Tag Archives: funding

Care funding commission must consider all adults

Here we go again. Today sees the launch of the latest Commission on the Funding of Care and Support (catchy title) for adults.

We’ve been here before, most recently with last year’s Big Care Debate. That got as far as a White Paper before the election, but as soon as the government changed the proposals were swiftly dropped. So we’re back to square one. Again.

Nevertheless, the new commission has been detailed to report back within a year. Health secretary Andrew Lansley expects legislation in front of Parliament next year, and it will eventually form part of a larger White Paper that also takes in the Law Commission’s work on creating a single modern statute for social care, and the Government’s vision for social care.

The commission will focus on:

  • The best way to meet care and support costs as a partnership between individuals and the state
  • How an individual’s assets are protected against the cost of care
  • How public funding for the care and support system can be best used to meet needs
  • How its preferred option can be delivered, including an indication of the timescale for implementation, and its impact on local government (and the local government finance system), the NHS, and – if appropriate – financial regulation.

The politicians have, as usual, made all the right noises about this; for instance, Lansley said; “we must develop a funding system for adult care and support that offers choice, is fair, provides value for money and is sustainable for the public finances in the long term.”

All regulation political guff and nothing that anybody disagrees with; it’s just that successive ministers have said this for some years, so its hard not to feel cynical.

But reading between the lines, service users should not get their hopes up that reform will improve things too much. As care services minister Paul Burstow said: “Trade offs will have to be made but we are determined to build a funding system that is fair, affordable and sustainable.”

Trade offs? Is that a euphemism? To me, that is a subtle way of saying that to get to a solution, some existing ways of being funded may have to be axed/cut back. However, this is just speculation on my part – I may be reading too much into it.

But the commission does take place against the backdrop of swingeing budget cuts and this will form a major spoke in their thinking, hence why a leading economist, Andrew Dilnot, has been chosen to chair it.

He will be assisted by the CQC’s Dame Jo Williams and Lord Norman Warner, a Labour peer and former director of Kent social services – and also an outspoken critic of Gordon Brown’s free personal care at home policy earlier in the year – who will help to ensure that the commission does not just focus on the numbers.

As with the last commission, a range of funding options will be assessed, including a voluntary insurance scheme, as favoured by the Conservatives, and a partnership of state and individual contributions, the Liberal Democrats’ preferred option. No mentions of a compulsory levy – aka Labour’s “Death Tax” – being considered in the press release however, so we can assume that that won’t be an option.

But if this is to be successful the commission has to look at funding care for all adults. One of the criticisms of Labour’s last attempt was that it focused too much on older people – especially the voter-winning solution to people having to sell their houses to pay for care – with people with disabilities sidelined.

While older people do make up a significant proportion of those receiving care services, those with disabilities are just as important and any solution has to appreciate their needs and circumstances as well.

The solution also must been seen to improve – or at the very least not cut – services, if it is to get widespread acceptance from the public. Again, this will require doing more with less – a neat trick if you can pull it off.

But what the commission must do above all is to come up with a conclusion. The Big Care Debate had 3 options, but no one option was significantly ahead of the others. This commission should look at all the options and consult widely with frontline workers and service users before making a decision – and then sticking to it.

Coming up with a solution to funding adult social care is not going to be easy – otherwise it would have been done years ago – but this time it needs to happen. However, while some tough choices will have to be made – the financial situation is inescapable – the option of doing nothing is even worse for service users.

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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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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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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.

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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.

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White Paper reflections

It is now a day since the White Paper came out, and the response from the media, social care organisations and rival political parties has been quick and, in the main, fairly critical.

The White Paper was given short shrift by most of the mainstream media. While its aims of creating a National Care Service were seen as laudable, many focused on the delays to making changes, how it would be paid for – and by whom – and the lingering “Death Tax”.

Those that gave the White Paper the most enthusiastic welcome tended to be the organisations that are government-backed. To paraphrase Mandy Rice-Davies, well, they would, wouldn’t they?

Charities and third sector organisations seem to have generally given the White Paper a good welcome, but again question where the money will come from for it.

Meanwhile, think tank the King’s Fund – an advocate of the partnership approach before the paper came out – welcomed the ‘ambitious’ plan, but questioned where the money to do it would come from, calling for detailed proposals urgently.

I reckon the King’s Fund was spot-on.

Now I’ve had time to reflect, it seems clearer that the White Paper has been geared to the election – it is big on ideas, but short on detail. Style over substance, if you will.

I really like the idea of the National Care Service – its aims are laudable and it is something to be aspired to. In an ideal world it would be here already.

But – and it’s a big but – I cannot work out how it would be paid for, without having to raise taxes, impose compulsory levies on the public or take money from other budgets. Nether, I suspect, judging by the content of the paper, do the government.

Also, given that the original aim of its preceding green paper was to address the funding of adult social care – with the hope that it would get rid of the current means-testing system – it has singularly failed to do it.

Indeed, the whole question of funding was fudged, with a call for another commission to be set up to investigate the best ways. Evidently the government didn’t want to be associated with any new taxes before the election, so has kicked it into the next parliament.

As a result, the system will creak on, as it has done for years, hated by many. A chance for genuine – and needed – reform of the funding system has been lost, sacrificed at the altar of electioneering.

For me, that clouds all the good ideas contained in the White Paper.

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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.

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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.

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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.

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