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Commissioners and the Care Act

CMM is offering readers the opportunity to put their questions to senior decision-makers. Is there something affecting your business that you’d like an answer to? Are you facing specific pressures you’d like to know how to tackle? Add your questions to the comments section below.

With the Care Act looming, what are commissioners’ thoughts on the changes, how are they looking to tackle them and is there enough money to see them through?

David Pearson, President, Association of Directors of Adult Social Services responds.

With the Care Act rapidly approaching its Phase One of implementation, it will probably be regarded as one of the most fundamental parliamentary contributions to our sector since the post WW2 legislation, consolidating as it does that family of statutes which give teeth to our aspirations towards well-being, integration and personalisation. It can and will make care and support fit for the 21st Century.

It has also given rise to a host of activities related to grounding it fully and securely within the statutory framework which make up our collective practice with adults of all ages with disabilities or illnesses requiring care and support to meet needs and achieve personal outcomes.

Witness, for example, the intense work being carried out by Public Health England, the Department of Health and other bodies on a sophisticated communications strategy designed to raise the awareness of users and carers at the same time as local authorities are preparing to meet the additional demands that they are anticipating. There is evidence of considerable training investment being directed towards the new legislation. Anticipated demand has led to enhanced recruitment of social work staff. New obligations to work with the NHS have required intensive discussion and joint training – all of which come at a price.

Meeting the cost

No, we haven’t finally reached agreement on the overall costs of implementation. But rising to the challenge of taking on new responsibilities and meeting growing demands at a time of maximum financial austerity will have its cost. Part of meeting that cost will, of course, inevitably be drawn from users of the system themselves.

It’s fantastic that we are all living longer – a real tribute to decades of scientific and medical advance. But it is worth briefly rehearsing as well what additional demographic demands adult social care is facing, as well as what pressures the austerity of the past five years has brought. The figures do not make happy reading! Although local authorities have protected social care budgets as far as has been possible, funding to adult social services has been reduced by a further 1.9 per cent, or £266 million, in 2014/15 to £13.68 billion. This will be the third year of continuing cash reductions and the fifth year of real terms reductions in spending.

Yes, we have had the help of some money in the Better Care Fund for 2015/16 and this is very welcome. As has been the £25 million new money distributed recently for the sole purpose of alleviating the crisis in the NHS’ accident and emergency services. But the continuing scale of reductions in funding to local government presaged by last year’s Autumn Statement continues to be a cause for extreme concern.

Councils and providers need to work closely together locally to negotiate and agree the price paid for care based upon local circumstances.

We have experienced a 12 per cent cut in real terms at a time when – irrespective of the pressures the Care Act will bring – demand for our skills and services has increased by 14 per cent. Inevitably this has led to fewer people receiving support, with councils over the last four years making savings to their adult social care budgets totalling £3.53 billion. Some 150,000 people who might have qualified under previous eligibility criteria now no longer receive services.

The Association of Directors of Adult Social Services’ budget survey for 2014/15 showed a 5.8 per cent reduction in the numbers of eligible adults receiving services during the previous year. The biggest decrease was directed towards older people supported in community settings which reduced by 7.9 per cent compared to a 4.7 per cent reduction in the number of older people in residential care.

Quality services

Transparency, accessibility and simplification are the Care Act buzzwords and well-suited to grappling with the complexities of ‘how, what and when’ social care is paid for. Unlike the bigger £100 billion-plus NHS, social care is not a ‘free at the point of access’ service. It is rationed. Councils have to apply means and needs eligibility tests to allocate these precious resources, with most people having to fund all or some of their own care and support with the council contributing the rest.

With increasing numbers of people living longer with multiple complex health conditions, there is a competitive market of providers to meet this growing demand. We have a competitive market, and it will be the job of councils to ensure that it is high quality, sustainable and one which is diverse.

At the same time, councils are equally concerned with money and high quality, focusing on making the most efficient use of scarce public resources to keep pace with demand of the most vulnerable in our local communities and commissioning for better outcomes.

This difference could be significant and there is a general acknowledgement of a potential cross-subsidy existing, where it could be assumed that private funders paying high fees are in turn underwriting the lower fees paid by councils or individuals. However, this is not immediately evident, as fees paid are normally confidential between the individual and the provider/commissioner.

Appropriate price for care

This difference also opens up a debate about what is the appropriate price of care. Councils and providers need to work closely together locally to negotiate and agree the price paid for care based upon local circumstances. These discussions are often informed by the use of financial models, such as the Association of Directors of Adult Social Services Price of Care tool, but do not cover fees paid by self-funders.

The new duties in the Care Act for councils to arrange care on the request of individuals is very likely to expose these differences. While this duty promotes greater transparency about the cost of care, a number of commentators have also expressed reservations about what this could mean for the sustainability of the market.

There are a number of scenarios for what might transpire: the biggest concern of care providers is that with greater exposure of costs, the market will drive the price paid down to the lowest common dominator. From a consumer point of view this must be welcomed, but providers argue that this could undermine profitability and market diversity. On the other hand, commissioners have commented that this exposure of price paid for care could drive prices upwards, with providers challenging lower rates being paid.

Either way, there is fundamental need to ensure the system is properly funded and that there is access to a rich diversity high quality of services and support. These questions will be at the heart of the current consultation on the Care Act Phase Two duties to be introduced in April 2016, and the Association of Directors of Adult Social Services welcomes the opportunity to contribute to these important decisions.

David Pearson is President of the Association of Directors of Adult Social Services.

What are your thoughts on the Care Act? Do you feel commissioners are ready for the changes? Do you think it’s possible implement the Act with the amount of money currently in the system? What are your thoughts? Add to the debate in the comments below. Subscription required. 

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