Cllr David Williams is the Leader of Hertfordshire County Council
As we finish the party conference season which was dominated by Brexit considerations, it is fair to assume the future of social care, alongside other domestic reforms, will take something of a back seat with March 29th now looming large on the horizon. Yet the party’s long-awaited social care green paper could be one of the most important publications over the course of this year. Successive governments have put forward proposals that tinker round the edges rather than deliver radical reform. Many of us felt that the Care Act – introduced under the Coalition – and the principals contained within it, provided a sound basis for change. Unfortunately this was not supplemented by sufficient money for councils to implement a key element of the reforms, a ‘cap’ on care costs.
The present funding crisis facing many local councils, from Northamptonshire to Somerset, Birmingham to Torbay, is fuelled by social care costs, chiefly the demands of a growing elderly population and people with learning disabilities. The County Councils Network (CCN) warned last week the ‘worst is yet to come’ in service cutbacks as its 36 members prepare to make savings of almost £1 billion in 2019 to their overall budgets, on top of £705 million this year already. These savings are having to be made because those councils face a funding gap of £3.2 billion – with the costs of our ageing demographics the key contributing factor. Importantly, filling this gap means services simply ‘stand still’ and are maintained – rather than improved. This is unsustainable in the long-term; fundamental change is needed.
The government did announce £240m to be invested into social care this winter; this funding and the recognition of the pressures councils are facing are both welcome, though this is clearly a short-term boost. However, government must also provide clarity on the continuation of existing funding streams. Going into 2019/20 there has yet to be clarity on whether the Better Care Fund money for adult social care, worth some £10bn to local government over the last three years, will continue. It is imperative that clarity is provided to the councils urgently, so they can begin to plan and commission new services, or maintain them, using this funding stream. If not, many councils will be playing catch-up, to the detriment of residents.
Also the Government must publish both the NHS ten-year plan and the green paper in tandem this autumn, not only to show its commitment to integration, but also to begin the debate as the best way in which to deliver health and social care services post-2020. Ahead of the paper’s release, CCN has produced its own social care paper, which outlines ambitious yet practical reforms that our councils believe could create system sustainability and deliver better outcomes for residents. A key ‘ask’ from counties – who by virtue of containing the largest and fastest growing elderly populations face the most acute social care pressures – is to ensure there is the correct balance of contribution between the state and the individual.
It is important people are not subjected to catastrophic care costs and live in fear of losing their savings. This must be countered either through a cap and threshold model, something which CCN has long-advocated, and which has been proposed by the last two governments, or through another approach such as free personal care. Research shows that that if a lower cap is set the more it would cost the local authority. If a cap is set at £50,000, it would cost county local authorities £700 million per year, whilst the introduction of a social care threshold at £100,000 would cost £308 million a year. Clearly, councils are not in a position to afford either and any reforms put forward by government must be fully funded. This is where reforms to the state can come in: if we consider national taxation rises too political unpalatable, then the idea of a social care levy for those over 40, or the recently-floated idea for adults to pay into a social care national fund, could be considered.
Whilst the NHS’s £20 billion windfall clearly means there is less money to go around, the Spending Review provides the opportunity to inject money into local government, alongside reforming the way councils are funded through the ‘fair funding review’ and business rates retention. Equally important, to lessen the burden on the Treasury, we need to ensure the best use of the funding announced for the NHS. There is a strong case for a larger proportion of the recently announced NHS money to be invested into preventative social care, as well as shifting activity away from acute care to primary and community-based care, along with mental health. CCN will be advocating for local government to play a greater role in the commissioning of these services, to deliver greater alignment with social care.
Whilst social care may lack the national status the NHS has – and therefore is not as clear a vote winner – they are interdependent and investing in one without the other is a false economy. Investing in local government delivers results. Since the introduction of small annual cash injections into reducing hospital discharges, CCN member councils have reduced delayed transfers of care by 41 per cent (from 74,228 last May to 40,209 this June); whilst the NHS equivalent figure is 14 per cent. Considering that local government has done more than any other part of the public sector to create savings – protecting care services whilst over 40 per cent has been wiped off their annual budgets since 2010 – it is fair to argue the present situation could have been a lot worse if local government and its track record of innovation and financial prudence was not responsible for social care services.
The challenges of delivering yearly balanced budgets, whilst caring for the most vulnerable, must not be underestimated. Whilst comparing like-for-like is unfair, it is clear that the NHS has not been in the same boat. This is why some suggestions that social care should be amalgamated into the NHS are overly-simplistic – especially given that many NHS bodies run on yearly deficits. Any such move could also lead to a democratic deficit, with the transparency and accountability of decisions in the NHS insufficient when compared to local government.
We look forward to engaging in the proposals when they are published over the next few months. Twelve social care green or white papers have gathered dust down the years as short-termism took precedence.
Let’s hope this one is lucky number 13 and sets out the radical reform the system desperately needs.