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’
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.”
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.”
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.”