The government’s funding settlement for adult social care will not be enough to meet existing shortfalls or future cost pressures and risks causing more unmet need, service failures and hospital admissions.
That was the warning today from local authority, NHS, provider and charity leaders in a letter to cabinet ministers urging immediate talks designed to find additional funds for the sector.
Extra money
Contrary to predictions, chancellor George Osborne announced additional, targeted money for adult social care as part of the spending review, which has set government funding limits from 2016-20. This was from two sources:
- Additional money for the Better Care Fund – the integrated health and social care budget – paid directly to local authorities and rising to £1.5bn a year by 2019-20.
- The opportunity for councils to raise an additional 2% a year through a council tax “precept” with the money going to adult social care alone. If all councils did this in each of the four years of the spending review, the government estimates it would raise almost £2bn a year by 2019-20.
Despite this additional money for adult social care, overall, local government is due to see its funding fall by 6.7% in real terms from 2016-20.
In their letter to Osborne, health secretary Jeremy Hunt and communities secretary Greg Clarke, the Association of Directors of Adult Social Services (Adass), NHS Confederation, Care and Support Alliance (CSA) and Care Providers Alliance (CPA) warned that the money would not be enough to deal with current and future pressures.
Settlement will not resolve funding crisis
These include the impact of inflation, increasing numbers of older and disabled people and the new national living wage, which comes into force in April next year, on care costs.
“We believe the package put forward for social care will not enable us to fill the current gap in funding, cover additional costs associated with the introduction of the National Living Wage, nor fully meet future growth in demand due to our ageing population,” said the letter, signed by Adass president Ray James (pictured, above), among others.
“There are also additional pressures that arise from the costs of regulation, cost of emerging policy, pensions and many others. Without concerted action across government and the sector, the settlement is not sufficient, not targeted at the right geographies and will not come soon enough to resolve the care funding crisis.”
The associations called for further talks with the Treasury, Department of Health and Department for Communities and Local Government to help “avert the crisis” in social care. Without additional money in the settlement, they warned that there was “potential for significant and adverse impacts”.
Service failure and unmet need
These included:
- An increasing number of older people, disabled people and their carers without any, or without sufficient, support to meet their needs.
- An acceleration of the failure of domiciliary, residential and nursing home providers, which would happen mostly in areas where most service users are state-funded and which are also the areas least likely to benefit from the council tax precept.
- An increasing pressure on the NHS with more people admitted to hospital and more delays to get people home safely.
Council tax concerns
The letter follows analysis suggesting that the council tax precept will raise less than half of what the government predicts – just £800m by 2019-20 – and its benefits will accrue disproportionately to well-off areas. Poorer areas will be disadvantaged because they have less ability to raise funds from council tax.
As reported in The Observer, the King’s Fund found that it was highly unlikely that all councils would levy the full precept in every year as some council leaderships had been elected on a platform of not raising council tax.
The letter from Adass, the NHS Confederation, the CPA and to ministers also raised concerns about the council tax precept, asking ministers how it could be ensured that it delivered the money required for adult social care and did so equitably between areas.
Funding will come too late
The letter also warned that the money from the Better Care Fund would come too late to be of significant benefit. There will be no additional BCF money in 2016-17 and sector leaders are concerned that most of it will be provided in the later years of the spending review period, 2018-19 and 2019-20.
The associations also asked for clarification on how the government had funded the additional costs of the national living wage through the spending review. The new wage floor for people aged over 25, set at £7.20 an hour next April and due to rise to over £9 by 2020, is due to add about £1bn to council adult social care costs by 2019-20.
The letter comes ahead of the local government settlement, which will set out in more detail how much money councils will receive from government in 2016-17.
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This is quite a significant group of public sector bodies. Maybe they can knock some sense into Georgie baby boy before elderly care falls off the cliff. It is teetering on the edge right now. All it needs is the puff of wind that Georgie has blown and the effect will be very interesting.
Watch this space
The “crisis” of social care is built into our current system, and it is not primarily a cash and cost crisis. More money will simply help the current system to last a bit longer and thereby convince all those who are now begging for more that yet more is needed the next time round. The well intentioned but short-sighted people and organisations pleading the funding case have been part of maintaining this upside-down system.
For example, the ever expanding dictates and demands of the regulators, based on a universal expectation of failure, command a high proportion of providers’ resources simply to satisfy the regulator. While, with increased fees, care home residents (or the local authorities who pay for them) may be paying nearly £4 a week to the regulator (for what?), they will be paying at least twenty times more for the home to “evidence” compliance with the regulator’s demands. Even though the care may be good, a home that falls short of providing such evidence may go out of business putting further strain on the system.
Compliance with regulation is only the beginning of these unwarranted costs because there are many linked subsystems and “improvement agencies” which all have to be paid for and consume the time and effort (and talent) of social care providers. In England, Skills for Care received c £1.5m from DoH to run the development programme for social care managers, but they’ve virtually closed down the programme when it was just getting going. Vast sums of money go into such schemes. Consultants, trainers, and bureaucrats feed off the sector, while the workforce and their managers, and most importantly the clients are starved of resources and are usually blamed for the failures of a system that can never be made to work.
If we want a system that works, we have to design and build it from the core task of care and make it work at a local level with all the other services. Some fine organisations manage that against all odds, even now.
There are too many duplicated responsibilities and the aim of achieving cooperation between Health and Social Care will not be assisted by this.
Also, there needs to be an understanding of what is ‘good enough’ within care provision. ‘Excellence’ costs and there is no justification for creating a competitive ethos within provision-all people using the health and social care services should receive good standards of service.
This does not mean that services should not be inspected by what should be an independent body. Failures such as Winterbourne View show how even with inspection there can be extreme failures within care, so vigilance remains essential.
References to failing service providers needs to take account of the fact that many of these are profit-making and so can ‘fail’ whenever they start to lose money. Another very important consideration in this area is the fact that standards within such services can only be achieved by having properly trained and dedicated staff, and not a large turnover of staff as is often the case.
Who can blame those staff? How committed would anyone be to working long hours, often out-of-hours in terms of what would be considered an ‘office day’ and dealing with the needs of vulnerable people for, often, a very low wage?
Surely concentration on meeting people’s basic care needs has to be the first priority. Having health and social care agencies chasing statistics which get them ‘stars’ or any other form of recognition for simply doing what they are meant to do in any case, i.e. assess, protect, provide, enable, investigate, diagnose and treat…….etc. is a total waste of time and resources. It has also led, in my personal experience, to an expecation that management merely need to concentrate on producing certain statistics to show that things within organisations are happening when, in actual fact, those organisations are failing in certain areas.
To reiterate what has been said many times before, there are ‘lies, damned lies and statistics’.
As Head of Care for a well known Company, I am looking at the other side of the fence from the Customers point of view in relation to the extra work that I have to put in to help and reassure people who receive care in the Community. We all understand the pressures that the social work team have been put under with the cuts…. but the pressure that the people have been put under to accept less care, less support and less input is deeply frightening. It’s not going to be long before a provider will be sued/fined/given a safeguarding because somebody is drastically hurt in a fall because of lack of supervision or worse. But the very fact that our elderly and vulnerable people in society are at the receiving end of these cuts is extremely disgusting and fills me with anger that the majority of these people fought wars to give us this right to do this to them.
I totally agree with Alicia, whilst LA’s and Health Authorities get more and more money they continue to reduce funding to the Private Sector, thus , through means testing etc ., make the Public pay themselves for Care which should be paid for by the State.
All our elderly have paid all their lives for Care in their old age only to see it squandered by the Public Sector (All of whom are on large pensions of course)