Social care funding: not a win-win

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The funding transfer for social care announced in the Spending Review was welcome. But the chancellor has taken away with one hand what he gave with the other

Is it only two months since ADASS launched its annual budget survey onto an austerity-drunk world with a headline which resonated throughout the country? `Social care funding,’ it read. `A bleak outlook, getting bleaker’.

This reflected a view that after at least five years of financial restraint – some would see that restraint stretching back even further – and the loss of some £3 billion out of the adult social care pot, matters had got to such a state that directors had to say loudly and clearly, that they couldn’t be allowed to get any worse.

Directors everywhere are well aware of the difficult economic choices the country is facing and having to make. And we are well aware of the enormous help given to our departments by inward transfers of health service funds.

Social services departments, too, have gone many an extra mile to make their services more efficient although, as our survey showed these efficiencies are sometimes nowhere near so `painless’ as they sometimes seem.

However, taking all these views and developments into account, it is absolutely clear that all the ingenuity and skill that we have brought to cushioning vulnerable people as far as possible from the effects of the economic circumstances cannot be stretched any further, and that some of the people we
have responsibilities for may be affected by serious reductions in service – with more in the pipeline over the next two years

Has last month’s Spending Review for 2015/16 helped alleviate the plight of adult social care services and the people they ought to help and support?

Err… yes. There is nothing there to ring out the bells for. Directors will not be seen dancing in the streets. Nor, in particular, will their finance directors. If it was hard enough before to peer confidently into the future, the crystal ball is even murkier following the chancellor’s deliberations.

But there can be no doubting that the global figure of £3.8 billion being made available, conditionally, for adult social care is good news. £335 million will be made available for Dilnot – and even better – this is not part of any other flow of money: it is additional, as is the £2 billion made available for adult social care.

What is bad news though is the really serious reduction – just over ten per cent – in the overall local government settlement. The spending review might enhance and encourage integration with the health service. But that could be made more difficult while local government – the bedrock of our departments – begins slowly to disintegrate.

The hardest thing we might have to disagree with is hearing the government say that although local government has lost £2.5 billion, they’ve gained a £2 billion transfer from the NHS. Try comforting colleagues in other local authority departments with that thought. Frankly, we are going to have real problems managing this within local authorities because local government overall has been hit really hard yet again.

Nothing is as it seems, of course. Of that extra £2 billion, £1 billion will be dependent on delivering results. Few directors, and certainly no chief finance officer will happily plan on the second £1 billion being available unless the conditions are very soft. The precise mechanisms for this social care application of Payment By Results have yet to be fully worked out: but we all know that there’s nothing quite like financial uncertainty to undermine confidence in service delivery.

The Dilnot issue is simpler, in a way, and a good story for local government and adult social care. Our original bid for £500 million implementation costs was met with a £335 million offer which will assuage many fears of a substantial underfunding.

The Department of Health is assuming that we won’t be able to do more than their calculations have allowed for, and that sounds like a sensible assumption. As sensible is their belief that of the number of extra people to be assessed, a certain percentage will not be eligible.

Other payments mentioned in the spending review report include one-off resources (in 2014/15) of £200m from the health service ‘as an upfront investment in new systems and ways of working that will benefit both services.’ While the overall £3.8 billion includes £350 million of capital funding
which will be available for projects to improve integration locally, including IT funding to ‘secure sharing of patient data between the health service and local authorities, and to improve facilities for disabled people.’

Also included in the spending review is a commitment ‘to ensure that more adults and young people have access to clinically proven psychological therapies and that every accident and emergency department will have constant access to mental health professionals.’

There are other issues, and other details. Carers’ monies and the impact of the transfer of the Independent Living Fund to name but two. But the overall sense is of a government recognising that this bleak picture really is getting bleaker, and trying to do what it can, by whatever means, to avert that eventuality.

There will be feathers to unruffle. Clinical commissioning groups have already shown their displeasure. And the Royal College of General Practitioners has warned of the likely adverse impact these changes will have on general practice.

These will almost certainly be the first reactions as the health
and social care parts of the wider care equation begin to relate the one with the other in a vastly different, but a vastly more productive way.

John Jackson is joint chair of the Association of Directors of Adult Social Services resources network

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