“In a time of famine, reform is absolutely essential, rather than the alternative, which is to slash, burn and retrench.”
These were the words of care services minister Paul Burstow (pictured above) at the Liberal Democrat conference two weeks ago when he attacked councils for cutting care spending before the outcome of the spending review was known.
Burstow also attacked as disgraceful the low proportion of adult service users with access to personal budgets – just 13%.
He did not deny that it would be difficult to achieve the efficiencies that chancellor George Osborne is looking for.
His answer will be the vision for adult social care, which will map out how the efficiencies can be delivered without affecting care – in other words how more can be done with less.
It is currently under development and will be published during the National Children’s and Adult Services conference in Manchester next month.
This will come alongside a refreshed Putting People First strategy, on which the Association of Directors of Adult Social Services is currently working.
The vision is being developed in parallel with the spending review and with the health White Paper outlining a brave new world for the NHS.
A Department of Health source said it will contain messages about personalisation and choice and control with personal budgets being further developed.
This will be combined with themes on Big Society, integrated working with the NHS, voluntarism and volunteering, as well as efficiencies through the use of assistive technologies.
The themes largely represent continuity with the Labour government’s vision. The difficulty is in the delivery at a time of massive cuts.
Richard Jones (right), president of the Association of Directors of Adult Social Services, cautions: “I don’t think the vision will be able to impact significantly on the kind of considerations councils will have on the spending review.”
This underlines the core problem. Adass’s submission to the spending review said that adult social care had already delivered radical change through major outsourcing and the focus on personalisation.
Furthermore: “No one has identified how savings of almost £6bn from adult social care could be achieved Any attempt to get close to this sort of reduction would have significant adverse effects on very vulnerable people.”
Adass and Jones recognise that further radical change is required, including next year’s report from the commission into long-term care funding, but this does not solve the immediate dilemma.
Jones suggests some efficiency gains can be made in councils’ personalisation processes. His hope is the vision will talk more about how an integrated approach with health can be further developed in the context of the health White Paper.
However, he says: “Reform takes time and doesn’t necessarily deliver the immediate balance.”
Richard Humphries, senior fellow at the King’s Fund, says that despite a deepening personalisation agenda, the cuts “will sharpen councils’ care role in relation to safeguarding and will leave them with a residual role for sorting out care for the poorest.”
The only answer was a complete transformation of the system, complete with a new funding settlement, but this will not appear until 2014-2015.
Personalisation consultant Jeremy Cooper, of iMPOWER, was similarly doubtful.
Its modelling suggests that 10% to 15% can be saved through more personalised processes creating efficiencies, but such a transformation would take a three-to-four year period.
“Any more [cuts] than that and you are going to be talking about stopping services out of the new social care offer.
“I wouldn’t say that stops you having a personalised solution but it means you have to take more out of it,” he says.
John Bolton (right), the former director of strategic finance at the DH, warns the scale of the challenge to reform systems should not be underestimated, and nor should the gains from reablement services and telecare be overestimated.
“Assistive technologies can’t do everything. We’ve not yet got robots to do the personal care tasks,” he says.
The health White Paper, which is facing increasing opposition from GPs, is a further fly in the ointment.
Burstow wants to see further integration between health and social care to bring about efficiencies.
But Jo Webber, deputy director of the NHS Confederation, warns that the upheaval caused by NHS reform could damage joint working with a retreat to the silo mentality.
Webber says: “The danger during the interim period is retrenchment of social care because of the cuts in local authority budgets and taking our eyes off the integration agenda.
“If the vision doesn’t enable us to have a clear direction of where we are going, then we will have missed the point.”
So having a vision is one thing. But without the resources to back it up, a vision is meaningless.
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