The current crisis in social care in England (and let’s be under no illusions, for ‘crisis’ is what it is) should come as no surprise.
Demand and need for social care, especially but not exclusively, for elderly people, has been rising for many years, and is forecast to grow at accelerating rates for many more years. as it has for younger adults.
Yet local authority budgets have been cut, year upon year, for over six years. This decrease in funding has inevitably led at best, to budgets, which have not expanded to match growing demand – and at worst, to wholesale cuts and cessation of social care services.
And now, the Local Government Association (LGA) is warning of a £2.6 billion shortfall by the end of the parliament in 2020 unless action is taken now to deal with the problem.
Let’s be clear: this is a disaster in the making, the outcomes of which are: poorer and less social care provision for those in need; and increased pressure on staff and providers whether they are in the public, voluntary, social enterprise or business sectors, as well as the NHS.
Desperate to avoid cessation of services, providers are all too often cutting back on the quality of care, and too often, especially in the business and voluntary sectors, they are cutting staff terms and conditions, with staff commonly working, in reality, for less than the National Living Wage. This is particularly the case in domiciliary care. With their margins squeezed beyond even short-term viability, we are witnessing increasing numbers of business and charity sector providers going bankrupt and/or having to close their provision.
Provider costs are increasing because of a range of issues, including the welcome introduction of the National Living Wage. Re the latter, it is deeply unfortunate that voluntary and charity sector providers have commonly argued against such measures and increased quality regulations simply because they have zero expectation of local authorities increasing funding to compensate. Care should not be provided at the expense of staff any more than clients/users should be denied improved quality standards.
To address funding pressures, I note that many local authorities are increasing the ‘care need threshold’ above which users have to ‘jump’ before they are entitled to social care, which is publicly or part publicly funded. So – care ‘is’ being rationed, and more and more people are having to pay for their care. This is inequitable and simply extends the already significant inequalities between places, and between families and individuals. Equally disappointing are delays in assessments, which of course mean that people have to wait longer before even being considered for care.
Unsurprisingly, local authorities are also seeking to ‘manage demand’, but too often this manifests itself as denying or delaying access to care. There have even been examples of some local authorities contracting companies to ‘manage demand’ down in sometimes horrendous ways. Preventative services and different models of intervention that maintain the dignity of service users and improve their lives but which also reduce financial pressures on limited budgets are, of course, to be welcomed. However, these are very different to the harsher forms of ‘demand management’.
For decades, the trends of funding reality and its consequences have been recognised by social care professional leaders and staff, NHS leaders, local government, academic and think tank health experts, regulators, charities and most of all by service users and their carers – plus those who need the care services which they are currently being denied.
Disappointingly, and to no one’s surprise, successive government’s responses have been to blame local government, and call for increased efficiencies. Having apparently run out of ideas, the current government has allowed local authorities to raise an additional precept of 3% a year over the next two years. However, as the Institute for Fiscal Studies (IFS) has stated “if Councils make full use of the 3% precept in each of the next two years, they will not be able to use the precept in April 2019: a cap of 6% in total over the next three years applies. In other words, council tax increases can be brought forward to raise money in the short term, but this will do nothing to plug the longer-term funding issues adult social services (and councils more generally) face.” Yet again, the only solution thus far the Government can come up with is to kick the problem down the road.
What I find especially cynical about the current proposed ‘solution’ is that council tax is a regressive tax. And whilst unavoidable for most local authorities, the council tax base varies between places. This means that poorer places raise less revenue from a 2% council tax increase than wealthier places. Need for social care services especially, is often greater in those places with lower council tax raising ability. This all simply adds to the unfairness of the situation and compounds inequality between places for people with identical social care needs. And significantly, the Government’s ‘Better Care Fund’ does not adequately address these inequalities and shortfalls in funding.
The Government should address the funding gap in the Budget.
Whilst the health and social care integration has to be part of the solution to the current crisis – that is clear. And whilst such integration will not resolve all the issues.
New additional Government funding has to be the immediate solution.
Charities and wider voluntary sector also have a role to play through: advocating for service users and their carers Charities should not be afraid to speak out for decency, quality and the interests of service users. Above all, as many of the national sector leaders are doing, they must join local government leaders including the LGA, NHS leaders, professional bodies, and trade unions to bring pressure on the Government to close the immediate and future years’ social care funding gap. They should speak out against the inequity and inequality of the current position, as well as the Government’s inadequate solution of relying solely upon council tax precept increases.
Social care should be regarded as a ‘social good’, just as much as the NHS. And ideally, it should be free at the point of delivery – but even when/if it is not, it should be based on rights, fair funding and equity across the country and between places.
How elderly people, especially the physically and mentally frail elderly, as well as younger disabled people and those with mental health issues, are treated and cared for is a core indicator of the values and ethos of any society – and of its Government. The Chancellor must act and produce the money.