David Pearson could hardly have picked a tougher year to become president of the Association of Directors of Adult Social Services (Adass). The Nottinghamshire director’s year in the hot seat, which began in April, brings a further round of budget cuts, a ten-fold increase in assessments under Deprivation of Liberty Safeguards and the implementation of the Care Act 2014, dubbed by ministers the biggest reform to adult care in over 60 years.
Fortunately, he says he likes a challenge and thinks it is a privilege to be shaping key issues at a critical time for social care. “In a way this is a great year to be president,” he says.
Adass’s annual survey of councils’ social care budgets in England, which comes out tomorrow, shows that councils’ coffers have been squeezed for a fourth year in succession. “We are getting to the point where it is unsustainable if we want to make sure we are meeting need appropriately at a level of quality the public expect,” he says.
An unanticipated additional squeeze on councils’ budgets is the fall-out from the Cheshire West and Surrey deprivation of liberty rulings. The Supreme Court’s decision in March, which broadens the definition of a deprivation of liberty, means that councils will have to carry out over 80,000 more assessments this year, according to figures compiled by Adass. Pearson says this increase in work is expected to cost an additional £86m a year, and that figure does not include legal fees.
We would like local government to have additional funding…to recognise that [the Supreme Court's deprivation of liberty ruling] was not entirely predictable and is very significant in terms of costs.”
Another seismic change for councils is the advent of the Care Act, which will be implemented from 2015 to 2017. The act introduces national, rather than locally determined, eligibility criteria, a cap on the amount self-funders pay for their care, and new duties on councils to provide preventive services, advocacy and support for carers.
The first draft of the government’s eligibility criteria was criticised by Adass for being outdated – in basing eligibility on people’s perceived deficits, not their strengths or desired outcomes – and underfunded, in setting a threshold that was too low for the level of funding that would be provided.
The second draft, published last month as part of the draft regulations and statutory guidance on the act, sought to address both issues by rewording the criteria and setting a seemingly higher threshold. But while the government’s intention is for the threshold to be roughly equivalent to the ‘substantial’ band under the Prioritising need in the context of Putting People First used by most councils, Adass remains concerned that councils will be short-changed to implement it.
Pearson says the government has allocated a “relatively small” amount of money for the change – about £25m a year, equivalent to the costs of enabling the three councils with a ‘critical’ threshold to lower this to the new national minimum.
Adass is discussing the subject with the Department of Health and has commissioned the Personal Social Services Research Unit at the London School of Economics and Political Science to look at recent assessments from between 15 and 20 councils and see whether their eligibility would change if they were assessed using the proposed criteria.
Costs of integration
Integration of health and social care is also a major theme of the Care Act, with £3.8bn of existing funding pooled into the Better Care Fund to contribute towards this. This is designed to spur the development of social care and community health services to help keep people out of hospitals and remain independent, and replace acute healthcare. However, these new services will take time to emerge and there will be a need to keep existing acute health services running in the meantime.
Pearson says: “Adass and the Local Government Association have said some transitional funding over and above what we have now would be helpful to overcome some of these barriers. In many countries it has taken much longer to achieve this magnitude of change.” At the start of June the LGA called for the Better Care fund to become a five-year commitment.
The Care Act also gives councils the power to delegate most of their adult social services functions, including assessment and care planning, though excluding safeguarding; councils would retain responsibility for ensuring these functions were carried out properly. There was such uproar when a similar power was proposed in April for children’s services that the government decided to restrict outsourcing to not-for-profit providers.
The models for the exercise of the new power in adults’ services are the seven social work practice pilot sites, five of which are continuing beyond the pilot phase. Pearson suggests that the drive for integration could result in the delegating of responsibilities to integrated care organisations responsible for health and social care. But although councils have outsourced almost all care provision over the past two decades, delegating assessment and advice services might give councils pause for thought as these early stage services are “so fundamental to the way people go on to experience social care”, he says.
With the Care Act draft regulations and guidance out to consultation until 15 August, Pearson recommends that social workers have their say.
“This is the opportunity to shape what is put into practice. In many ways the regulations and guidance are more important that the core provisions of the act,” he says. “Read and contribute to the debate because you will be contributing to the future of social care for the next 30 to 40 years.”