Enablement could help adult care through downturn

    With cuts looming over adult care budgets, Geoff Ettridge ponders how enablement programmes to help service users retain independence can help councils manage budgets.

    Every local authority is now wrestling with the challenge of setting a budget for 2010-11 and beyond. Some estimates are that adult social care budgets may need to be reduced by more than 1%; set within the context of inflation and increasing demands, this represents a significant reduction.

    Councils are also having to take steps to ensure their in-house services do not become a drain on resources as more of the social care budget is allocated through individual budgets.

    In the unlikely event of individual budget schemes allocating enough funding for someone to afford to purchase an in-house service, they may choose not to. In this situation a council could find itself paying twice for the same service.

    Many local authorities have become adept at setting budgets in difficult times and their managers skilled in using various techniques to remain within them.

    These have largely included unspecified efficiency savings, rationing access to care, holding job vacancies and the “robust” ­management of contract prices for ­providers.

    As effective as these devices have been, it is questionable how long this approach can be sustained. Apart from not tackling fundamental budget problems, it can slowly erode the quality of services.

    The challenge for all public sector services will be to make less go further.

    All local authorities now have Fair Access to Care arrangements in place that ensure services are provided to those with the greatest needs.

    If access cannot be restricted further, strategies will need to be adopted to delay the onset of dependency, maximise independence and help people retain or regain their independence.

    Councils have gained considerable ­experience of running enablement programmes. Although mainly pilots, evidence is emerging that they can reduce the level of care someone may require or delay the need for continuing care.

    Some were intake services for new clients and others focused on the discharge of people from hospital. But none appears to have sought to reduce the care needs of people already receiving a care service.

    Enablement

    The mainstreaming of enablement services will not in itself be enough and services will be required to ensure that people are accommodated appropriately, have enough income and that they are not socially isolated. The need to address these issues is recognised by local authorities who, through partnerships, run benefit take-up campaigns, invest in community alarm systems and commission additional extra-care accommodation. But failure to integrate these initiatives into a wider network of community support services could undermine the durability of the benefits gained for users from participating in an enablement programme.

    Although local authorities are not yet in a position to put their 2010-11 budget proposals into the public domain, some are looking to pull together their work on enablement services and the transformation of social care through the Putting People First programme.

    It would be a mistake to underestimate the effort and investment that will be needed to close or externalise in-house services and to implement a care system that will need to focus on reducing people’s care needs. Practitioners will need to be made more accountable for the effectiveness of their interventions and managers will need to balance controlling unit costs with the need to provide services that will reduce the costs of someone’s overall “care career”.

    It appears that county councils may be better placed to fund project teams to deliver these changes. But all authorities will need, at least, to ensure that what remains of the social care reform grant – provided to implement Putting People First – is used not to offset immediate budget pressures but to reform services and their provision.

    Geoff Ettridge is an independent adviser on care services

    This article is published in the 3 December issue of Community Care magazine under the heading Budgeting less for more

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