Last month the government bowed to pressure to inject more cash into adult social care. Chancellor Phillip Hammond announced an extra £2bn for services by 2020, with half of it coming into the sector immediately in a bid to stave off a crisis.
John Jackson, who heads up the resources network at the Association of Directors of Adult Social Services (ADASS), says the cash could stop the hardest hit councils from running out of money in the next 12 months. But for most, he adds, it’s needed to cover the planned savings that would otherwise by “impossible or very, very difficult to make”.
With government funding for councils cut by 37% in real-terms between 2010 and 2015, many authorities are struggling, says Jackson. Directors have made savings of £5.5bn from social care budgets over the past six years and estimate another £1bn will have to be found this year.
Jackson says the new government cash will therefore reduce rather than remove the pressure for savings, particularly with social care representing a growing share of council budgets.
“People think when there’s new money for adult social care, it means there doesn’t need to be any cuts – but that’s just not true,” he says.
“If local government funding falls, although local authorities are putting money into pay for demographic and inflationary pressures, they are also going to say adult social care is more than a third of the budget, it needs to contribute to savings.”
‘Nothing left to squeeze’
The problem now, Jackson says, is most savings options have been “completely exhausted”. Back office efficiencies have been found and cheaper ways of meeting care needs pursued. Care fees have also been squeezed to the point some providers are handing back contracts, going bust or quitting the sector. This “clearly cannot continue”, he adds.
“The reality – and I say this as an ex-director – is that ultimately care needs must be met.
“So if there’s only one provider and they are charging a significant amount, then at a certain point your negotiation has to finish and you’ve got to make a deal and agree a price for that person so they are looked after in a quality, safe and caring environment.”
So where will the cuts fall this year? Jackson says there’s been a lot of media attention on the growing numbers of people going without care. This change is due to support services for people with lower level needs being stripped back, he explains – it’s not because eligible care needs aren’t being met.
“So with day services and a number of services provided by the voluntary sector, councils are saying we don’t have to provide these services and we’re going to stop funding them.
“On an immediate level, that may not result in an increased pressure on adult social care, but there is a bigger uncertainty about what it may mean longer-term.”
‘Public sector risks’
Moves to target care packages for savings are also causing tension, Jackson says, although he argues packages must be reviewed because “from a quality and safeguarding point of view” councils need to ensure that care needs are being met.
“There are cases where councils are saying ‘well this person is getting X amount of one-to-one support and actually this could be reduced. That could benefit the person because it’s about supporting independence…but it doesn’t always feel like that.
“A lot of local media coverage is about people being unhappy with what councils have done, even though they are complying with the law.”
Jackson believes housing support that helps vulnerable people to live independently in the community continues to be at risk. These services were once supported via a £1.8bn ring-fenced grant through the government’s Supporting People programme, but have been “cut back very significantly” in recent years, he says, because they are not a statutory requirement.
“That again has risks for other parts of the public sector. It could impact on mental health services, the criminal justice system – and it’s clearly already having an impact on A&E.
“These are people who don’t formally have an adult social care need, but by any definition are potentially vulnerable – the homeless, people with minor mental health issues, ex-servicemen, care leavers. There’s a whole agenda there that councils have struggled to carry on funding.”
The question now is how adult social care funding will be resolved for the future. Concerns about sustainability have long-been raised by ADASS and echoed by other sector bodies. While the government has spent years ducking the issue, it has now promised a green paper.
Jackson says this paper must go further than Andrew Dilnot’s “excellent proposals” on care and support funding, which were published in 2011. These talked about “the impacts of uncertainty and of people needing significant amounts of adult social care in later life,” Jackson says, but did not address the fundamental issue of the sustainability of the existing system.
“We know over the next 30 years there are going to be more and more pressures on adult social care. We need a long-term solution – one that goes well beyond this parliament.”