Paying for social care

There are an increasing number of local news reports coming through of cuts being made to social care provision and charges for it being put up. Unfortunately, this is going to be repeated across the UK in the coming months.

 In the past day or so, 2 stories have come across my radar, both of which detail aspects of social care cuts in local authority areas.

 These are just taken at random and happen to be the ones that appeared in my inbox. There have been others over the past few weeks and there will be more to come, these are just to illustrate my point.

 Firstly, www.getwokingham.co.uk reported that Wokingham Borough Council has confirmed that it will no longer offer free services to people with savings of more than £23,250 and will introduce a £16.30-a-day charge for day care services.

Meanwhile, Community Care carried a story about Derbyshire County Council’s plans to save about £4 million a year by ramping up its eligibility threshold for social care services.

I suspect that many more councils will follow suit as budget cuts really begin to bite. The oft-quoted figure of 25% savings having to be found still haunts managers and commissioners in local authorities who will have to make some very uncomfortable decisions in the coming months.

I don’t wish to be the harbinger of doom, but, well, I’m going to be; these cuts could get deeper too. The comprehensive spending review, which sets local authority spending budgets for the next 3 years, is in October, and with cutting the UK’s deficit at the top of the government’s priority list, there are likely to be more cuts to come.

While many politicians claim that cuts won’t affect frontline services, it seems to me to be political flannel. Cuts of that magnitude will inevitably affect frontline services, as the 2 reports above show.

Currently 72% of council have their eligibility criteria set at ‘substantial’. Meanwhile, 24% will cater for people with ‘moderate’ needs and only 1% provide services for people with ‘critical’ needs, according to the Local Government Association and the Association of Directors of Adults Social Services.

I reckon that the percentage of councils catering only for ‘substantial’ or ‘critical’ needs will rise in the next year, which will mean that increasing numbers of people with moderate needs will be left out of the care system, unless they can pay for it themselves.

The government has talked about a focus on early intervention and prevention – which is to be applauded – and will help to keep people independent for longer. There is also a focus on those with the highest needs, as there should be.

But this leaves an enormous hole in the middle of people with moderate to quite complex needs who, unless they are lucky enough to live in an area that isn’t scrabbling around for every penny it can find, won’t be getting any services.

To me, there are inevitable knock-ons from this. For instance, without any care services, more people will end up with higher – and more expensive – needs faster than if they had got support earlier. It also puts more of a strain on carers, many of whom undertake the role without any financial support, or just for the Carers Allowance, which is still only £53.90 a week.

Not only this but services such as day care and meals on wheels, which are often vital lifelines, will also be cut back on.

I apologise if this makes for grim reading – I take no pleasure in writing it – but I can only see hard times ahead for everyone associated with social care. I doubt I’m saying anything revelatory, either.

But, to end on a positive note, if there is one thing the sector is good at, it is being resourceful. Social services, charities, third sector organisations and carers will always find ways to provide services that make a difference. This won’t stop because of local authority cuts.

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…

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.

More work needed to raise social care standards

While the Care Quality Commission has tried its best to get a positive spin on the findings in its review of adult social care services  published today, as ever, most people and the media have focused on the negative aspects of it. And they’re right to.

Despite the overall quality of services improving in the past year in all areas, there is still a significant minority of ‘poor’ and ‘adequate’ services being provided to adults and especially older people.

Poor services are always unacceptable and need to be rooted out or given help to improve. Reports like these highlight them, but it means nothing if it doesn’t help to bring about change.

To this end, the CQC’s chief executive, Dame Cynthia Bower, said the CQC is determined to raise standards, hence why 8 councils have been designated as ‘priority for improvement’ councils and another 16 are to have an in-depth inspection of their services.

Elsewhere, the new registration system for adult social care providers, NHS providers and independent healthcare will have a single set of safety and quality standards. Also, the CQC is to get tougher powers and will be able to respond to concerns more quickly.

But local councils also have a role to play in improving services, especially commissioners; they need to look at the services they are purchasing and, if they are failing, move elsewhere. Obvious perhaps, but still needs to be said because it seems some commissioners don’t do this.

Unfortunately, this may be easier said than done. While eligibility criteria for receiving social care remained largely constant in the past year, after the previous 2 years when the number of councils providing care for ‘moderate’ or ‘low’ needs fell markedly, the spectre of eligibility levels being raised again in the coming years because of dwindling budgets looms large.

With budgets being squeezed, commissioners may feel under pressure to look at the cost of services rather than the quality. By the same token, service providers may also be under financial pressure and be looking to make cutbacks, which could affect the quality of their services.

So, in essence, the CQC’s reports are positive – let’s not forget standards are improving – but they show how much work still needs to be done. But by acknowledging this, and laying out strategies to help, the next report should be more positive still. As long as budget considerations don’t impact too much, that is.