A number of questions raised in Simeon's post.
Firstly, the governments SP strategy cannot make any difference in strategic or operational terms as this is only a vague steer. CLG has removed virtually all statutory guidance and statutory directions and has given 85% of all authorities so-called "excellent" status. This means that these local authorities have the 'freedoms and flexibilities' to do in SP as they will. In short SP is a local not a national programme. The fact that 95% plus of all local authorities inspected have NOT attained excellent status by the Audit Commission reveals the nonsense in this central government thinking and 'hands-off' approach.
Secondly, blurring the boundaries. Yes, in theory, joint care and support funding and joint commissioning is the way forward. In theory it is not just justifiable but the best way forward. In practise however all that has been achieved is in many cases the direct opposite. For those services that require care and support funding - and there are many examples - the reality is a nightmare and this mess threatens the supported living model of care as a viable delivery model, to the detriment of all involved. The national imbalance that sees £14bn or so a year in care funding and circa £1.5bn of support funding gong into the same pot and then administered by the £14bn per year budget holders means one thing only - that the £1.5bn is gettiing squeezed to meet shortfalls and deficits in the care funding budgets.
SP brought the notions of "support" as opposed to "care" to the forefront of social policy funding. "Support" from central governments own stated intentions added a preventative agenda to this area - prevention here meaning if "support" is delivered then disempowering aand higher-cost 'care' would not be needed. CLG's own published figures also show that for every £1 invested in SP the public purse saves £1.70 in care and other costs. So, why reduce this preventative budget in the first place, and secondly why lump it in with care funding that doesnt save the public purse? In addition, why do away with SP as a separate and distinct identity as this also does away with the (cost-efficient) entire preventative and proactive agenda? If care funding is both rationed and reactive, which it is, why remove the cost-effective preventative and proactive option and complementary funding stream?
The whole 'blurring the boundaries' issue is really a smokescreen for budget holders as it allowed both care and support budget holders to tighten eligibility. In care at the top end thus denying those vulnerable persons categorised in need of level 1 and level 2 care. SP tightened its eligibility criteria also at the top end of support meaning that high-level and high cost services were no longer funded. The problem with this is made evident when both support and care is seen in a continuum of need and 'help'.
To explain we need to posit both support and care as 'help' and the continuum of need matches 'help' needed as follows.
From lowest (A) to highest (G) 'help' we then see:
A - Low level support
B - medium level support
C - high level support
D - level 1 care
E - level 2 care
F - level 3 care (significant)
G - level 4 care (critical)
All involved in care recognise that category D and E is virtually unfunded nationally due to tightening of eligibility, and in many cases F. In addition SP has to a large extent failed to continue to fund level C. So, currently, we see just A,B, F (partly) and G being funded.
A helluva lot of vulnerable people are being socially excluded on a financial basis. Further the main preventative 'help' (category C) has been removed. As such, the aggregate need for support will increase, the pressure on care budgets increase and for those services that need both care and support such as the supported living model have been adversely affected most by being hit with this 'double whammy' in reduction in both care and support eligibility and thereby funding. Whilst budget holders squabble over who pays, vulnerable service users are getting shafted.
in summary, joint commissioning and joint funding in theory is the best way forward. SP 'enforced' this through its mandated commissioning bodies - a equitable decision-making unit of housing, social services, probation and health. Yet all this has achieved is parochial empire building and fights over who pays that has led to a huge black hole in service provision. The first three years of SP saw from CLG official figures almost 200,000 less vulnerable people receiving support, or about one in six vulnerable people losing all support.
"Supporting" people like "Valuing" people are entire misnomers as vulnerable 'people' are neither supported or valued. Rather they are pawns and constraints in fundholders budget battles
Simeon's post here is in the care home evictions thread. My comments thus far are limited to criticising councils and the impact their decisions have on vulnerable people. To complete the picture the impact on 'deliverers' of support needs comment. SP providers (the deliverers here) dont know whether they are coming or going and significantly cannot plan for the future delivery of services as funding is so risky. Commissioners are seeking to do away with accommodation-based provision in favour of floating or visiting support on the basis that it is cheaper and therefore more vulnerable people can be supported. This is entire nonsense again driven by (applied rigidity of) the theoretical principle that funding should follow the person. In theory of course this is right but it is so superficial.
If you take vulnerable people out of needed accommodation-based provision that caters for both planned and reactive support and reduce both the intensity of suport and the frequency of support then their needs dont reduce and often increase. What happens in practise is the demand for AB support increases at the same time that supply reduces - Result is even more pressure in terms of cost and in terms of need - yet another double whammy.
The fact that visiting support per hour costs more than AB support seems not to have been taken into account by commissioners. Yet official figures show this clearly and reveal that floating or visitin support costs between 10 and 30% higher than AB support. Simple arithmetic reveals that a fixed pot of money buys less floating support hours than AB support hours. It is also the case that a worker must deliver less support hours in a visiting service than in an AB service as the time involved in travel, etc has to be taken into account. The fact that an AB service can respond more effectively and quickly than a visiting service - often stopping perceived problems escalating - also has not been taken into account.
In reality the superficiality of funding following the person is exposed. In theory it sounds goods, in practise it leads to less actual support, a reduction in the quality of support, a reduction in the frequency of support, a reduction in the operational effectiveness of support - all at a higher cost! While commissioners continue to have such nonsensical theoretical principles driving their thinking vulnerable people get shafted and so does the public purse.