuse for inaction would be fatal. Given that financial problems seem almost inevitable, the real issue is how social care (and partners) can use whatever money they do have to maximum advantage. When money is tight, we can either try even harder to do more of the same, or we can acknowledge that it was more of the same that got us here in the first place and try something different. Rather than focusing on whether or not we get extra funding, what matters most is what we do with the money we already have and how this can support new ways of working.
Against this background, health and social care partnerships are going to be even more important in the future than they are now, and collaboration between local authorities will also increase. However, if there is one major ray of hope on the horizon, then it must surely be direct payments and individual budgets – whatever money is or isn’t available, these take existing resources and enable them to be used in radically different ways.
If the review fails to deliver from a social care perspective, a crucial way forward will be to unleash the creativity and innovation of people who are experts by experience – more of the same is not an option.
Dr Jon Glasby is a reader in health and social care at the Health Services Management centre, University of Birmingham, and a board member of the Social Care Institute for Excellence