By James Balbes
The antipathy that has developed between those who commission and those that provide adult social care services does not work in the interests of the individuals who rely on these services. Rather, it has worked against them with the last few years being characterised by an environment in which judicial review, silent embargoes and a mutual hostility have come to define relationships – at the expense of genuinely collaborative partnership arrangements.
The situation is worsened when inflation and demographic change are taken into account; the Association of Directors of Adult Social Services projected in their annual budget survey last year that, since May 2010, cash-strapped local authorities have cut a combined £3.53 billion from adult social care budgets. LaingBuisson projects that once care home cost inflation is accounted for, older people’s services have seen a cumulative reduction in fees of 5.7% in real terms (not even taking into account changes in the RPI). Learning disability providers and service users have not been spared from the pain with an estimated 90,000 people losing access to state-funded support between 2008 and 2013.
In such an environment, it is easy for the various players in the system to feel as though they have been victimised and to turn on each other. However, the nature of the services that we provide and the fact that external financial pressures will not relent in the near future make it imperative that providers and commissioners come together in the interests of the individuals who use adult social care services.
Care Act changes
Fortunately, developments that have and are taking place can be used to facilitate this transition. The section in the Care Act 2014 on integration, co-operation and partnerships, provides a legislative basis for a co-ordinated approach between providers and commissioners; Commissioning for Better Outcomes – a set of commissioning standards that local authorities can use to assess themselves and each other – offers a framework that can be followed in order to achieve outcomes-based commissioning; and the soon to be published Provider Protocol co-produced by the Local Government Association and provider sector will attempt to improve the manner in which providers and commissioners interact with each other.
All of these improvements are positive, but will be completely futile if not accompanied by behavioural and cultural change. This necessitates providers and commissioners sitting down together to discuss the sufficiency of the cost setting of an individual’s care package, commissioners not creating unnecessary bureaucracy through duplicating regulatory processes, and providers innovating where appropriate to ensure commissioners and those who use services have access to a diverse care market.
If cultural change accompanies the alterations that have recently taken place across the policy framework, then the sector can look forward to a period in which conversations take place about how a care package can be formulated to improve an individual’s outcomes. If, however, the status quo remains, then the bitter divisions that have characterised recent times will remain. This will benefit no one, and the ones who will suffer the most will be the often vulnerable people who rely on adult social care services. This cannot be allowed to become a reality and stakeholders of all stripes must use the tools now at their disposal to ensure that it doesn’t.
Jamie Balbes is policy officer at Care England, which represents independent care providers