Is it just me…?

Editor in Chief, Robert Chamberlain, reflects on a new report that questions whether personalised care can be achieved amid local authority spending cuts.

Published on 6th June, a new report from the Public Accounts Committee expresses concerns regarding local authorities’ abilities to provide ‘truly’ personalised care while seeking to make savings in adult social care budgets.

Chair of the Public Accounts Committee, Meg Hillier MP commented, ‘The need for adult social care is increasing but in recent years the amount spent on such care by English local authorities has fallen in real terms.

‘Against this backdrop, there are clearly risks in pursuing new approaches to providing care.

‘Personal budgets have great potential, but the interests of users are paramount and must be protected.

‘It is vital people receiving care do so through the form of personal budget that best suits their circumstances. They should also be supported to make best use of it.

‘In this time of real funding pressures, central government must work with local authorities to safeguard the market for social care, including assessing the impact of the National Living Wage and other factors on provision.

‘The Department of Health and its partners must also show they are learning from available evidence and data so that care users can be confident of getting best value from the resources available.’

According to the report, Personal budgets in social care, the Department of Health, ‘does not believe that everyone counted by local authorities as having a personal budget does actually have genuine choice and control over the services they receive’.

The Public Accounts Committee states that there is a need for greater clarity on how local authorities can implement personal budgets to maximise benefits to users.

The plight of providers

Reassuringly, the Committee recognises the ‘real threat’ to care providers’ survival in the context of the current and future market. The Report’s summary states that, ‘Local authorities face a substantial challenge supporting sustainable local care markets which offer the diverse range of provision needed for users to personalise their care, while care providers are struggling to recruit and retain appropriately qualified staff as financial pressures increase’.

The Public Accounts Committee calls for the Department of Health to provide guidance for local authorities and care providers to determine what high-quality care with proportionate support looks like and the real costs of delivery.

It recognises that the social care market is fragile and calls for the use of analytical tools to safeguard both the interests of service users and care providers alike.

Is it just me?

I welcome this report and the issues it raises. There is a clear need for commissioners and providers to work together and co-create models of care that are affordable, sustainable and, most importantly, better meet the needs of service users.

There are obvious instances where cost driven decisions currently disadvantage those in need of care. For example, the move to provide more domiciliary care as an alternative to that in a residential setting sounds like a welcoming proposition. Yet, in reality, this often results in a vulnerable adult receiving just 15-minute home care visits rather than appropriate support when needed.

To me, the elephant in the room is the dynamic in the relationships between local authorities and care organisations.

Too often, the buyer power of councils is used to bludgeon providers to drive down costs. Their use of external consultants to engage with the market to drive down care fees, in return for a commission, is a perfect example of strong hand tactics.

In addition to the recommendations, I would call for action to be taken to address this prevalent culture. There are excellent examples of how some councils have worked with care providers, especially in learning disability supported living, but unfortunately, this is far from the norm. Procurement practices need to become more about partnership than dictatorship to benefit service users and stabilise the market.

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