Coming face-to-face with the impact of social care cuts you’ve made: a director’s story

Liverpool Council’s adult social care director Samih Kalakeche tells Community Care about the reality of delivering care in austerity

Liverpool town hall Picture credit: babelsberger/fotolia
Liverpool town hall Picture credit: babelsberger/fotolia

Asked how it feels to see the consequences of cuts he’s made to adult social care services Samih Kalakeche recalls a memory that still makes him “go cold”.

Kalakeche, Liverpool council’s adult services director, was approached by the father of a young man with learning disabilities. His son was being supported by a local authority-run day centre, which the council had just announced would be outsourced to save costs.

“He took me aside, held my arm and broke down,” he recalls. “He said ‘you have broken me’, this place is my savior.

“It just made me feel so little. This man in his late 60s was standing in front of me basically saying ‘you’ve finished my life’.

“I stood there wishing I could do something different, but I couldn’t.”

Kalakeche tried to reassure the father that the council was not closing the centre and would still be providing support to his son but it didn’t matter.

“As far as he was concerned, the staff who were supporting his son were his extended family,” he says.

“The new people coming in were not his family, they were strangers, and he felt really strongly about it. That day has remained with me, and will remain with me for a long time.”

‘Less money, less care’

Samih Kalakeche (002)The story will strike a chord with many adult social care directors in England. Their departments saw 31% wiped from their budgets over the past five years, according to the latest survey by the Association of Directors of Adult Social Services.

Liverpool has been hit hard by central government cuts to public spending. The council’s overall budget has been cut by 52% since 2011-12, with an inevitable knock-on effect on funding for adult care. Three years ago, Kalakeche’s department had a budget of £220m. This year it stands at £170m, a cut of 22%. By 2018-19, it’ll be £130m.

While there’s been plenty of lobbying at national level for more funding for social care, the talk is of ‘challenges’ and ‘difficult decisions’ – terms that can mask the true significance of cutbacks. In contrast, Kalakeche is refreshingly straight talking about the impact of cuts in his local area. “The more money we lose, the less care we can provide,” he says.

In the quest for efficiency savings, Liverpool’s social care workforce has been cut from 1,300 staff to 760, so far. Next to go will be between 2,000 and 4,000 care packages.

When the cuts have landed, preventative services have often been worst hit, says Kalakeche. While he’s confident Liverpool is providing services to the most vulnerable and has done “pretty okay” on implementing the Care Act, he feels this has been at the expense of services for those with mild to moderate needs.

“We see a number of people who have early onset dementia, aged 55-60 – we used to have preventative services around those clients, but we don’t anymore,” he says.

“What’s going to happen? Those people will get severe dementia and end up in residential and nursing care. This is the challenge I am facing as a director every day – do I direct resources to the neediest or to prevention? The answer has to be the neediest.”

The Care Act 2014 placed a statutory duty on local authorities to consider whether or how a person’s needs can be reduced or prevented, at every interaction with that individual. But as the funding pressures mount, this seems far from achievable.

Kalakeche says the cuts to prevention keep him “awake at night”. He believes removing this layer of support is simply a ticking time bomb. “We’re just waiting for an influx of those [mild to moderate] clients now – in the next five years, or even less,” he says.

‘Where do you stop?’

Yet Liverpool has no choice but to make further cuts. Kalakeche says over the next three years, there will be less supported housing accommodation for people with low level mental health issues and less support within the homelessness service.

“Sometimes you just think ‘where do we stop?’” he says.

“If we don’t do something radically different very quickly we are going to see more and more people without a roof over their heads because the prevention element has gone.

“That’s what really hurts me when I look at where the cuts have to be. It hasn’t affected those with high level needs, it affects those with mild to moderate needs and that hurts because deep down as a director you know it’s not right.”

‘Hammered by cuts’

The “hammering” of the council’s back office, including cuts to its finance, legal and administrative departments, has also placed increasing pressures on social workers.

“Our social workers caseloads have increased and they totally feel that,” he says.

This is leaving practitioners with little room for anything other than ticking boxes.

“I have an open door policy and some of my social workers tell me: ‘I came here to provide care and support and I’m finding myself doing assessment and care planning.

“We are losing that element of ‘social work as the enabler’ because people only have time focus on what they need to do.”

There is a population of 465,000 in Liverpool, served by only 230 qualified adult social workers. The main pressures on teams are the Deprivation of Liberty Safeguards (DoLS) because the council does not have the money to recruit extra staff to complete assessments.

“I’m just waiting to be challenged on it,” Kalakeche says. “People subject to the DoLS are having to wait for their assessment, so I wouldn’t be surprised.”

The council is prioritising urgent work, such as safeguarding referrals, but Kalakeche acknowledges that staff are failing to complete annual care package reviews on time.

“People are sometimes delayed by one or two weeks, and that’s not acceptable really.”

‘Service innovation’

It’s a bleak picture, but there have been some positives, Kalakeche says. By closing 12 day centres and seven residential homes, the council has been able to inject funding into a number of care hubs, which provide short-term reablement support to older people.

“People are able to come out of hospital quicker, stay with us for up to six weeks and then a special team transfer them back to their own home,” he says.

“That’s been very successful – we’ve got approximately 130 beds and the turnover is about 700 to 800 episodes of care, which is really good.”

Two other hubs have also been built to support adults with mental ill health and learning or physical disabilities. These cost £2.5m to set up, but the council has opened the hubs up to the local community in order to raise extra funds.

“We’ve got a spa and we opened an art café with internet for students to come and use,” he says. “We’ve also opened cafés in the three hubs for older people.”

This income goes some way to provide preventative services like outings or social activities, which the council cannot afford.

“It broke my heart to close lots of services, but at the same time austerity brought new innovation and a new way of working in the city,” Kalakeche says.

“The saddest thing for me is that I can’t provide the prevention element of the service, it breaks my heart when people say to me ‘I used to go three times a week to this place and now I can’t go more than once a month, what do you want me to do for the rest of the month?

“I wish I had the answer.”

‘Little solace’

More tough times lie ahead. The 2% social care ‘precept’, a council tax levy introduced under the 2015 Comprehensive Spending Review to raise social care funding, will bring little relief to Liverpool. Most of the city’s housing is band A, says Kalakeche, one of the lowest council tax bands that covers properties worth up to £40,000.

“If we do raise council tax by 2%, we will get £2.4m, which is nothing,” he says. “That amount is not going to support more than 30 people for two years maximum, it’s really not worth it.”

One final question, Kalakeche can answer with more clarity: does he envisage there will come a point in the next few years where the council is unable to meet its statutory duties?

“Yes, most definitely. That’s a discussion I’m having with my local authority. So far, our politicians have made a commitment that we will protect the most vulnerable. But if we keep being hammered financially, I don’t know where else we can get it [the money], I really don’t.”

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8 Responses to Coming face-to-face with the impact of social care cuts you’ve made: a director’s story

  1. Tom J May 11, 2016 at 11:42 am #

    Thank you to Community Care for posting this and thank you to Samih Kalakeche for offering an honest and sobering account.

    Many politicians (and people who vote from them) are being shielded from the destruction and horror of their austerity agenda. We need more directors to speak up.

    We also need a political party to change the current direction of travel and the solution cannot be ‘grin and bear it until 2020′. What current use are Labour councillors if they merely pass on Tory cuts to people like the man in his late 60s mentioned in this article?

  2. Jason May 11, 2016 at 12:25 pm #

    This is what we need – honest, painful accounts of the impossible, stupid and damaging situations this government has created and even now refuses to accept as it’s own work. Who cares if the deficit is coming down (if it even is) – we are all poorer now.

  3. loiner May 11, 2016 at 5:52 pm #

    adult social care is seen as the cinderella of social care. l can honestly say there are some councils that are giving good support to people with learning disabilities and their families. l know of one in the North-East that is winning the hearts and minds of people who have had no faith or trust in social services, because they have changed their methods of working

  4. Sandra Miller May 11, 2016 at 9:30 pm #

    Painful but refreshingly honest account of the impact of cuts.

  5. Old School May 12, 2016 at 1:56 pm #

    Thank you Samih – I am sure many of the Senior Managers in Social Services would like to be as honest and reflective as you are. I think most of us realise that these cuts imposed on Cities like Liverpool are coming from central government and not the senior officials in the council such as yourself.

    The press currently are only interested in this ridiculous ‘in or out’ comedy that deflects from the reality of this governments policy on welfare provision. Actual real harm to people and our communities is being done by the erosion of services on a weekly basis throughout our country.

    What difference will being ‘in or out’ make – none whatsoever!

  6. Blair Mcpherson May 12, 2016 at 2:31 pm #

    Ok so no one wants cuts but what have Directors done to oppose budget cuts. I don’t mean special pleading with in their own LA I mean collectively as respected professionals who know the damage done. Where was the adass?

  7. Get me Out Of Here May 12, 2016 at 5:03 pm #

    Perhaps Comrades Derek Hatton, Tony Mullhearn and Terry Fields had it right back in the 1980s. Maybe it is again time for Civil Disobedience. I am tired of hearing we have no choice, we are just following orders. First the deficit isn’t decreasing its actually increasing as our trade deficit worsens. You need clarity that Austerity is a class project by the 1% aimed at the 99%. The objective being a complete destruction of the welfare state, NHS, public services and the eventual privatisation of what is left. The Tories of the South who vote for criminal tory regime are somewhat insulated from Liverpool and places like it by distance, they will not come face to face with the results of their votes. The Tories have always hated Liverpool and I have no doubt that setting an illegal budget and throwing down the gauntlet of defiance is the only way to fight back. The Tories do not care about the poor, old, young and those born without trust funds. The truth is you are facing class warfare by privileged elites in the South of England. Better to stand and fight then live on your knees. Hatton was right in the 1980s and what you have now reflects the reality of the class war being waged against you.

  8. Hannah W May 13, 2016 at 10:28 pm #

    A very honest account,
    It’s good to see directors and those in positions of authority in the council openly acknowledging risk and the negative effects of cuts, and demands from the Government upon the most vulnerable.
    As well as bluntly admit the negative impact it will have upon society.