The comprehensive spending review gave rise to an enormous amount of speculation about its content before publication, despite holding out the prospect of little extra cash for social care. As social care heads for the buffers, unless the CSR succeeds in diverting it on to a new track, there were high hopes that the journey towards personalised services and a workable system of long-term care could begin in earnest.
Among the chief speculators was Andrew Cozens, whose blue-skies thinking at the Improvement and Development Agency at last stands a chance of becoming ground-level reality. It is a vision of services, widely shared in the new era of adult social services directors, that he plans to talk about at the national children and adult services conference in Bournemouth next week.
As a former social services director himself he sees care managers still too often paid to act like 19th century poor law guardians, deciding who qualifies for out-relief and at what level. Dumping the poor law will require new money as well as clever ideas.
“If you read the runes in the sorts of things [care services minister] Ivan Lewis has been saying lately, he wants to see a step change in social care and I think that’s Gordon Brown’s motivation too,” he said, shortly before the CSR was due to come out this week. “I think there’ll be a substantial push for carers, a substantial push for personalisation, and real encouragement to switch the focus of services to better outcomes for the whole population.”
What interests Cozens is the challenge of engaging with the whole population – not, for example, just the 5% of older people who come into contact with social care.
“Our line is that social care should be seen in the context of the wider responsibilities of local authorities. If we’re going to have an approach to services which is individualised and based on entitlement, you’ve got to stop social care paying for and fixing wider societal problems that occur, say, when housing and transport aren’t right. It has to be part of a wider planning forum.”
That forum is local strategic partnerships, which have a mixed record of bringing together communities with commissioners and providers to refashion local services as a whole. Here, too, the CSR should have an impact: it was expected to spawn public service agreements around personalisation, later life, and equalities which should gather government departments around common spending priorities, producing a greater sense of urgency where it has been lacking at local level. They should be accompanied by fewer centrally set targets, more local flexibility and a renewed emphasis on outcomes rather than outputs.
Cozens views advice and information services as key to involving the whole population. In the new world of local area agreements, councils will be judged on their ability to improve outcomes for all older people and not just the means-tested few who come to the attention of social services. “You’ve got to start from a different place from deciding whether someone meets the eligibility criteria or not. That requires you to think about a much more generic, customer-focused service. I try to imagine the service someone very outspoken, like Janet Street-Porter, will expect when she is older – or Dame Denise Platt for that matter.”
The idea is that, ultimately, everybody will have choice and control – their own pot of money and the power to decide how to spend it – plus an advice, information and advocacy service funded by the local authority, a “fantastic social enterprise opportunity” for someone, says Cozens. It will help people to make good decisions about how to spend their money on social care, not bad ones which may prove costly for the council later on.
“It’s about the 95% of people who don’t routinely have contact with local authority social care but who, if we get it wrong, could be accelerated faster into it. I wouldn’t call that a social care model, I’d call that an ageing society, citizenship model. It’s around councils gearing up to the fact that older people want access to information and an access strategy for the whole of council services.”
Several councils have opted for a single point of access to their own and, sometimes, other public services: pharmacies are an obvious “front door” with the potential to provide health checks along with advice on issues such as leisure, adult learning, housing, transport and social care.
There is the possibility of a green paper early next year following the Wanless report on care for an ageing society, and Cozens is optimistic that the government seeks a serious debate on the funding issue.
“I don’t think they’ll take up the challenge of Wanless at this stage. But I do think the government will recognise the need to do something. This CSR won’t fix it, but the next one might. In the meantime, we need to work very hard on a citizenship model that prepares the way for an ageing society.”
This article appeared in the 11 October issue under the headline “Looking beyond means testing”