Category Archives: Social care funding

Would increasing NHS spending cut social care services?

Interesting stuff from shadow health secretary Andy Burnham today, as reported in the Guardian, who claims that increasing NHS spending could adversely affect social care provision.

Burnham objects to the government’s commitment to increase NHS spending in real terms year on year; “If they persist with this councils will tighten their eligibility criteria even further for social care. There will be barely nothing left in some parts of the country, and individuals will be digging ever deeper into their own pockets for social care support,” the Guardian reports him as saying.

As a cynical journo, my instant reaction is this is just a way of scoring a few cheap political points before the emergency Budget next Tuesday. And it probably is – but he does make a couple of salient points nevertheless.

It has struck me as odd that the only department with a guarantee of an increase in spending – amid swingeing cuts for everyone else – is health, especially at a time when the NHS is performing relatively well – if you take meeting the majority of targets as ‘well’. It smacked of a sop to the electorate – increasing health spending is always a vote winner.

Also, while there is nothing to say that the increase in NHS spending will come from the social care budget, there is nevertheless an element of robbing Peter to pay Paul with the Conservative commitment too – its reasonable to assume that increases in one department will mean that others gets cut. There are no spending commitments for social care (that I know of), so cuts in this area would seem inevitable.

Burnham also notes that putting the NHS in a stronger financial position to social care would make joint working – the current prevailing trend – harder to achieve.

Also, cutting social care could increase the burden on the NHS if more people end up in hospital due to falls etc due to struggling without care services they need because they cannot afford them. They could stay there longer if there is not the social care provision – meals on wheels, housing, care services etc – to support them in the community on release.

But whatever happens in next week’s Budget, it would seem the future for social care is an austere one; at a local level, there are already news stories of cutbacks in services, or charges for them increasing. To pick one example at random, here is a story from the online version of the Northampton Chronicle & Echo about county council proposals – currently out to public consultation – to raise £600,000 by increasing the cost of social care services.

Northampton County Council justifies this plan by saying that without the increase in charges, services would have to be cut.

This is a situation repeated across the country. It would seem that social care providers and service users are going to have to do more with less. How the government – and local authorities – will deal with this will be interesting to see. All should become clear in the coming weeks.

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Hospital car parking charges need reform

Today’s blog returns to an old hobby-horse of mine: hospital car parking charges.

This issue is back on my radar again as I will be making regular hospital visits for the next few months (my wife is pregnant) and was stung for more than £2 for an hour’s parking earlier this week.

Some of you may remember a recent blog where I highlighted/ranted at what I saw to be the scandal of hospital car parking charges for visitors and patients (Hospital car parking charge scandal) and how this should be ended. Pleasingly, it seems that I’m not the only one that thinks this way: consumer watchdog Which? has now called for charges to be revamped.

As reported by the BBC today, Which? has published a list of the best and worst performing hospitals in terms of clamping and fining car park users (or abusers, depending on your viewpoint). The worst were Epsom and St Helier University Hospitals NHS Trust (most clampings) and Leeds General Infirmary (biggest finer). Barnet and Chase Farm Hospitals NHS Trust charged the most at £4 – £4!! – for 2 hours.

The fines and clamping system highlights another issue I have with car park charging; having to be aware of how long you’ve got left on your ticket.

Again, I’ve experienced this one; having recently bought a ticket for 3 hours parking (which I assumed when I purchased it was more than enough) I had to dash out of a waiting room to extend my parking stay. I shouldn’t be thinking about a parking meter when being given important information about my unborn child.

Hospitals visits can be stressful enough without having to worry about the threat of extra charges, fines or even clamping, especially when it is usually through no fault of your own; we all know how hospital appointments can – and often do – run behind schedule.

Perhaps the worst bit is that there is little sign of this ending. While Labour announced plans last year to scrap charges for in-patients, their families and friends within 3 years, the new coalition government has made no such commitment. And with budgets cuts imminent, they are a useful moneyspinner for cash-strapped PCTs that they will not give up voluntarily.

Which? has called for a ban on clamping and towing, as well as “fairer” charging systems such as allowing patients to pay on departure rather than arrival – although some already do this, to be fair – or reimbursing patients for additional parking fees when appointments are delayed.

All good points, and hopefully, given the clout that Which? has, someone in power will listen.

But for me, it doesn’t go far enough; as I’ve said before, I’m not against charging per se, but it does seem ridiculous to pay more than £2 for an hour, given the costs of upkeep of a car park (not that much) and the number of people who pass through one on any given day (lots).

Surely a flat rate of, say, 50p to park would be fairer? After all, unless my memory is deceiving me, it’s not all that long since that was roughly the cost of parking at many hospitals. That would cut out the stress of the charging, but also still cover the costs of running it – car parks should not be there to make money out of people who have no option but to go there.

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Back to the future for social care

I had a peculiar sense of déjà vu reading new care services minister Paul Burstow’s interview in the Daily Telegraph the other day. While spoke about his hopes – and the need – for reform of adult social care, I had the funniest sense I’d heard it somewhere before.

Maybe because I have; about the time the green paper on adult social care was first mooted by the old Labour government a few years back. And a various points since then, up to and including the run-up to last month’s election (Doesn’t it seem a long time ago now?).

In the Telegraph interview, Burstow – who has a decent reputation within the sector – spoke of the need to find “a sustainable funding settlement for social care” and to reform a system that will soon become “not fit for purpose”.

Nothing new there. Many commentators – as well as service users and workers in the sector – have been saying this for years, to no avail.

There is also nothing new in his outline for the funding options that will be discussed by the upcoming independent commission; a voluntary scheme, a partnership scheme where state and individuals contribute, and a compulsory levy after death – yep, Labour’s much-derided ‘Death Tax’.

This is something of a turnaround for the government, which only referred to the partnership and voluntary models in its coalition document, released just a couple of weeks ago.

But what is new is a little detail on the timescale for reform. Those of us who thought that the coalition’s plans kicked the issue into the long grass now know how far; Burstow wants the soon-to-be-formed independent commission report back on funding options within a year, with a White Paper ready by autumn 2011.

He admits this is ambitious, but necessary as the Baby Boomers hit old age.

Nevertheless, it is good to see a timescale being laid out, even if it isn’t the one most people involved in the sector would have liked – in an ideal world reform would already have been carried out.

Also, carrying on with the positives, Burstow does seem to have a good handle on what needs to be done – saying it would be wrong to fixate on the problem of older people having to sell their homes to pay for residential care, something that the last consultation seemed to, almost with an eye on the upcoming election – and is willing to consider a range of options.

But what the independent commission comes up with remains to be seen – as does how different it will be to what came out of last year’s Big Care Debate – although the rumoured presence of economists on it suggests that it may be geared towards saving money.

Again, it feels like we’ve been here before. So while this could easily be a false dawn – and there have been enough of those over the years – at the moment, it is probably best to give the benefit of the doubt to the government, while all the time reminding them of what is needed and why, and to call them to account if they let the sector down.

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Children’s social workers warn of increased risk if services are cut

As warnings go, it is a stark one; cut budgets in children’s social work and put vulnerable children at far greater risk of harm.

This is the headline message from a survey by BASW, conducted over the bank holiday weekend.

A massive 96.6% of respondents said they are concerned at the effects any cuts could have on already understaffed and overworked social workers. As I’ve mentioned in previous blogs (such as Baby P effect sustained) vacancy rates in children’s social work departments are running nationally at about 10% and since Baby P the number of referrals to them has increased markedly. Any more cuts would exacerbate the situation.

This survey is obviously designed to act as a warning to government and local authority purse-string-holders who are currently scrabbling around trying to make billions of pounds worth of cuts – cut children’s social services at your peril. The more subtle subtext is that they would be effectively to blame if another Baby P occurred.

It’s also something of a pre-emptive strike by BASW; the coalition government hasn’t said much about children’s services yet, other than announcing the scrapping of ContactPoint and supporting the recommendations of the Social Work Task Force, and this has worried many in the sector, who fear that children’s service isn’t a priority and therefore a prime target for cuts.

While this was only a small survey – 151 respondents – and so by no means representative of the national picture, it does give an interesting snapshot of the continuing problems in children’s social work.

For instance, only 5% of child protection social workers say their team is fully staffed with permanent social workers, with more than half (52.5%) saying their team is understaffed by 30% or more and 13.1% saying it is by half or even more than that. More than 63% say that their department is understaffed, even with agency staff – who aren’t ideal because they are often short-term and don’t offer the continuity permanent staff do to vulnerable children.

For those in the sector, this will be nothing new. But that’s not really what matters here; it is whether it makes an impression on those who control the money – and I suspect it won’t. A lot of uncomfortable fiscal decisions will be made in the coming weeks and children’s services may well find its budget squeezed, as will many other sectors who also view their funding as crucial.

I’m not saying I agree with this, but this is what I suspect will happen, and there is little that I can see that can be done to stop it.

If budgets are cut, obviously children’s social workers will continue to do their best, but it stands to reason that it would raise the chances of another tragedy along the lines of Baby P happening – you can’t easily do more with less.

If a tragedy were to occur, it would raise some very challenging questions, not only of the profession, but also of government this time.

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More funding needed for mental health research

While Homer Simpson may have said “people can come up with statistics to prove anything”, there are some occasions when bald numbers do tell their own story. Mental health funding is one of those.

For instance, according to a review by the Medical Research Council, mental health is estimated to cost £77 billion each year in England alone. It accounts for 15% of all disability due to disease and affects 16.7 million people in the UK at any one time. Yet only about 5% – £74 million – of medical research budgets are dedicated to it per year.

Professor Til Wykes from the Institute of Psychiatry at King’s College London hit the nail on the head in a recent BBC piece, saying that mental health research is “incredibly underfunded”

This seems especially so, given that mental health problems affect more people at any one time than cancer or heart disease – both of which receive more funding.

Given the statistics, it is hard to argue with Prof Wykes. Whether this relative lack of funding is down to stigma or the fact that mental health is not a “sexy” illness is debatable, but at least there are moves to challenge the situation.

For example, in its review, the MRC has outlined the priorities for the research community for the next 5-10 years:

  • Focus on the prevention of mental disorders based on better understanding of causes, risk levels and new approaches to early preventive measures
  • Accelerate research and development to provide new, more effective treatments for mental illness, and implement them more rapidly
  • Expand the capacity for research in this area in the UK.

The MRC will work with funding agencies such as the Economic and Social Research Council, the National Institute of Health Research and the Health Departments of the devolved administrations on approaches to take forward these recommendations, but whether more funding will be forthcoming is debatable.

The logic for more funding is hard to argue against – basically, more research would lead to better and more effective ways of preventing and treating mental illness, thus reducing the burden to the country and saving money – but the financial state of the country may dictate what happens.

With the Department of Health looking for savings, research budgets look set to be slashed for many areas of healthcare – although not dementia – so any large increases may be out of the question, although an increase in real terms may be feasible. Whether that is enough is another matter – it may be another case of innovative work having to be done with fewer resources, which could hold back the pace of development – to everyone’s detriment.

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Welfare reform plans worry disability groups

As the new government starts to get itself into gear, one of its key policies seems to be welfare reform and getting people into work – but getting it right, especially for people with disabilities or mental health problems will not be easy.

The idea of welfare reform and ending dependency on it is good – and some would say long overdue – but it has to be ensured that it is fair, especially for people with disabilities or mental health problems who are currently receiving Employment and Support Allowance (ESA)/Incapacity Benefit (IB).

While most people with disabilities or mental health problems want to either return to or gain paid employment, some are not capable of it. Others are capable, but only perhaps certain jobs or part-time hours.

However, the Work Capability Assessment, which determines if someone is capable of work – if they are deemed capable, they are moved onto the £25-a-week lower rate Jobseekers Allowance rather than ESA/IB – is flawed, some groups claim.

For instance, Neil Coyle of the Disability Alliance, calls the Work Capability Assessment ‘unfair and ineffective’ in today’s Daily Mirror.

Meanwhile, Paul Farmer, chief executive of mental health charity Mind, says “the current test is not up to the job of measuring whether people with mental health problems are fit for work.”

The test was trialled among new claimants at the end of 2008, and involves rigorous medical assessments carried out by an independent company. Of the 500,000 tested, only 9% remained on ESA. This test is now set to be rolled out to all 2.6 million claimants.

But this worries Farmer, fearing that people with mental health problems will be incorrectly assessed. “We urge our new Government to review the benefit assessment… so that people aren’t deprived of their benefit and forced to look for work they can’t do.

“Work can be good for mental health, but only when it is suited to the individual. The Government has proposed to sanction anyone turning down ‘reasonable offers of employment’, but people should not be forced to accept work that risks damaging their mental health, putting them back on benefits and back at square one. Sanctioning people who can’t secure an appropriate job misses the point about why they are locked out of work in the first place.”

There are other wrinkles in the government’s plan to get people into work; we are just coming out of a long and deep recession and jobs are scarce and very competitive – 2.5 million people are unemployed remember.

Despite all the efforts of various schemes to tackle stigma against people with disabilities, it does still exist; two thirds of employers are unwilling to offer someone with mental health issues a job, according to Farmer.

A solution that is fair for everyone will not be easy, but if the government is to stick to David Cameron’s quote that ‘that those who can should and those who can’t we will always help’, then this needs to be got right and concerns from such groups need to be considered, to avoid the problems that could arise from trying to get people into jobs that are not suited to them.

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Social care possible victim of government cuts

Chancellor George Osborne announced the first wave of cuts to public spending yesterday, but it is still unclear what this will mean for social care – yet.

Most of the announcement dealt in headline terms – talking about millions of pounds worth of cuts to government departments, but not saying exactly where they will be made.

For instance, councils have been told that they will have to cut £500 million worth of services in the next 10 months. In the absence of concrete details, there is lots of speculation about where these cuts could come – such as in residential and home care for the elderly, according to a report in today’s Times.

This would seem likely – a recent poll for the BBC’s Panorama said that more than half of councils were considering making cuts to adult social care provision.

In practice, it may mean that eligibility criteria gets ramped up again, so that only those with ‘substantial’ or ‘critical’ needs will get services – which already happens in many council areas. Also, services such as day centres may be targeted for cuts, as will any service that struggles to demonstrate it provides value for money.

With budgets needing to be slashed other areas, such as the roll-out of the personalisation agenda, may be hit. There is the £237 million Social Care Reform grant scheduled for this year, and there is speculation that might be cut, according to a report in Community Care.

Meanwhile, children’s services were largely protected from the cuts, except for the abandonment of the Child Trust Fund, which wasn’t that popular anyway.

But this is just educated speculation. I assume the details of the cuts will gradually come out in the next few days and weeks, which should shed more light on what will happen and then councils – and service users – can start to plan for the future.

But what is certain is that these are only the first cuts – and not necessarily the deepest. June’s emergency Budget is expected to announce further spending cuts, while with the Comprehensive Spending Review – which sets out council budgets for the next 3 years – there are fears that council funding could fall off a cliff.

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