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We've reported today on Age UK's research showing a £500m increase in the funding gap for older people's social care in the past year. The news story gave no indication as to how they reached this figure so I thought I'd do it in a blog post. Forgive the Q&A format for those who find that irritating

What is the basis for the £500m figure?

It is the gap between how much councils needed to spend on older people's social care in England in 2011-12 to maintain services at the same level as in 2010-11, and the amount that they actually did spend. In this case, between £7.8bn for spend required and £7.3bn for spend delivered. (All of the comparisons below between 2010-11 and 2011-12 show changes in real terms i.e. inflation has been taken account of the equation by basing all figures on 2011 prices).

How was the £7.8bn figure reached?

This was based on research carried out for Age UK by the Personal Social Services Research Unit at the London School of Economics, specifically Julien Forder and Jose-Luis Fernandez who are recognised experts on adult social care economics.
The £7.8bn figure is split into two parts: service costs (£7.0bn) and care management (£0.8bn). Forder and Fernandez calculated that service costs needed to rise from £6.8bn to £7bn from 2010-11 to 2011-12 to keep pace with rising demand/need for care due to demographic change. With a nod to the very tight financial environment that councils are in, they calculated that this could be achieved while massively cutting spend on care management, by 27%, from £1.1bn to £0.8bn. We'll return to this cut later.

How was the £7.3bn figure reached?

This is a bit more complicated. Government figures (from the Department for Communities and Local Government) show councils spent £7.645bn on older people's social care in 2010-11 and are on course to spend £6.961bn in 2011-12. The latter figure excludes the £648m transferred to councils from primary care trusts to spend on adult social care, as mandated by the Department of Health. Age UK has assumed that all of this money has gone on adult social care and been allocated between clients aged over 65 and under 65 in line with existing spending patterns. This mean 51% has gone on older people, boosting council spending on the group by £330m, which, when added to £6.961bn gives you the £7.3bn figure.

Has Age UK overestimated the decrease in spending on older people's social care?

It quite possibly has. I would be very surprised if the £648m transferred from PCTs has been spent as Age UK assumes. This funding is intended to be used to support services at the boundary between health and adult social care that help keep people out of hospital or enable them quicker discharge from hospital. Spending on these services - reablement, falls prevention, intermediate care etc - is concentrated on older people to a greater extent than adult social care as a whole. Therefore you would assume that more than 51% of the £648m has gone on older people.

Moreover, the NHS was allocated £150m in addition to spend on reablement services. We have no idea how this money is being spent. But it is a fair assumption that most of it is going on social care for older people. Also, a further £150m was allocated to PCTs in January to spend in conjunction with local authorities in a very similar way to the £648m figure.

All of these point to Age UK overstating the decrease in funding on older people's social care, so the £7.3bn figure could be, say, £7.5bn.

Has Age UK overestimated the increase in the funding gap?

No, not necessarily. The £7.8bn target spend figure is based on the assumption of a 27% cut in care management costs for older people from 2010-11 to 2011-12. While care management has been cut back, a reduction of this magnitude is highly unlikely. A more modest decrease in care management costs, from £1.1bn to £1bn, would leave a target spend for 2011-12 of £8bn. Were actual spending to be £7.5bn, you'd still be left with a £500m increase in the funding gap.

The £8bn and £7.5bn figures are totally notional. They are just designed to explore the assumptions used by Age UK and to suggest that any risks in these may cancel each other out.

Bit of a news round-up this morning rather than one of my lengthy rambles:

Adult social care funding

The government has been urged to implement the Dilnot commission's proposals on care funding reform by chiefs of 41 councils across the South and Midlands, amid ongoing concerns that it won't, reports The Daily Telegraph.

Meanwhile, the Local Government Association has awarded £1m to 50 councils in a bid to generate £50m in efficiency savings in adult social care. Under its adult social care efficiency programme, the authorities will be supported to implement measures that have been proven to release savings.

Sacked sheltered housing manager

A sheltered housing manager - sacked for breaching moving and handling policies when helping an incontinent resident on to a commode so she could wash her - is seeking to appeal against a tribunal decision that she was not unfairly dismissed, reports The Evening Standard. More than 3,400 have signed a petition in support of Sue Angold.

Direct payments, fraud and abuse

This Guardian article on the risk of financial abuse and fraud from personal budgets and direct payments (and this related one about how poor direct payment monitoring was identified in a serious case review of a service user's murder by his son)  is generating quite a lot of chatter. Top social work blogger Ermintrude2 has done a strong blog post on this topic today, arguing that it is wrong to link risk and abuse to any particular method of delivering social care (i.e. personal budgets) and there is no evidence to suggest that personalised methods of delivery are more risky.

Carers charities merge

The Princess Royal Trust for Carers and Crossroads Care are to merge in April. The charities - two main providers of services for carers - have long worked closely together and, in the current climate, the merger is no surprise. Princess Anne - president of the trust - will be president of the new, as yet unnamed, charity.

(Blog updated 3.45 16 Jan 2012)

Lots about care funding in the news today so it's worth trying to unpick what's going on. Here are the main lines in descending order of importance:-

• The government is considering imposing a cap of between £50,000 and £60,000 on people's lifetime care costs, with the state picking up the bill above this point, reports The Daily Telegraph. This is significantly above the £35,000 cap proposed by the Dilnot commission last year and hence quite a bit cheaper for the public purse.
  
• Cross-party talks on forging a solution on care funding are due to start tomorrow, reports the BBC, the first such talks since the acrimonious breakdown of discussions before the 2010 election over Tory allegations of Labour plans for a "death tax" to fund care.
• Three-quarters of people support a cap on lifetime care costs as proposed by Dilnot, an Age UK survey has found, reports The Daily Mail.

The latter is hardly a surprise: who would not want more rather than less help from the state?

As for cross-party talks, who knows? Labour's current position on care funding is unclear and expecting health secretary Andrew Lansley and care services minister Paul Burstow to come together with Labour's Andy Burnham and Liz Kendall on social care when they are at daggers drawn on the government's NHS reforms may be asking too much. But let's be optimistic.

The idea of a £50,000-£60,000 cap is more worrying. Andrew Dilnot (left) was not theological about having a £35,000 cap but instead proposed a range of £25,000 to £50,000. However, he said that £35,000 was "fair and realistic" and that anything above £50,000 would not be fair, on the basis that people with lower levels of wealth may not receive adequate protection from the risks of needing social care.

A £60,000 cap would cut down the bill to the Treasury of implementing Dilnot from £1.7bn a year to about £1bn a year.

However, it would mean the reforms would fail a key test: namely, protecting people from the risk of high levels of care costs in older age.

£60,000 is a considerable sum (and it's worth noting that the cap excludes living costs in residential care, which would be additional to the £60,000); a cap of this level would make people far less likely to save or take out products to insure themselves against future care costs (another key goal of the Dilnot package), meaning that a market in such products would fail to emerge; and while making little difference to wealthy families, would hit those with moderate levels of wealth (for whom the difference between £35,000 and £60,000 is most significant).

(Updated bit) The DH has now distanced itself from the £50,000 to £60,000 figure in a statement to this Guardian story. The story also provides a useful link (see emerging findings on this page) to the source of the story: a paper in November by one of the groups feeding into the government's engagement process to shape the forthcoming White Paper on care reform. 

Contrary to what I have said above, this group, which was looking at the role of financial services in the care system, suggested that a cap of this level could stimulate people to save for their care and encourage the financial services sector to develop suitable products to enable them to do so. However, it's also clear that this figure was also given with a nod to making care funding reform more affordable for the public purse.

The group, which included civil servants and representatives from the social care and financial services sectors, also said more analysis was needed on the impact of different levels of cap. Hopefully, this is being done now and the results of this - rather than efforts to keep the overall bill to the state down - which shapes the White Paper.

Another day, another report on integration for the government, this time from the NHS Future Forum (the advisory body set up to inject common sense into the government's NHS reforms).

The proposals are pretty similar to those put out in last week's report from think-tanks the King's Fund and the Nuffield Trust: strong support for social care and the NHS to be measured against the same performance indicators, for pooling budgets and commissioning and for building services around patients' needs.

Notably, for professionals, there is a call for every person with long-term conditions to have a named care co-ordinator, who could be a social worker.

The government has, largely, accepted the proposals.

However, the question is, will this work where other initiatives to do the same over previous decades have not? 

Social care academic Bob Hudson thinks not, in a powerful piece for The Guardian today, in which he argues that the whole issue is being looked at from an NHS perspective (with adult social care seen as the "handmaiden" to the health service), weakening its potential impact.

More significantly, he says the agenda amounts to yet more exhortation for health and social care organisations to integrate - precisely the approach that has failed for 40 years, he says.

Also, he notes the big tension in the government's NHS reforms between competition for business between providers and integration of care pathways for patients.

Not an easy square to circle, he says.

I fear we may be revisiting this topic with another mountain of reports in years to come.

(Added 13 January: Just spotted this blog post from social worker and psychotherapist Claudia Megele about the government's integration plans, which raises important concerns about the compatibility of these with other government actions, such as the injection of greater competition into healthcare through the Health and Social Care Bill).

Happy New Year! I returned to work today to see social care at the top of the news headlines.

Social care's great and good have written an open letter to the prime minister (in the Telegraph) urging that he and his fellow party leaders deliver on social care funding reform this year to put an end to indignity and isolation for older people, dependence for disabled people and the denial of life opportunities for carers.

It's great to see social care on the front pages and at the top of news bulletins, and you cannot fault the timing: this is, of course, the year in which the government publishes a White Paper setting out how it plans to reform social care, including its funding. Moreover, cross-party talks are due to start.

Before Christmas, we predicted that the government would not deliver on social care funding reform, specifically that it would not implement the proposals of the Dilnot commission to put a £35,000 cap on lifetime care costs for all because of the £1.7bn bill.

An optimist might argue that we made the wrong call, and that the festive period showed that both government and opposition were up for making social care funding reform work.

On this line, Labour has shown how much of a priority it puts on social care by putting out research over Christmas showing how much charges for home care and other community services had risen in the past couple of years (6% for home care). Releasing the research, shadow minister for care and older people Liz Kendall urged Cameron to engage in serious cross-party talks on reform. The positive narrative would also point to action from government in the shape of a £170m injection of cash into social care services for people discharged from hospital to manage winter pressures over the coming months.

This money - one-tenth of the cost of Dilnot - was found from Department of Health savings but meeting the full cost of Dilnot is a call that only the Treasury (and Number 10) can make. Moreover, whatever the pros and cons of the Dilnot package it doesn't, in itself, purport to solve all or most of the problems outlined in today's letter to Cameron.

This is because Dilnot is about expanding the existing publicly-funded social care system to cover self-funders (who would benefit from the cap); it is not about filling the funding gap in the existing system (put at £2bn to £4bn), which manifests itself in rising charges and eligibility criteria, squeezes on providers and inadequate quality.

This £4bn-6bn black hole (Dilnot plus funding gap) is not the whole story. As the government, councils and the sector know, the way social care operates needs fundamental reform  through better integration with health and housing, more personalisation (in the widest sense) and more intelligent commissioning. This should generate efficiencies that would reduce the Dilnot plus funding gap black hole from £4-6bn a year to something less than this.

However, I very much doubt that even the reduced figure would be something the Treasury would stomach, particularly in the current economic climate.

That is why I remain a pessimist - though I would be beyond delighted to be proved wrong.

Over a million pensioners are facing Christmas alone, according to Dying Matters, the coalition dedicated to designed to improve attitudes to dying and death. Today it is launching a campaign asking people to look out for and call in on older neighbours and relatives who are on their own, particularly those who have been unwell or bereaved in the past year.

Professionals supporting people at the end of life may want to check out this online resource from the Social Care Institute for Excellence, bringing together publications, videos and other training materials on the issue.
In the video above Scie practice development manager Pamela Holmes uses an example from her own experience to highlight the importance of the information hub. She has also posted a piece about this.
Also today, the National Institute for Health and Clinical Excellence has published a quality standard on end-of-life care, setting out what service users should expect from health and adult social care provision.

Among the standards are:-

• That people approaching the end of life are offered a comprehensive, holistic assessment and a personalised care plan.
• That they are offered timely, personalised support for their social, practical and emotional needs.
• People in their last days of life are identified in a timely way and receive co-ordinated care in accordance with their personalised care plan.

Worth a read when you have a moment.