When Ray James was appointed president of the Association of Directors of Adult Social Services last year, his predecessor, David Pearson, said the role taught him to “dance in the rain” such were the severity of the “storms” facing social services.
James will tomorrow finish his term as ADASS president, having steered the organisation through a difficult year (or better put, another difficult year) for social care.
There have been chinks of light. James welcomes the fact frontline care workers will receive a higher income through the new national living wage. He’s also glad efforts to improve both dementia care and mental health services gained more profile and traction last year.
Yet, as Pearson predicted, there have also been plenty of storms for James and his colleagues to weather.
Pressures on services
Directors faced the pressure of implementing the Care Act and handling the ongoing fallout from the landmark Cheshire West ruling on deprivation of liberty, all with dwindling resources as council budgets were squeezed yet again. Meanwhile, concerns over the financial sustainability of care providers led to fears the sector could see a repeat of the 2011 collapse of Southern Cross.
With a new majority Conservative government coming in last May and a five-year spending review settlement following months later, efforts to convince ministers to address the funding pressures facing social care understandably featured heavily on James’ to-do list.
He says he’s particularly proud of the way agencies across the sector – user groups, providers, professional bodies, charities, trade unions among them – joined forces to present a strong, united argument to government on the importance of social care and the risks it faces from a lack of investment.
Speaking with one voice
“We have continued to speak with one voice through a spending review and all sorts of other difficult periods, and that has been helpful,” he says.
“I think the government has listened and we probably got more recognition for social care in this spending review than any previous one.”
Yet more recognition for social care in the latest spending review, is not the same as enough recognition.
The government agreed to give councils the ability to use a new social care ‘precept’ – allowing an additional council tax raise of up to 2% each year – to generate more ring-fenced funding for social care. Ministers also committed to investing more in social care through the Better Care Fund, a pooled budget with the NHS, from 2017-18 onwards.
Both commitments, while welcome in principle, fall short of what the sector needs, says James.
“The precept is the only new money in the system for the next two years and there are problems with its distribution,” he says. “It is inversely proportioned to where the new demand will be – those councils with the sharpest demand increases will see less benefits.”
Directors have told him that the savings they need to make in the next two years equate to “many multiples” of the amount they are going to get through the precept. This is also a reality in Enfield, where James is director of adult services.
Uncomfortable decisions lie ahead
This means some uncomfortable decisions lie ahead to find savings. The introduction of the national living wage leaves no room for manoeuvre on the price paid for care, says James, and reviewing the size of care packages will become increasingly necessary.
“We will need to explain to people that while we might have spent £150 on their care every week last year, for example, we can only spend £140 this year,” James says.
“It’s really important that we have honest conversations about how that money should be spent, what will make the most difference to the person, and be transparent about it.”
Transparency is important to James – it’s something he says he’s pushed for during his presidency, but it’s also been a source of disappointment in relation to the national living wage. The government insists there is enough money in the system to fund the policy, but the Local Government Association estimates it will cost councils an extra £330m this year alone.
“Ministers at the Treasury have not been willing to share how they arrived at their assertion that there was enough money to fund the living wage,” says James.
“I haven’t found anyone at all outside the Treasury who agrees with that. If we’re all in this together then the transparency should run from the Treasury right through to the frontline.”
Pressure on home care providers
Directors fear this will impact the sustainability of home care providers. That’s an issue James’ successor, Harold Bodmer, director of adult services at Norfolk Council, says he plans to prioritise during his term as president.
“Anybody associated with domiciliary care knows this is a fragile part of our service,” says Bodmer. “We absolutely welcome the national living wage but there are cost pressures associated with that, which haven’t been met.”
It’s not just about funding though, he adds.
“Availability is also an issue. I work in a large rural area and it is really difficult to arrange home care. We need to have a new debate around home care, it’s about looking at different models and moving to a new outcomes-based approach.”
Stabilising the home care workforce will also be important in the development of integrated care services, says Bodmer.
“Domiciliary care is an absolutely fundamental part of the pathway from acute hospitals into the community and it is not always acknowledged as such. One of our key priorities as directors is to think about where social care sits in the integration debate and how social work contributes, to ensure it doesn’t get lost in that.”
Social work reform
Bodmer says another key goal is to ensure adult social care is “firmly at the table” in the debate on social work education and regulation.
David Cameron has made reforming children’s services one of his key missions of this parliament. As part of this change programme, the government has revealed plans to create a new social work regulator and a commitment to expand fast-track education programmes, both of which will impact adult social workers. With the reforms driven by the Department for Education, is there a risk the voice of adult social work gets lost?
“Social work is social work and then you have specialist functions and skills built on it, and there are some very specialist adult social work services,” says Bodmer.
“We are really keen to promote social work with adults as a significant profession and ensure people recognise the skills and difficult job it is in terms of dealing with risk, decision-making and helping people to take control of their lives.”
Ministers have yet to consult widely on its children’s social work reform proposals. James says the government will “absolutely miss a trick” if it doesn’t harness the expertise of people working in the profession when developing the policies.
“We’ve been really pleased that the Department of Health have consistently involved people across the sector, and those with lived experience, in developing and implementing new policy,” he says. “There’s much in that approach to recommend to the Department for Education as they start to work out the detail on the proposed social work reforms.”