For social care, this week’s spending round announcement was one that gave with one hand while taking away with the other. Chancellor George Osborne used his speech on the government’s spending plans for 2015-16 to unveil a few presents for social care.
There will be a £200m windfall for the Troubled Families programme so that its intensive multi-agency support can be offered to an additional 400,000 families; there is also a one-off £335m payment to help councils implement reforms to adult social care funding set out in the Care Bill. Biggest of all, £3.8bn from the NHS will be put into local budgets to provide integrated care to older and disabled people, jointly managed by councils and clinical commissioning groups.
But alongside these apparent boosts to social care budgets, Osborne also lopped a hefty 10% off core government funding for councils, which comes on top of a 33% reduction in Whitehall funding from 2011-15, according to the Local Government Association. When the whole package is taken together – alongside anticipated changes in council tax – town hall budgets are expected to fall by a further 2.3% in 2015-16 in real terms. This will mean significant added pressures for children’s social care, without the relative protection afforded adults’ services.
Adult social care impact
The £3.8bn for integrated care has received a very warm welcome, following three years in which 20% has been taken out of adult social care budgets in England, according to the Association of Directors of Adult Social Services.
“There was very little room for manoeuvre in adult social care budgets so an injection of further funding in a pot that was getting smaller and smaller compared to the amount of need we had to meet was very good news,” says Adass president Sandie Keene.
But detail matters when it comes to government funding and the integrated care fund is no exception. For starters, the NHS is already being directed to spend over £1bn a year on social care, most of which is transferred to councils. In addition £1bn of the 2015-16 will only be paid out when local targets are met, something adult social services – unlike the NHS – are “not at all used to”, says Keene.
“We will need to look at the fine print there very carefully and work with our clinical commissioning groups as to how realistic the targets are,” she adds. “I understand that a lot of the pressure and attention will be given to performance in health targets – hospital admissions, A&E visits and so on – and social care is not the only player that could influence those figures. We would want to make sure we’re not taking on a disproportionate risk.”
Payment by results
A Department of Health spokesperson says there will be “a strong element of local determination in setting these outcomes”. Local services will also need to develop plans for integrating their care and get them approved by local clinicians and health and well-being boards, she adds.
The plans will need to show how local social care services will be protected and how services will take a joint approach to assessments and care and support planning. They must also describe how data sharing between local authorities and the NHS will be improved and there is also a requirement for people’s NHS numbers to become the basis of this. Finally, services will need to explain how they will offer social care and health support seven days a week.
Keene feels that the shift to seven-days-a-week services will not be a massive culture change for adult social care and that some social workers would prefer a more flexible working week. “My sense is that people are prepared to work evenings and weekends so it’s about marrying up workers’ aspirations and the needs of the service,” she says.
The Department of Health believes pooling budgets in this way will mean those in need of care and support will get individualised support earlier, resulting in better outcomes and fewer hospital admissions and A&E visits. Keene believes the money will result in more investment in reablement services.
“Hopefully it will also give greater certainty to some of our providers of home care services so that we can have a more steady supply of home care and not have waiting listings for people who need care,” she adds.
Money for social care funding reforms
Aside from the integrated care budgets, local authorities are also getting £335m to fund changes to social care funding under the Care Bill, particularly:
- implementing a universal deferred payments scheme enabling self-funding care home residents to have their fees met by councils and then recovered on the sale of their houses;
- and preparing for the implementation in April 2016 of the £72,000 cap on the reasonable costs of care incurred by self-funding individuals.
In its briefing responding to the spending review, the Local Government Association warned: “We will want to work closely with the sector to understand the likely costs involved and whether the £335m is a realistic figure.”
More positively, an LGA spokesperson says it is unlikely that councils will seek to squeeze adult social care as they seek to make further savings in 2015-16.
“Getting adult social care right is important for securing the wider sustainability of local government as a whole,” he says. “The money announced in the spending round is an opportunity to take forward integration at a greater scale and pace. Underinvesting would run counter to pursuing the much-needed joint activity which can reduce pressures on both sides.”
But while adult social services itself may not be a target there may be knock-on effects from cutbacks to housing, leisure, culture and elsewhere says Keene.
“Things like leisure services and libraries are things that individuals who may be vulnerable enjoy using, so if they are not able to use those services and have their social needs met through these universal services there may be more pressure where people have those needs,” she says.
Children’s services impact
Adult social care may have emerged from the spending round a relative victor, but the same cannot be said for their colleagues in children’s services. Last year, the Audit Commission reported that councils had succeeded in protecting children’s social care from significant cuts. However, Association of Directors of Children’s Services president Andrew Webb warns councils will struggle to continue this, given the further reductions announced by Osborne this week.
“To me, it is inconceivable that areas that have been protected in the last two years won’t be re-examined in the run to 2015,” he says.
What this is likely to mean for children’s social work is more pressure from tight budgets, the current baby boom, unexpected rises in demand and government pressure to speed up family justice and adoption processes. “If any more pressures push the numbers of children in care up higher, it immediately takes money out of the other children’s social care activities – safeguarding and preventative areas,” says Webb.
He also argues that it is impossible to insulate children’s social care from cuts to other children’s services. “Even though core assessments, care planning and so on have been protected a bit up to now, all those services that contribute to managing children safely in the community, such as children’s centres, are almost certainly going to have to be revisited and cut again,” he says.
Services for vulnerable ‘will have to be cut’
“If you simply look at the spend on children’s social workers or children in care and say it’s protected, that only tells a very small part of the story about children in need and the services that their families get which are going to have to be cut.”
And Webb, who is also the corporate director of services for people at Stockport Council, is concerned that the overall hit to council budgets may be more than the 2.3% suggested in the spending round. “Our analysis of the general reduction in the money for local authorities bears almost no relation to what the Chancellor actually said would be the real impact of cuts – it’s going to be a much greater amount than that,” he says.
Even the £200m Troubled Families funding might not prove to be the silver lining it seems, even though councils are welcoming of it. It is, as yet, unclear where the money for expanding Troubled Families has come from and local authorities fear that this ‘new money’ will be paid for with cuts in other areas of children and families work.
“Until we can look at both sides of the balance sheet it is not possible to say how much benefit this investment in Troubled Families will bring,” says Webb. Either way £200m is not a big amount compared with what’s being lost from local authority budgets as a whole.
Five years of austerity
By the time Osborne’s plans come into effect, local authorities will have been living with austerity for five years, raising the question about whether children’s social care can maintain quality under the circumstances.
“I can’t say whether these latest cuts will have a negative impact on quality but, alongside the changes coming into family justice and adoption and so on there is no let up in the additional pressure in the system at a time when even more money is being taken out,” he says. “That needs to be acknowledged, but what happens as a consequence of that I can’t predict.”