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.

Personal care at home delay makes sense

Firstly, an apology for not updating the blog recently. This has been down to sheer volume of work – several projects all came in at once that required all my attention and didn’t allow me the time to sit and write a blog.

But these projects have been completed and normal service should now be resumed.

However, despite my little hiatus, the main debates in social care do not seemed to have moved on much. For instance, everyone is still speculating what will be in the adult social care funding white paper, nobody thinks that the government has got its sums right on the free personal care at home policy and councils are still causing controversy over cutbacks they are having to make to budgets. Plus ca change.

Taking one of those themes – free personal care – there was probably a collective sigh of relief among councils across England earlier this week when news came out that the House of Lords had voted to delay the measure until an independent review is carried out, which means that it is now unlikely to be implemented before the general election.

Many council chiefs have voiced their concerns over the costing of it (although not all, it has to be noted), with the phase ‘back of a fag packet’ used more than once.

While the bill is not yet dead – the government could still try to push it through – a delay in its implementation at least makes sense.

As Lord Best, a crossbench peer and president of the Local Government Association, said, there are worries that arrangements to help the 400,000 people it is expected to cover might not be up and running in the next few months – especially as there are local and national elections coming, with possible changes of leadership and policies – and that local authority budgets have already been set for 2010-11, so finding the funds is tough.

Pushing this bill through now could end up with services being rushed in, and just think of all the potential problems with that – getting the administration right, putting the care services in place, finding the funds – and that’s just for starters. The potential for it all going wrong is arguably high, which could end up harming service users, carers and social care staff.

If, after the election, it is still thought that free personal care at home is a viable proposition, then ministers should look at a timetable for implementation. Doing it now, with some many other things going on, is simply asking for trouble.

Commissioners must be creative in face of budget cuts

After what seems like an eternity talking about potential cuts in local authority budgets, they are now with us – and are as bad as predicted.

Around the country, local authorities are publishing their budgets for 2010/11 and they do not make for happy reading. From what I have seen, no local authorities are increasing their budgets, and many have announced multi-million pound cuts.

Some local authorities are making cuts to adult social care services as a result. Councillors are keen to point out that frontline services will not be affected, saying they will mostly be made in back-office functions or through efficiency savings – conveniently opaque terms that do not reveal exactly where cuts will be made or to whom.

What this does do is make the job of the commissioner of adult social care services more important than ever; it is they who will decide which services are cut and which are bought.

Getting more from less is a difficult trick to pull off successfully, but they need to rise to the challenge. Fortunately, personalisation gives them the opportunity to do it.

With personalisation’s focus on the individual, it gives commissioners more flexibility to work with independent providers and the third sector to provide a range of services tailored to the local community, rather than the local community having to fit into the services commissioned.

This can mean that the services commissioned offer better value for money because they are the ones that people want – not what the local authority think they need. Also, services that do not provide value for money can be safely axed.

Personal budgets also give service users more choice and control. While it can be argued that they don’t get either if the budget isn’t enough to cover their needs, they often, anecdotally, get services in more cheaply than the local authority had done.

Budget cuts should focus the minds of commissioners and those that do innovate – and work fully with providers, the third sector and service users – should help their service users to achieve better outcomes.

Their role should be about shaping the market and enabling it to develop, rather than dictating it.

Money money money

Sometimes I wonder as I write these blogs if I am beginning to sound like a stuck record; the issue of funding – or more accurately, the lack of it – seems to crop up at some point in the majority of pieces I post.

But I make no apology for this. Funding is arguably the most important issue within social care at the moment.

While providing outcomes for service users should be the number one priority – and I’m willing to bet that, on the record, any politician or director of services worth their salt will argue that it is – I suspect that how social care is paid for is exercising them more.

For quite some time now, directors of adult and children’s services have accepted the fact that they will have to do more with less money in the coming years.

Now, many are starting to find out how much less they have; for example, Cambridgeshire County Council has announced that the adult social care budget for 2010/11 is being slashed by £10.3 million, as the council looks to save £88 million in total.

They are not alone; many councils across the UK are having to make similar size cuts, with the resulting risk to certain services – often those at the less critical end, such as meals on wheels.

In addition, the government’s free personal care at home plan is causing much concern within town halls. While few argue with the aim of the policy, many feel it simply cannot be paid for, especially as it is generally felt that Labour has significantly underestimated how much it will cost.

Cllr Graham Gibbens, cabinet member for Kent adult social services, as quoted on kentnews.co.uk, said: “In an ideal world, we would wish to give free personal care at home to as many elderly people as possible. However, it is simply not affordable, particularly since we are in the throes of a debt crisis.”

Gibbens’ quote neatly sums up the current reality of social care. In a recession, idealism counts for little; money influences all conversations now, and will do for some time to come, regardless of who wins the upcoming election.

Now, it is up to commissioners, providers and social care staff across the sector to accept this and work within these financial parameters to ensure the money available is used to the greatest effect.

It is a significant challenge, but one that they have no option but to rise to. It may force commissioners to be more innovative in their thinking, and providers to ensure they deliver value for money, but they have no option.

Free elderly care tax rises warning

Ever since Gordon Brown announced plans to give free personal care to the elderly late last year, the policy has faced a sustained barrage of criticism. And it isn’t showing any signs of stopping.

While in theory, free personal care for the elderly in their own home sounds like a great idea, the practicalities of it could well outweigh the benefits, according to leading figures in social care.

One of the major bugbears is the cost. The government reckons it’ll cost £670 million, but nobody else seems to; the vast majority of commentators think they have significantly underestimated.

Where the money will come from is another bone of contention. There is no new government money for this, it will come from a variety of sources; the majority, £420 million, will come from existing Department of Health budgets, while local authorities will provide the remaining £250 million from ‘efficiency savings.’

‘Efficiency savings’ is a woolly phrase at the best of times, but it is particularly worrying for council leaders because they are already trying to find millions of savings in anticipation of swingeing budget cuts in 2011.

Now some, including the heads of Hampshire and Essex councils, are publicly warning that to pay for the policy could mean council tax rises of a couple percent – never popular among the public, even less so when there is a recession on – or cuts to frontline services.

But the objections are not solely for financial reasons. A senior figure within social care told me that the policy could create perverse incentives for people to not go into residential care; if they went into a care home, if they have assets worth in excess of £23,000 they would have to pay for their place, whereas in their own home, care is free.

As a result, older people could stay in their own home for longer than it is really safe for them to do so, and could also become isolated, if they are housebound. Is that really a better option than residential care, where they have round-the-clock care, plus the company of the staff and other residents?

However, this unpopular policy may never make it into force. Lord Lipsey, a Labour peer – and vocal critic of the bill – believes that it has no chance of coming into force before the election. What happens after will depend on which party wins.

There is a feeling among some – including, perhaps inevitably, Conservative health spokesman Andrew Landsley – that the policy was announced to gain political capital.

If what its critics say will happen does, the bill could well end up backfiring on Labour, as well as the social care industry. For everyone’s sake, let’s hope they are wrong.

Alastair Darling to make budget cuts public

For months now, talks of budget cuts have been rife among council departments, especially social care. Many councils are already tightening their belts in anticipation of big cuts in 2011, when the next comprehensive spending review is scheduled for.

However, all the talk has thus far been based on guesswork. At the National Commissioning Conference in June, there was talk of public sector cuts of up to 10%, which was met with sage nods rather than gasps of shock, but it was emphasised that this was only a guess.

Meanwhile, the Institute of Fiscal Studies says that total departmental spending will have to fall by 3.2 % a year for 3 years if the government’s target of halving the budget deficit within 4 years is to be met.

The only certainties given by the government so far are that police, education and health budgets will be protected. There is no such guarantee for social care, and the lack of new money made available – thus far – to help drive the recommendations in the recent Social Care Task Force report seem to indicate the prevailing wind.

However, the guesswork is set to end, according to the Guardian. It carries a report saying that Chancellor Alastair Darling has committed to publish more internal estimates about range of departmental spending cuts the Treasury expects to make in the next 3-4 years after a grilling from the Treasury select committee yesterday. This may extend to being more open with the public about spending assumptions for the years post 2010-11 as well.

Anything that gives people – inside local councils and outside – a clearer picture of what is, or will be, happening is to be welcomed. People are more accepting of cuts when they are given the facts of why it is happening, rather than just being told that it is.

Everyone knows that cuts are coming, but knowing how much will be an advantage. It can inform public debate and ensure councils have a better idea of just how swingeing the cuts will be.

Can England afford free personal care?

This will have set alarm bells ringing in Westminster this morning; Harriet Dempster, president of Scottish social work body the Association of Directors of Social Work, has admitted on radio that Scotland may not be able to afford its policy of free social care for all elderly people for much longer.

With costs for the policy rising – it was up 11% last year to £358 million – and swingeing budget cuts on the horizon, Ms Dempster said the policy may have to become means-tested.

Ms Dempster has called for a debate on the policy’s medium to long-term viability, including whether more well-off elderly people could afford to pay for services. In response, the Scottish Government has said it remains committed to the policy.

The Scottish experience should be heeded by ministers in England as they consider introducing a similar programme, as outlined in its Personal Care at Home Bill earlier this week. The government says that it “will cost £670 million per year”, but these have been widely questioned.

Indeed, the £358 million cost of the Scottish scheme is for only 50,000 people; the English version could cover up to 280,000 people with ‘substantial and critical’ needs. So if the costs were the same on both sides of the border – they won’t be, but this is just for example purposes – in England that could mean the policy costs about £2 billion per year. This figure doesn’t include the further 130,000 people who will help with ‘re-ablement’ in order to regain their independence and prevent ill health.

If – and it’s a big ‘if’ – the policy did come in, that £2 billion figure would quickly rise, simply because of demographics; the UK has an ageing population so more people would need it in time.

Again, with budget cuts coming, where would the money for this come from without making cuts to other services? Answers on a postcard please…