Social care services are teetering on the brink of cutting services to vulnerable people in need. The new Health Secretary’s warm words on integration needs to be matched by adequate funding
There were varied reactions to Health Secretary Jeremy Hunt’s speech at the recent national children and adult services conference in Eastbourne.
But whatever your view on the content, two factors are important. First: this was his first major speech in his new role, and he deemed social care to be sufficiently important to devote it to it.
And second? Even by the time he’d got to his second paragraph he had made a reference to what has been constantly on his and his minister Norman Lamb’s minds and lips since they took office.
‘The word,’ he said, ‘I have heard more often than perhaps any other in my first month is “integration”. Our NHS is an extraordinary organisation of which we are all deeply proud. But by itself, it’s not enough.’
Not many people have had the privilege of hearing a penny drop so loudly and resoundingly. And more: throughout the conference week the mood music playing was, `yes, we understand the financial pressures facing you’. And `yes, we are in for tough budgetary times in the coming months and years’.
Even before the current period of austerity it was widely acknowledged that adult social care was underfunded. Since then we have taken a further hit, with £1.89bn in savings from adult social care budgets. And even if the Dilnot recommendations are implemented, his proposals will not deliver additional resources into our cash-strapped system.
So the second funding question that sits alongside the Dilnot question is how much will it cost to deliver the kind of care system set out in the White Paper, and how will this be funded?
This question needs an answer. Getting to an answer will require an honest appraisal of the costs of different types of care. On this we need a good decision at national level.
I still feel that care services are `on the edge’, and by that I mean we are teetering on the brink of reducing services to a number of people in need of them – and perhaps of dangerously squeezing the margins expected of independently provided services.
As the bodies accountable for ensuring people’s needs are met, local authorities must engage better with providers, who in turn have a responsibility to ensure they can deliver against a
service specification for the price they tender.
The issue about separate funding streams is one we need to tackle as well, because where a cost falls is not necessarily where a saving lands. What we have to do is stand back and assess what we spend overall on, for example, older people. And then consider whether our public pounds are being spent in the best possible way.
We need to look at what would best meet needs and then spend accordingly, regardless of funding streams. Indeed, we have the powers to do this under the proposal in the new Bill; and in the Health and Social Care Act we have a duty to do so. But we do not always have the will, the courage, or the trust.
So. Close to the edge? Yes. Over the edge? Not yet. Overall, it is clear that national government is relying on local government and its partners to take good decisions to drive forward its vision. But as a quid pro quo, we in local government and our partners are just as much relying on
national government to take a good decision about how to fund it.
To add a Dickensian touch to our dilemma – these are Hard Times. But there are Great Expectations!
Sarah Pickup is Director of the Association of Directors of Adult Social Services