Academic Trish Hafford-Letchfield examines research that casts light on the impact of the recession on local authority adult care services
KEY WORDS: Adult care ❙ Funding ❙ Abuse ❙ Personalisation
AUTHORS: Ruth Chamberlain, Diana Sanderson, Jacqueline Curtis, Liz Newbronner and Caroline Glendinning.
Aim: To explore the impact of the economic slowdown and its effects on adult social care and support services both positive and negative.
Methodology: A qualitative study based on a sample of four local councils in different parts of England. Data from telephone interviews with staff in finance and commissioning, council members and providers was validated by comparing findings with views from national organisations and other local authorities as well as relevant research findings.
Conclusion: There was increased reporting of abuse, and significant rise in people presenting with debt, mental health, employment and housing problems. Concerns were expressed about the impact of increased competition particularly on personalisation. There were mixed views about the impact on creativity and agency partnerships if the latter became more inward looking. Overall, the exact impact was difficult to assess because other factors such as demography and increased public awareness of safeguarding were mitigating factors.
The Local Government Association funded this study to gain an in-depth understanding of the impact of the economic slowdown on social care particularly as it moves through its different stages It explored how this interacts with personalisation and to understand the different factors influencing how services are actually developing.
A key aim of the research was to document some of the issues arising early on in the recession to try to capture and then predict any specific vulnerability in social care and how at a local level, organisations could ride the storm.
Findings and analysis
There were concerns from councils about pressures on their income from service user debts, requests for deferred payments and those no longer eligible to pay. Inability to sell homes, loss of interest on savings, not being able to rely on families and inflation appeared to be affecting older service users disproportionately. This may be linked to increased reporting of financial abuse, stress and anxiety and demand for services. Local authorities were finding it difficult to negotiate lower payments with providers which affected top-up fees.
It was difficult to relate any rise in requests for assessments to the economic downturn because factors such as changes in demography; increased performance reporting and perhaps a greater awareness of social issues as a result of campaigns on social care issues, were also present.
Eligibility criteria had been affected. This was seen by those in the third sector as being cost-driven and not matched by a corresponding increase in funding. This gave them less capacity for providing informal support. Voluntary sector providers reported unease about the renewal of their contracts and their future funding. Three of the four authorities reported increased reports of domestic abuse and safeguarding.
Councils reported acute rises in numbers seeking job seekers allowance and made links between unemployment, homelessness and health and well-being. While it was too early to judge, there were some indications that disabled people might be affected disproportionately in situations where there is a decrease in opportunities for work and support to re-enter work.
No local authorities had given formal directives to make reductions to care packages but it was anticipated that the economic downturn would sharpen this approach in future. Although supply seemed stable, a range of factors were “starting to bite” – such as a shortage of specialist providers, local closures of care homes and suitable flexible recruitment.
Councils had been warned not to use the ring-fenced social care reform grant for personalisation to meet existing service pressures. However, some anecdotal evidence confirmed impact on direct payment recipients. For example, some councils had cut back on the amount of money given directly to service users and placed restrictions on how they might spend it. There were mixed views about the impact on personalisation ranging from having to be more creative and innovative with fewer resources as well as recognising that the savings from self-directed support can only be realised when people are enabled to be more creative.
Some of the voluntary sector participants, however, expressed doubts about the sustainability of personalisation and were suspicious that it could be used to make cost-savings given that it is expected that those using personal budgets will spend less on care than councils might traditionally.
Other areas explored were the potential for participants in strategic and local partnerships to become more inward-looking; fewer resources available for developing public engagement and prevention; and the challenges for sustaining local pay and conditions with affects on staff morale.
Since this research was undertaken, there have been further and more dramatic shifts in the government’s economic policy. This was reflected in some of the perceptions of those interviewed in the research that referred to “the calm before the storm”. Its findings are useful and valid but represent just the hors d’oevres.
At face value, the 2010 Spending Review appeared to sustain investment in adult social care. However, the combination of pressures including a failure to ring-fence funding for adult social care or to invest in related areas, makes commitment to radical reform more rhetorical than reality. This report highlights the complex interactions between local issues and how choices made here can dramatically impact on the wider health and social care system and its wider community. Yeats et al (2011), for example, have made strong economic arguments for how social care investment has the potential to reduce spending in other areas such as prevention, more integrated sites for provision and co-production.
As a snapshot of how the economy affects all of us, this research report is invaluable. The four case studies enabled detailed examination of the evidence through a range of stakeholder perspectives and presented pertinent and coherent themes in relation to a number of issues of interest to those responsible for managing the future direction of adults’ social care. The authors acknowledge the limitations of what can be learned from such a snapshot so further interrogation of these issues through ongoing research is strongly indicated.
● Thinking about ways to invest in and develop more sustainable services through individual or collective purchasing power makes this report recommended reading. It could form the basis for local team discussions when discussing resources or as a training tool to encourage the mapping of local needs and services.
● Managers should work together through difficult times to ensure that they achieve the right outcomes when meeting public and political demands. For example, they need to recognise that by reducing or ending contracts with voluntary providers, service users could develop further problems where they are no longer accessing regular or adequate support, there could be costly severance clauses and further down the line, the need for more costly services perhaps including health.
● Careful consideration of both short and long-term consequences will help avoid negative choices and reflect a need to be more creative in deploying resources.
● Commissioners and voluntary sector providers can use some of the findings to improve their business planning processes for example by realising the importance of sharing information about commissioning intentions to influence service provision and the development of policy, particularly around personalisation. Harmonising the commissioning process through principled conduct, procedural fairness, openness, trust and information exchange in negotiations with the independent sector can help all those involved in delivering services with less risk and more confidence.
Trish Hafford-Letchfield is a teaching fellow at Middlesex University
● Yeates N, Haux T, Jawad R, Kilkey M, (eds) (2011) In defence of welfare: The impacts of the spending review. Social Policy Association
More research at Community Care.co.uk