The prevailing media narrative this week has been that adult social care in this country is in crisis – and that the answer is to spend a lot more money on it. The reality is more complicated.
Let us start with the “crisis”. Talking about a crisis is often effective for those in opposition. Either the Government concedes there is a crisis – and thus acknowledges terrible failings for which they are responsible. Or they deny there is a crisis and sound complacent and out of touch. Of course, it will only get an opposition so far if people doubt they could do better. Ed Miliband’s talk of a “cost of living crisis” did not quite do the trick.
With adult social care, one measure of how bad things are is the number of people stuck in hospital even though they are well enough to leave; because the local authority has not set up the necessary care arrangements. This is certainly a serious problem in some areas – but it varies very widely as the figures show.
In my local council of Hammersmith and Fulham last year there were ten people on an average day, per 100,000 of the population, needlessly stuck in hospital due to Council delay in making alternative arrangements. In Wandsworth the figure was below half of that: 4.4 per 100,000. Why? This is not a rhetorical question; I have logged the query with my Council for an explanation. But I would be surprised if the answer comes back that Wandsworth spends twice as much proportionately on adult social care as we do or has twice as high a proportion of elderly residents.
In September there were virtually no delayed discharges attributable to social care in some councils – Peterborough, Rutland, Newcastle and Torbay. But the worst ten per cent of councils oversee delayed transfer of care rates that are 20 times worse than the top ten per cent of councils. Half of all delayed discharges are in just 20 councils.
It’s only one measure. There is a hugely welcome trend of more people being cared for in their own homes – helped with personal budgets and adaptions made possible by new technology. That reduces the need for care homes. For those who are placed in care homes there are indications that the worst ones are closing and that standards are improving.
The Care Quality Commission’s annual report has just come out. It said that 72 per cent of adult social care services are rated as good or outstanding (last year’s report had the figure at 59 per cent). It added:
“Our evidence suggests that finance and quality are not necessarily opposing demands; many providers are delivering good quality care within the resources available, often by starting to transform the way they work through collaboration with other services and sectors.”
The views of “service users” tend to quite encouraging too. 64.4 per cent say they are extremely or very satisfied with their care. 85.4 per cent “reported that the services they received helped make them feel safe and secure.” 76.6 per cent “reported they have control over their daily lives.” More disappointingly, only 45.4 per cent “reported they had as much social contact as they would like” although that was slightly up on last year.
For 2011/12 the equivalent figures were all lower – 62.8 per cent were all “extremely or very satisfied with their care and support”, 63.8 per cent felt safe, 75.1 per cent “had as much control as they wanted or had adequate control”. (I can’t see the social contact figures for that year.)
So if there is a “crisis” now, what was there last year? What was there in 2011? On the whole the situation is improving.
We can see beneath the national statistics, plenty of innovative good practice that is providing improved care for the elderly and other vulnerable adults locally, Last month I wrote about the arrangement by Bath and North East Somerset Council with the NHS to integrate services using Virgin Care.
Here are some other positive developments which the Local Government Association has reported on:
- Bexley Council’s ‘Moving On’ team comprises staff who have a particular expertise in helping people with learning difficulties to find suitable accommodation. Choosing the right type of housing, finding a home and getting the right mix of support is crucial. Each person is assessed to determine the level of support they require and there are various options to choose from. Some people choose to live independently with the help of support workers whilst others live with family or friends. Telecare (special equipment such as monitors, sensors and alarms) also helps many people to live independently. At the beginning of the programme, which has now been running for over a year, five self-contained flats were opened. These were quickly filled with people who had been living in residential care but who wanted greater control over their lives. To date there have been 26 successful moves which have resulted in a saving of nearly £1 million for the council and, more importantly, helped those involved to live more independently.
- Buckinghamshire County Council faces growing cost pressures from the increasingly complex needs of an ageing population. In response, it has developed a preventative social care model that supports people to live independently in their own homes for longer. The new model can save as much as £13,900 per user per annum based on the avoidance of adverse conditions, including preventing depression, hospital admissions and entry into care. This is against an estimated cost of £1,000 per person for delivering the service.
- Hundreds of the county’s residents will be helped to return to their homes after Essex County Council signed four new contracts to encourage independent living. The contracts will see four dedicated residential reablement units established across the county, enabling residents to, for example, avoid moving from hospital into residential care. The units, where residents will be able to stay for up to six weeks in preparation for returning home, will help them regain skills and confidence following an illness, accident or disability. Residents will be given the support needed to tackle everyday tasks such as preparing meals, managing medications, personal care, shopping and laundry. The new units will allow social care teams to refer up to 800 residents a year.
- Hampshire County Council has formed a partnership with PA Consulting to offer comprehensive telecare services to local residents. PA Consulting are responsible for all aspects of the telecare service including promotion, assessment, installation, monitoring and maintenance. Just under 2000 installations took place in the first year, resulting in better outcomes for the users and a net saving for the council.
- Hertfordshire County Council works in close partnership with its district councils to secure improvements in residents’ health and wellbeing and has distributed £200,000 of its public health budget to the councils. This supports initiatives such as supporting those with dementia to live in their own homes and sport and physical activity programmes for the over-50s.
- Staffordshire County Council, in partnership with Staffordshire and Stoke-on-Trent NHS Partnership, has established the UK’s biggest integrated health and social care provider. The decision, confirmed by the Department of Health, involved nearly 1,000 care staff and a £153 million budget transferring from the council to the Partnership NHS Trust. It is now responsible for all adult social and community healthcare in Staffordshire and all community healthcare in Stoke-on-Trent, delivering everything from physiotherapy to day care. By reducing duplication and streamlining the delivery of integrated care, savings of £24 million have been achieved and reinvested in additional care. Patients have benefited as more people receive care in their own homes rather than in hospital or a residential home.
Earlier this year there was an interesting study from Professor John Bolton on how changes can both save money and improve the service.
“Nottinghamshire ran 35 different day care services across the county in 2010 when they launched a consultation which aimed to reduce the number of centres to 13 – one for each “locality” in the county. This approach required the new centres to be able to cater for anyone with respite care needs, with people from all ages and conditions attending the same centre. Nottinghamshire would focus the day centres as respite care for people with relatively high care needs – mostly older people with dementia and younger adults with profound learning disabilities (often combined other physical disabilities or challenging behaviours).
“At the same time they rationalised and reduced the amount of transport required to help people get to these centres (and this was charged for separately outside people’s personal budgets). There still are some voluntary sector day centres in the county (in addition to the 13 council run places) which customers could choose to attend using their personal budgets and the amount to fund that was fixed at a set rate. “
The new arrangement saves the Council £3.8 million and “has proved to be generally popular with the customers using the new services. ”
North Tyneside has done particularly well at helping people stay in their own homes:
“Two major routes that can assist people: the allocation of assistive technology, from a call alarm system to more sophisticated technology; and the use of community resources through a “well-being service”. The former has meant that the Council has now issued over 3300 items of equipment to help people have both more peace of mind and personal security (there are 40,000 older people living in the borough) through assistive technology. The latter has led to a range of support being offered from volunteer befriending services, to practical help or links to community groups and organisations.”
Then there is this to report from Tameside:
“Tameside’s approach included encouraging local societies, sports clubs and associations to include in their activities opportunities for adults with learning disabilities who could use small personal budgets or their own personal resources to undertake community activities in a productive and positive way. Not only did this save money but also greatly improved the life experience of these younger adults.”
Another report from Professor Bolton included this welcome news from Torbay:
“A study found that domiciliary care reablement was significantly overused, when actually for many older people a simple programme set by a physiotherapist which the patient could self-manage (with support) would be a better alternative. The study found that in about 50 per cent of the cases this alternative would have been much less costly and produced the same (if not better) outcomes.”
The announcement yesterday by Sajid Javid, the Communities and Local Government Secretary, included a rejig of the New Homes Bonus money. Also, upper tier councils will be able to push up the Council Tax by an extra six per cent over the next two years with a Social Care precept. With a further increase for general spending, some Council Tax bills could rise by ten per cent in two years. This is written up as what the Government will “allow”. But, of course, a Council could double or treble their Council Tax if they win authorisation in a referendum.
There is plenty that councils are doing wrong. It is a scandal how much of the Public Health budget held by councils is wasted – effective preventative measures could ease the pressure on adult social care. The duplication in social work assessments remains a source of great irritation. Improving the supply of sheltered housing would often provide a better alternative to care homes. Doubtless I will return to these and many other criticisms. But let’s pause to consider what a good job many councils are doing. Faced with a challenge to save money, they have not only met that challenge, but provided a better service at the same time.