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.

Coalition kicks social care reform into long grass

The wait is finally over for social care; now we know what the coalition’s plans are for the sector.

Looking at what the government has published – see here for the full rundown – it is a mixture of reform and continuing existing policy.

Firstly, as expected, Labour’s National Care Service plans have been abandoned. This is clear from the announcement that a new commission on long-term care will be established to report back within a year.

I’ve said before that the last thing the sector needs is yet another commission on the future of long-term care. We had that last year with the Big Care Debate, and others previously. Precisely what differences a new commission will find I don’t know. It just seems like a way of kicking the issue into the long grass and delaying some difficult decisions. Again.

Also, the lack of reference to disabled people in the plans – one mention under the Access to Work proposal – shows the main thinking of any reform is geared to older people.

But interestingly, it says the commission will consider several options; not just the Conservative plan for a voluntary insurance scheme, but also Derek Wanless’ partnership model, where the state and the individual both contribute to care costs.

This is significant because when the results of the Big Care Debate came out, the partnership model was most popular among respondents, and some third sector organisations had also publicly backed such a scheme. It also shows that the Tories may be backing away from their widely-derided option.

Elsewhere, the existing personal budgets and direct payments schemes are to be extended, giving more service users control over their care. This is no surprise – it fits nicely with the coalition’s plans to devolve more power to communities as part of their ‘Big Society’ reforms.

Despite rumblings that some social workers are losing faith with personalisation, the extension of it is generally good news for service users who want to take control over their care, and means no significant upheaval for adult social work departments.

Also, as expected, there will be greater integration of health and social care funding, to focus on preventative action, access to respite care will be improved and Access to Work will be reformed.

So, while there are positives in the announcement, the overriding sense is of disappointment. Firstly that disabled people seem to have been overlooked, and that the much-needed reform of long-term care has again been put back until at least next year. The whole sector has been crying out for reform for years, and another commission – to tell us what we already know – does not help. Why can’t the information in last year’s Big Care Debate be used to put together a coalition white paper on social care reform? Or is that too obvious?

A blog on the plans for families and children will also appear later.

Social care needs to be a priority for new government

Since the Conservative and Liberal Democrat coalition took power earlier in the week and started outlining its policies, one issue seems to have been conspicuous by its absence: social care.

As I have previously blogged, in the general election campaign social care seemed to disappear off the political radar, despite it being touted as a key issue in the run-up to it being called. Now post-election, it continues to be ignored in children’s and adults services; nowhere in the policy outline was social care mentioned.

Indeed, Michael Gove, the new head of the (swiftly renamed) Department for Education, has said in a letter to civil servants that education is the priority for the department, thus seemingly sidelining children’s services, although he added that this area will be strengthened and reformed, but didn’t elaborate on how.

Also, Andrew Lansley, the new health secretary, has spoken extensively of the plans for the NHS, while adult social care has garnered barely a mention.

This lack of attention is worrying; ask anyone within adult social care and they will say that reform – especially of the way it is funded – is urgently needed. Children’s services also need to be strengthened and supported. They can’t be left to drift as they have done for the past few years.

Leading social care organisations are also worried. Counsel & Care, a charity working with older people, their families and carers, have called for reform of social care to be made a priority by the new government.

Meanwhile, Carers UK’s director of policy and public affairs, Emily Holzhausen said; “We are deeply disappointed that the programme for Government published in the coalition agreement this week does not establish social care as a political priority.

“Clear plans must be brought forward as a matter of urgency, setting out a sustainable funding model for fair, universal, and transparent care services.”

However, despite the worries, I’m trying not to be too negative. It is still very early days for the government and we shouldn’t be too quick to judge – social care is a complicated issue and it may take more time to put together a policy.

Also, Paul Burstow, a Lib Dem MP with a history of championing issues such as social care funding, dementia and adult protection, has been appointed as a minister for state – the rung below cabinet – in the Department of Health. Having someone with in-depth knowledge of and a passion for the issues involved could ensure that they get the attention they need.

But until the government makes any policy announcements, as with everyone else blogging on this in the sector, everything is speculation and educated guesswork.

A final thought; in among all the speculation, there is one decision on social care that will have to be made soon – whether to pass Labour’s Personal Care at Home Bill. The Tories are against it, as are the Lib Dems, who would prefer to use the money for this to give carers extra short breaks, so I think we know what the result will be there.

Do you agree? Please let me know your thoughts below.

What will new government bring for social care?

After all the courting of the past few days, the Conservatives and Liberal Democrats have finally decided on a political marriage. But what will this mean for social care?

Now the dust is settling, here is a little of what is known, plus some conjecture and guesswork.

Firstly, it means that Labour’s plans for a National Care Service are dead. The Tories always opposed it, and the Lib Dems also had problems with it, so it’s a definite no-go. This means that social care will go back to square one, waiting again for the reform it so badly needs.

On the upside, it looks likely that plans for a set of national eligibility criteria for social care services, proposed by Labour, will be brought in as the coalition parties also both support it. This should end the ‘postcode lottery’ of unfairness in social care and can only be a good thing.

Now, things become less clear; we know there will be big public sector spending cuts in the Budget, which will probably be in June. Both parties have denied that it will hit frontline services, but councils will have to make some big savings and services could be hit – such as scrapping some services that are not perceived to deliver value for money – and eligibility criteria could be ramped up again.

I suspect that a new White Paper on the future of social care may be commissioned in the near future. The Liberals are in favour of (yet another) commission on reforming care funding, but the Tories aren’t, so action may come relatively quickly – we all know the problems in the sector, they just need to be addressed.

Whether the Conservatives’ stated plan for a voluntary £8,000 insurance scheme to pay for elderly residential care comes to pass remains to be seen.

Both parties were relatively light on detail about reform in their respective manifestos, but there were differing ideas, such as the Lib Dem idea of giving all carers one week of respite, so it is hard so say in which direction the government will go.

Also, remember there were the secret cross-party talks about the future of social care earlier in the year – which Andrew Lansley, the new health secretary, scuppered – could anything come out from that?

Hopefully in the coming weeks we will hear something more concrete about what will happen to social care. The sector needs reform quickly, so the coalition needs to work together to find the best solution – whatever that is…

Uncertainty in social care after election result

So, 3 days on since the election result was announced and we still don’t know who will form the next government. As a result, from a social care perspective, we still don’t know where the future direction of policy will go either.

So, nothing has changed there, then. It’s been like this for months as green papers and white papers have come and gone, with little changing on the ground.

The only certainty, in terms of policy, came with Labour and its plans for a National Care Service, as laid out in April’s White Paper. But many in the sector doubted it would ever make it to fruition, given their standings in the polls.

Indeed, at the time of writing, a Conservative-Liberal coalition is looking possible, which would mean the end of Labour’s ideas; the Conservatives did not sign up to it, and the Liberals rejected several elements of it.  

Their ideas for reforming social care have not been laid out in as much detail as Labour’s, so many are left wondering what will happen.

My hope is that if there is a coalition – be it Conservative-Liberal, Liberal-Labour or some other variation – it will give a chance for a consensus to emerge over future policy direction. If that happens then if there is another election in the near future, there is a chance that the policy might be consistent. But that’s a hope.

More realistically, my guess is that another commission will be formed to review social care and make recommendations from that – although what could be said differently to the results of last year’s Big Care Debate is unclear. The Liberals said they would do this in their manifesto, although the Conservatives are said to be against that as well.

So, as I write, it seems like the only things that are certain are: the social care industry will continue to do its best with the limited resources it has and a funding system that nobody likes – like it has done for years; and that nothing will change that situation in the immediate future.

What happened to social care in election debate?

After 3 weeks out of the country – I was one of those caught up in the volcanic ash crisis – I’m getting back up to speed with what’s been happening in social care and where the main parties stand on it before the election.

There was precious little mention of social care or older people in last night’s TV debate – well, the bit I watched before jet-lag caught up with me – but I haven’t seen much else about it in the news. I’m told there was not much talk about it while I was away either.

Considering that social care was supposed to be one of the main debating points in this election, everyone seems to have gone quiet on it since Labour announced its White Paper on the future of social care and plans for a National Care Service.

But while we know about Labour’s plans, you have to look hard to find the Conservative and Liberal Democrat policies on older people – social care as a category isn’t there, disappointingly.

More disappointing is the lack of concrete policies. For instance, the Conservatives pledge to introduce a ‘home protection scheme’ to ensure people don’t have to sell their homes to pay for care, but don’t say how it would work, or how it would be funded.

They do however advocate the extension of direct payments and individual budgets to give people more choice and control over their care. While this is a continuation of an existing policy, it does hint that if the Tories win, they may not make fundamental changes to the personalisation agenda.

Meanwhile, the Lib Dems say they would undertake a review of social care. It’s difficult not to be sarcastic about that pledge – hasn’t the sector had enough of those in recent years?

More promisingly, they talk about re-establishing the link between the basic state pension and earnings.

There has also been little mention of the future of social work, although there are fears among some social workers that cuts to frontline services may be made; there have been assurances that teachers, doctors and nurses will not be axed, but no such declarations made for social work.

So, the future of social care, one of the bigger issues facing the UK, has once again been swept under the carpet. In a way it is not surprising, because there are no easy answers or snappy soundbites and some of the solutions may not be vote-winners. But it should have been a key part of the debate because this will affect everyone in the UK at some point.

General election: let battle commence on social care

Finally, one of the worst-kept secrets in the country is officially announced; the general election will be on May 6.

It has been said by many that adult social care will be one of the crucial points on which the election is fought. If so, this can only be a good thing, but only if the public know exactly what they will be voting for and currently, they don’t.

We know Labour’s plans for the future of adult social care; they were in last week’s White Paper. They have outlined plans for a National Care Service, along the lines of the NHS. How it would be paid for is still unclear – but don’t let practical details get in the way of a good policy.

But as for the other main 2 parties – and, in the interests of balance, all the minority parties as well – we know that they don’t think much of Labour’s ideas, but other than that, we know very little about their plans.

The Conservatives have been plugging away with its £8,000 voluntary insurance scheme for paying for elderly care. However, those in the know in the sector don’t believe that this will come up with enough to cover the costs. The Tories disagree. Other than that, we know they favour telecare and a national system of assessment and eligibility for care, and that’s about it.

Meanwhile, the Liberal Democrats want to find cross-party consensus on the way forward in social care, as was being discussed in secret by health ministers earlier this year before Andrew Landsley blew the lid on the meetings. They also want yet another commission to investigate possible ways forward, and have said they would spend £420 million to give carer’s an extra week’s respite – as long as they care for more than 50 hours per week.

I haven’t heard much from any of the minority parties on social care – if anybody knows more, please leave a comment below.

But all this shows that we do not have a full debate on social care – that can only be achieved when others announce their policies and can be analysed objectively against the others.

That is the challenge now for the Conservatives and Liberals – show us your plans and let us decide which way forward is the best for social care.

Adult social care White Paper: good points but short on funding detail

For all Andy Burnham’s fine words about following in the footsteps of Bevan and establishing a National Care Service, the White Paper – Building the National Care Service – doesn’t address the main problem with social care – and the original purpose of the green paper last year: how it is paid for.

But first, the good points:

The proposals for a National Care Service – free at the point of use, given according to need, with the principles of being universally accessible, having a strong national framework locally delivered, being preventative and flexible, with support for carers, and information and advice for all – is admirable.

Social care has – as the government admits – lagged behind other sectors, such as healthcare in terms of provision. It has never had a national structure and one is well overdue. It is hard to argue with the government’s aims here.

The commitment to put in place nationally consistent eligibility criteria for social care – enshrined in law – is one that many have been crying out for. The ending of the postcode lottery will go some way to addressing the perceived unfairness of the current system.

Likewise, ensuring accurate, relevant and accessible information about what people are entitled to, how the assessment process works and how to access care services is provided to everyone, and improving the gateway for accessing social care and disability benefits to make it simpler and easier for people, are also welcome and long-overdue developments.

Keeping Attendance Allowance and Disability Living Allowance also shows that the government has listened to some outcomes from the Big Care Debate – getting rid of this would have proved very unpopular.

The continuing commitment to the personalisation agenda – in giving service users choice and control – will also be welcomed by the majority, not least social workers who may have feared yet more upheaval.

But on the downside…

It also talks about people in residential care only having to pay their own fees for 2 years. Fine, but the average time spent by an older person in residential care is 3 years, so they would only get one year ‘free’.

Also, while people in residential care would still have to pay their accommodation costs, there is a commitment that no-one will have to sell their house to pay for care within their lifetime. With a deferred payment plan, their family may have to pay for it out of their estate after their death.

This leads neatly to the crucial bit – and one I suspect made with an eye on the election – no decision on the funding of the National Care Service will be made until 2015 at the earliest. Not so much kicking it into the long grass but the jungle.

This is where the White Paper falls down. The social care sector has been creaking along with the much-hated means testing system for years. It is widely accepted that the system needs reform – mostly because it is too complicated and perceived as unfair in some cases – and while it says it will address this, it doesn’t say how.

The government still leans towards some sort of compulsory levy – which means the so-called “Death Tax” isn’t dead – but is not specific on what. Indeed, they have called for a new commission to look at when and how the fee should be applied, and how much it should be. But wasn’t that the original aim of last year’s green paper?

However, in fairness, there wasn’t a great deal consensus on funding. Andy Burnham revealed that, of the 3 funding options outlined in the green paper, 35% favoured a partnership approach, 22% opted for an insurance model, while 41% backed the comprehensive approach.

Meanwhile, the Conservatives are still talking about their £8,000 voluntary insurance scheme to pay for all this. As mentioned before, this doesn’t seem to be enough and I doubt enough people will sign up to it, knowing it is something they may not need in the future.

So, much-needed reform is on the way for the social care sector. While the proposals are great in principle, I can’t help but worry how all this will be paid for – there is precious little on that.

Also, the lack of political consensus on this – the Tories branded the White Paper a ‘train crash’ in today’s Daily Mail – means that after an election we could be back to square one again.

What will be in the white paper?

After what seems like an eternity, the adult social care funding White Paper will finally be published tomorrow. So what will be in it? Here is my bit of crystal ball gazing…

Firstly, it will lay out Labour’s plans for a National Care Service that provides clear national entitlements for everyone, rather than the current postcode lottery. This was first mentioned in last year’s green paper and the idea at least was widely welcomed. The White Paper should flesh out exactly what that might entail and the funding for it.

The free personal care at home policy will also be in there. This has been championed by Gordon Brown and there isn’t a chance it will be dropped now, although the timing of its introduction may be put back until after the election.

In terms of funding, I expect that a ‘partnership’ model – where the state pays a portion of care costs and the service user pays the remainder – will be proposed. In the debate over funding, this seems to have garnered the most support and is something of a ‘middle’ way – and less politically divisive than, say, putting a levy on the estate of every person.

That option is a non-starter because the Conservatives branded it the “Death Tax”. Leaving aside whether it is a good idea or not, the negative publicity already around it would make implementing it political suicide.

Funding will probably be the most controversial part of this; while it is widely accepted that the current adult social care system needs to change, funding it is the tricky bit. For instance, the free personal care at home policy has been consistently lambasted because nobody believes the government’s estimate that it will cost £670 million – some say it could be more than £1 billion.

In addition, setting up a National Care Service, and contributing to everyone’s care costs, will cost billions. In a time where government departments – including the Department of Health – are scrabbling around trying to save billions, you wonder where the money would come from.

And then there is the election. The white paper will probably become a large spoke of the election campaign, which will be a bad thing. As I’ve mentioned previously, cross-party consensus is needed if the best solution for the public is to be reached. With an election, and all the ‘our policies good, your policies bad’ mudslinging that comes with it, this is out of the question.

Of course, the election also means that the White Paper may come to nought if Labour is ousted from power. The Tories have suggested they may go for another consultation before they do anything. If there is a hung parliament, who knows what will happen to it?

So, with that in mind, tomorrow’s White Paper may make promises, but it is by no means certain that essential reform will come to the sector just yet.

Little honesty in social care debate

So, the political mud-slinging has begun in earnest. As the Conservatives, Labour and Liberal Democrats all strive to tell you how bad the others are (or would be), reasoned debate goes out of the window.

The Tories have landed the first blow, accusing Labour of planning a £20,000 “Death Tax” to be levied on all estates after death.

To ram the point home, a new poster was revealed depicting a gravestone engraved with ‘RIP Off’ (see what they did there?) and the slogan: ‘Now Gordon wants £20,000 when you die.’

Health secretary Andy Burnham has rejected this accusation (or hinted that the party is planning it, depending on which paper you read), saying that “firm proposals” will be set out before the election – one assumes he means the White Paper on adult social care funding, which is still being promised, although time is fast running out if it is to appear before the election.

Currently, Labour is sticking to its line that it is considering the outcomes of the Big Care Debate, which took place last autumn after the release of the green paper on the future of adult social care funding.

The Conservatives have said even less, apart from their £8,000 voluntary insurance scheme.

Responding to this, another other related stories, Stephen Burke, chief executive of Counsel and Care, a charity that works with older people, their families and carers, has appealed for an “honest and serious” debate that recognises that better care will cost more, and that radical reform and proper funding is required.

While many people in the social care sector will agree wholeheartedly with that call, the chances of such a debate happening are virtually nil.

Also, any hopes of a cross-party consensus on the future of social care – something various social care commentators have called for – now appear dead and buried.

With the parties now getting into the swing of electioneering, everything they say will be geared to getting your vote. So a reasoned debate on the future of care funding will not happen, because it will require some tough – i.e. not popular – decisions to be made, if a crisis of care is to be averted. No politician is going to say anything that might lose them votes.