The short-term outlook for adult care is very bleak, Stephen Burke, outgoing head of older people’s advice charity Counsel and Care, tells Vern Pitt. Yet he retains some optimism
Counsel and Care chief executive Stephen Burke is stepping down from his role as the adult care sector faces one of its biggest challenges in decades cuts of 25% or more to government funding from 2011-15.
All will be revealed in less than two weeks when the government publishes its comprehensive spending review and, like many, Burke is fearful about the impact it will have on older and disabled people.
"We have a care system that is already in crisis and it looks as though it is heading towards meltdown," says Burke, who is leaving Counsel and Care after six years at the helm to move to Norfolk where he and wife Denise plan to set up a social enterprise.
He points to the fact that councils are already proposing to increase care charges and raise eligibility thresholds for care, even before the spending review reports, and is stark about the implications of these policies.
"We are heading towards a service that will just meet the needs of those with the very highest needs. It won't be strategic in terms of helping people earlier and helping them through prevention," Burke says.
But while he warns that things could get much worse as the spending review cuts take hold, he does see some room for optimism.
He believes the abolition of primary care trusts, which the government outlined in its NHS White Paper in July, could help generate long sought-after efficiency savings from joining-up health and social care.
GPs, who will take over responsibility for health commissioning, will need to bring in commissioning expertise in order to perform this role. Councils already have this, says Burke, so they could fill that void.
"Local authorities can use the opportunity to commission strategically across health and social care; that will also help them with the financial situation."
Hammersmith and Fulham Council - the authority that Burke led when it was under Labour control - has already provided a model for this approach by appointing a joint management team with its PCT, he says.
The other big saving opportunity Burke sees is in the provision of information and advice to people needing care. Alongside its national advice service, Counsel and Care also works with two councils providing more tailored local information services. Burke says that only through ensuring people spend their own money wisely can councils hope to prevent them falling back on public resources.
Some older people are choosing to go into expensive residential care quite early, he says. They need to be put in touch with financial planners to ensure they can pay for this for as long as possible before they come within the ambit of means-tested public support.
Improved information is a key component of the personalisation agenda, alongside personal budgets for service users. Some in the sector argue that users choosing and purchasing their own care will do so more cheaply than councils commissioning less tailored services on a bigger scale.
Burke says the "jury is still out as to whether, personalisation, per se, saves money". He warns that the agenda itself is in danger of going into reverse as councils tighten eligibility thresholds, because "rationing undermines the whole drive towards personalisation".
Like many in the sector, Burke's hopes for a renewed care system rest on the Commission on the Funding of Care and Support, which is examining how services should be funded in future. It is due to report next July, informing government legislation next autumn.
He points out that any recommendations the commission makes will not, most likely, take effect until social care has been through the ordeal of the 2011-15 spending review period.
"We have to ensure the care system we have is sustainable until then," he concludes.
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This article is published inthe 7 October issue of Community Care under the heading 'We could be facing care meltdown'