Care services minister Ivan Lewis has urged councils to deliver on the opportunities created “by the most profoundly important year in a generation” for the sector.
Lewis issued the call in an interview with Community Care at the end of a parliamentary year which has seen a raft of high-profile adult care policy initiatives, headed by the announcement of a green paper on the future funding and shape of services (see box below).
Big policy challenge
Lewis said the government had recognised that adult care posed one of the biggest policy challenges for the future, given the increasing number of older and disabled people, and much greater expectations of services.
He said the sector’s increased profile “was something we should be incredibly excited about but it means we have to live up to people’s expectations”.
Specifically, he suggested councils could lose their adult care commissioning role if they did not deliver on the Putting People First agenda to personalise services from 2008-11.
By 2011, the Department of Health wants all publicly-funded users to have personal budgets, except in emergencies for all councils to have high-quality information and advice services, available to all including self-funders, and to see a decisive shift from crisis work to preventive services.
Lewis stressed the DH would support rather than performance manage councils in delivering Putting People First, and emphasised local government’s leadership role in the process, through a “consortium” of the Association of Directors of Adult Social Services, Improvement and Development Agency and Local Government Association.
Questions over councils
But Lewis added: “If at the end of three years, local government has not delivered on those building blocks, I think there will be some really big questions to be asked about its capacity to commission these services in the future.”
The challenge comes with councils’ role in organising adult care locally already in question. The DH’s current six-month “engagement process” to inform the green paper is asking the public and stakeholders whether local variability in access to care remains justifiable, suggesting a reduced role for councils.
In January, Lewis asked the Commission for Social Care Inspection to review eligibility criteria after its State of social care report 2008 laid bare the variability of access to care between and within areas, and the poor outcomes for those denied support.
Lewis said the postcode lottery was one of the “big, big concerns” about people’s experiences of the care system, and that the current fair access to care services eligibility system was “entirely discredited”.
He said one option was that the government would be more prescriptive about people having a “national entitlement” to a level of care, regardless of where they lived, but added: “No decision’s been made to that effect.”
Another option being raised as part of the green paper engagement process is whether there should be one care system in future or two – with separate funding arrangements for adults of working age and older people.
The DH has suggested concentrating public funding on younger adults – who on average have both less opportunity to work or save and more costly care needs – with people who entered the care system later in life contributing themselves.
But Lewis said: “There’s a long way to go in that debate. I don’t think we’ve reached any firm conclusions.”
Another key debate is how the future costs of care will be met, given the growth in demand and expectations. The DH has estimated that there will be a £6bn black hole in public funding for care by 2027 if spending keeps pace with economic growth.
Regional stakeholder events, held as part of the engagement process, have shown strong support among social care managers, staff and users for filling this through public funding rather than individual or familial contributions.
Taxpayers reluctant to pay more
Yet, addressing the stakeholder event in London last week, Lewis warned that taxpayers would be reluctant to pay more.
Speaking to Community Care, he also played down the prospects of the government backing the conclusions of Derek Wanless’s landmark 2006 report for the King’s Fund on the long-term future funding of older people’s social care. Wanless’s partnership model – under which the state would meet over 80% of the personal care costs of all individuals, regardless of wealth – would herald significant extra costs for the taxpayer.
Lewis said: “While I’ve always said that Wanless was a very important contribution to this debate it’s absolutely clear to me that Wanless did not actually come up with all of the solutions if we’re talking about a fundamentally new care and support system, rather than how do we roll forward the existing social care system 20 years.”
Lewis said the DH intended to publish its Valuing People Now strategy on the future of learning disabilities in October. However, he revealed its target – outlined in last December’s consultation paper – to transfer the NHS’s remaining funding and commissioning responsibilities for people with learning disabilities to councils by April 2009 may not be met in full, with implementation staged instead.
There have been concerns among adult care directors that inadequate resources would be transferred to councils to meet their increased commissioning responsibilities.
Responding to this, Lewis said: “There is no easy answer other than we have to make sure there is openness and transparency, and move away from this nonsense that health and local government should be trying to undercut each other.”
Indeed, he said the government was making another push to promote integration between health and social care in general through a “high-level national group”, chaired jointly by Lewis and Mark Britnell, the DH’s director of commissioning and system management.
“We will look systematically, barrier by barrier, at the things that get in the way of integration. Some of this is about local leadership, but we also know there are genuine, cultural, attitudinal, legislative and financial inconsistencies that get in the way of working together.”
Despite challenging the sector to use social care’s increased status “to maximum effect”, he concluded by praising staff, saying: “I would not want this year to go by without paying tribute to those people who, often in very trying circumstances, do a tremendous job.”