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At breaking point
Social care 2017

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Q. What does 2017 hold for social care? What is the Government doing to address the issues? Will it make a difference? What can the sector do?  

A. Vic Rayner, Executive Director, National Care Forum
Vicky McDermott, Chair, Care and Support Alliance
Mike Padgham, Chair, Independent Care Group

Welcome, but in no way adequate, funding announcements

Vic Rayner, Executive Director, National Care Forum

The prevailing comment within social care about November’s Autumn Statement was – what comment? The silence from the Chancellor on the issue of the paucity of funding to care for the most vulnerable members of society was deafening. This was all the more disappointing when married with the almost unprecedented uniting of opinions across the sector – including commissioners, the regulator, providers, people using services and their carers – about the exceptionally fragile state of adult social care in the UK.

Amongst much of the anger expressed across the piste, I found the commentary on the decision take a worrying turn. The narrative began to focus on the unwillingness of the Government to fund the most ‘basic’ of care needs for individuals, and lots of headlines and political commentary centring on the ‘kind of nation’ that we wished to be, that didn’t even meet these basic needs.

Whilst I understand that this approach had the potential to apply leverage to the Government over its inaction, there is a huge risk that it reinforced in the general public’s mind the notion of a set of social care services far removed from the complex and compassionate care that is being delivered 24/7, 365 days a year.

Having seemingly ignored the needs of social care in the Autumn Statement, in contrast, the Secretary of State for the Department of Communities and Local Government put it centre stage in his statement about the Local Government Settlement in mid-December.

In perhaps direct response to the criticism levelled at the Chancellor, Sajid Javid delivered two explicit funding initiatives aimed at addressing short-term pressures within the system.

The first of these, to increase the flexibility of the social care council tax precept, falls foul of all of the challenges to the existing precept. It is seen to benefit wealthier parts of the country, which will gain substantially more revenue from the increase, and in contrast places a significant burden on deprived areas of the country where the tax will have a disproportionate impact on low income households.

The second rabbit out of the Secretary of State’s hat was the announcement of a new, centralised social care fund developed through re-profiling some existing local authority income. This fund will be used to target areas of highest need.

Whilst both of these are welcome, they are in no way adequate to address the current and future funding gap for social care. Neither did they begin to shift the balance of the debate into recognising that the cost of care is rightly high, and likely to grow, as there is nothing basic about either the needs of the people receiving care, or the skills of those delivering it.

More public understanding of the reality of the care crisis is needed

Vicky McDermott, Chair, Care and Support Alliance

While it is encouraging that the Government is finally starting to acknowledge the crisis in social care, its pre-Christmas announcement of the Local Government Settlement failed to deliver the money needed to address the immediate crisis in social care. Let alone tackle any of the long-term problems.

According the Institute of Fiscal Studies (IFS), the funding was worth £700m over two years, not the £900m the Government claimed. Local governments are also still having to make cuts so, as the IFS highlights, funding cuts could still fall on social care services, as long as councils prove the cuts are less than they would have been before the promised precept rise.

While there is confusion over figures, currently more than one million older and disabled people have unmet needs for care and support in England. These people are missing out on essential support for help with everyday tasks like washing, dressing or eating.

There are also record levels of delayed transfers of care as hospitals struggle to cope. The tightening of the eligibility criteria has seen at least half a million fewer people receive care since 2005/6 – a reduction of 30% – while increasing demographic pressures mean more of us need care.

Funding pressures mean that in some areas councils are not able to pay for the full price of care, and care homes are closing as a result. Government figures show that 380 care homes have closed since 2010. When care homes close, people have to go further away from family to find a place, which makes it harder on families to visit. Or, increasingly, there may not be anywhere for them to go at all.

Despite these warning signs, the Government still fails to give social care anywhere near the funding it needs.

A fundamental problem with campaigning on social care is that it is little understood and, therefore, not protected by public outrage like health or education. Can you imagine the understandable outcry there would be if a third of hospitals had closed? Or, if over five years, a third of students were turned away from our schools? That is the equivalent to what has happened in social care.

People often don’t even know what the term social care means. It isn’t part of the health service, like many expect it to be. It isn’t a benefit, even though you’re tested to receive it. It is hard to see. It isn’t summed up in three instantly recognisable letters such as NHS. It isn’t associated with hospitals or GP surgeries or ambulances or waiting rooms. It’s hidden from view, in the homes of older and disabled people. As many families know, not getting support is heart-breaking and potentially dangerous.

Because of this lack of public understanding, politicians keep failing to address the issue. Since 1997, and Labour’s Royal Commission, up until the last Conservative manifesto, which promised to introduce the cap on what individuals had to pay towards the costs of their own care (which was subsequently postponed to 2020), Governments of all colours have talked about changing the funding model for care, but have not implemented much-needed reforms. And the reform they have implemented, namely the Care Act, is being totally undermined.

Money is tight and political energy is being consumed with Brexit, on top of the normal business of Government. It is, therefore, clear that as we fight to ensure we have a care system that works, we need to reach more members of the public and highlight, in an understandable way, what the care crisis means for them, their family and their community, and demonstrate just how invaluable the service is. MPs need to start feeling the pressure to ensure there is proper action to tackle this crisis. And they need to feel that now before the crisis deepens.

We need fresh thinking and a root and branch overhaul

Mike Padgham, Chair, Independent Care Group

The Government’s decision to allow local authorities to increase their council tax to help pay for social care is a welcome move – but really not one that will solve the crisis that is affecting the care of our oldest and most vulnerable citizens for the long-term.

It is, at best, a sticking plaster on a gaping wound. The extra money councils will raise over the next couple of years won’t even begin to address the predicted £2.8bn shortfall and won’t scratch the surface of the problems facing social care.

We are seeing care homes closing or taking fewer people. Domiciliary care providers are also closing or handing back unsustainable contracts. In short, we see people going without care.

It feels very much like we have tried everything to get social care’s case heard – to no avail. What do we need to do? Is it time for supporters to stand as MPs or as local councillors to see if we can change social care from within? What solutions would we propose once there?

Allowing local authorities to increase council tax places the entire burden on council tax-payers and is only a short-term measure. We need fresh thinking and a root and branch overhaul. In short, if the country wants to end this crisis and give vulnerable people the care they have a right to, it is going to have to pay for it and more funding needs to go into social care.

To begin with, diverting funds into social care will save money for the NHS. It is obvious that looking after people, where they want to be cared for – in their own home or in care homes – is wholly better and less expensive than having them in hospital beds. Merging the NHS and social care into a single department – the Department for Social Care and Health, for example – is long overdue. It has never made sense to have the two separate. We should have this single department to provide services, properly funded through national, rather than local taxation. Would people say ‘yes’ if there were a referendum on aiding social care?

Using the independent sector more is another obvious solution. It has been proven time and again that independent providers can deliver services more efficiently and cost-effectively than in-house teams. The independent sector also has the flexibility and flair to come up with new solutions as care needs and economic climates change. There is a case for having the independent sector better represented at the heart of the decision-making process, to harness the entrepreneurial flair that the independent sector brings to the table. Why not second them into Government or the Civil Service to help?

We also need incentives to keep providers in the market and encourage new ones to join and invest, as we look forward to meeting the ever-increasing demand for care.

We are making progress, but it is one step forward, two steps back. Like the England football team ahead of a major tournament, we get our hopes up only to have them cruelly dashed.

We need to take decisive action to find a proper solution now. No more reports, no more talking and no more short-term, sticking plaster solutions. Otherwise, history is set to repeat itself in 2017 and beyond when more and more people will go without the care they deserve.

Vic Rayner, Executive Director, National Care Forum. Email: Twitter: @VicRayner 

Vicky McDermott, Chair, Care and Support Alliance. Email: Twitter: @VickyMcDermott 

Mike Padgham, Chair, Independent Care Group. Email: Twitter: @Mike_Padgham

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