Do we have a failing social care system or just a failing funding model?
‘Welcome to the New Year!’ I said to myself washing my face and listening to the early morning news headlines on the 3rd January. That very morning, the first working day of the New Year an open letter from charities, faith-based groups and senior figures in the NHS and local government said that we had a failing social care system that must be reformed.
The letter to the Telegraph argued:
As a society we face a growing care challenge. We should celebrate the fact that we are all living longer lives, particularly disabled people and those with long-term conditions. But the unavoidable challenge we face is how to support the increasing number of people who need care. It is a challenge which we are failing to meet – resulting in terrible examples of abuse and neglect in parts of the care system.
This comes at huge cost to the dignity and independence of older and disabled people, but also to our society, family life and the economy. An estimated 800,000 older people are being left without basic care – lonely, isolated and at risk. Others face losing their homes and savings because of soaring care bills.
Disabled people are unable get the support they need to live their lives independently and be part of society.
Businesses are losing increasing numbers of experienced staff who are forced to give up work to care for older or disabled relatives. These carers can then be pushed to breaking point, providing round-the- clock care. Our NHS is also paying the price, as a lack of support leads to avoidable hospital admissions and then keeps older and disabled in hospital beds because they cannot be cared for at home.
We have a duty as a nation to change this – but it requires political leadership.
I’m no social worker but whenever we look at the council budget it is hard to avoid the feeling that the social care element of the budget is a ticking time bomb that at any time might just blow up a council’s budget; especially when cuts are being made.
However, I don’t think social care is failing; I think the funding of social care within the local government budget is failing.
That is not to say there are not regulatory or market problems or that the structure of adult social care could not be strengthened or indeed that the standard of care in some areas could not be improved. I just have a lot of time for the people I know who do that job and the work they do and can’t help but feel that describing that aspect of it as failing does them, and the services they provide, a massive dis-service.
So why is the funding of social care failing?
From a budgetary point of view social care budgets, as currently structured within the local government budget, face three interlocking problems that make them different to most of the other budget items. Each of them on their own would be problematic for a local authority facing 25% cuts. Taken together they present local authorities with a series of challenges that must be addressed sooner or later and cannot necessarily be fixed within the context of the current structure of the local government budget.
1) Demographics: The amount of people entering the social care system is difficult to predict and therefore difficult to budget for. Each year the council will ask the social care teams to set their budgets based on their best estimates but no matter how good these are they will never be totally accurate. This leaves local government desperately scraping around for money at the end of each year if demand was too high or accused of predicting wrong, and therefore cutting too far elsewhere, if the estimate is too high. Either way, this is simply not a sustainable way of funding, or indeed planning funding, for social care.
2) The controllability of the market: Nearly the entire social care budget in our local authority, and I believe in many local authorities, is spent on providers from the private or voluntary sector. Squeezing money from them is difficult for a number of reasons, not least that these providers run the risk of doing a ‘Southern Cross’. Even worse, the providers might start to cut corners in response to the lower payments and this can lead to some of the problems mentioned in the Telegraph letter. Cutting costs with our suppliers is both risky and difficult to do.
3) Changing behaviour: If you want to save real money in Adult Social Care then it usually means asking people to do things in a very different way. This might mean asking the clients to receive a different type of service (which might or might not be better but is always cheaper) or asking the social worker to choose from a narrower range of contracts. Either way these changes are difficult for everyone involved and not easy to implement straight away.
Taken together these interlocking challenges, allied to the size of the social care budget relative to the rest of the council (which can be well over a third of any unitary council’s spending) make it extremely tricky to manage within the local government context.
The local government budget is by no means the be all and end all of the social care debate but any final solution developed by the Government needs to make sure that it is looking at all three sides of this budgetary problem whilst also addressing the wider sustainability of the social care system.
A solution that produces a sustainable funding settlement (one that is not at the whim of a cutting Secretary of State for DCLG for example), a means of accessing funding as the demography changes and recognises that the market for adult social care needs to be developed in partnership, both locally and nationally is a big challenge but one which I think we can’t avoid.
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