Oxfordshire county council has for the past four years pulled out all the stops to avoid passing on a 38% cut in its grant for services for homeless people. But now the authority says it has nowhere left to turn and is reluctantly planning to phase in the reduction, including stopping all funding for dedicated support for those with substance misuse problems.
“It’s not something I like to do, but we’re not unusual in doing it,” says John Jackson, the council’s director for social and community services. “The reality is that I have to protect services for people I have a statutory responsibility for.”
According to new research published today, Oxfordshire’s decision is emblematic of the state of adult social care services across England. Findings from a survey of adult social care directors reveal that half say that fewer people are getting services; barely one in three says they are protecting the size of the personal budgets older people and disabled adults receive to pay for their care and support, and six in 10 directors are braced for more legal challenges.
The Association of Directors of Adult Social Services (Adass), which conducted the survey, has hitherto been notably measured – critics might say overly so – in its response to cuts ordered by the coalition government since 2010. But now it warns that the social care system is on the brink of becoming unsustainable. Its president, David Pearson, calls on wider society to say how far it is prepared to protect “countless vulnerable people who will fail to receive, or not be able to afford, the social care services they need and deserve”.
Recalling that earlier this year the National Audit Office (NAO) questioned whether councils were approaching the limits of their capacity to absorb pressures on social care budgets, Pearson says: “Our survey shows beyond doubt that we have reached the point where we are unable to absorb the pressures they, and our survey, have identified.”
The survey adds to the sense of financial crisis. Demands for extra cash for the NHS are mounting and this week the Local Government Association (LGA) warns that councils in England face a £5.8bn funding gap by March 2016 due to further cuts in grant – forcing 12.5% savings in 2014-15 alone – and escalating demand for services, particularly for older people.
The funding gap for adult social care on its own will be £1.9bn by March 2016, the LGA estimated. Next year, 2015, is “make or break” for social care with the introduction of the government’s Better Care Fund, expected to pool more than £5bn of existing funds from councils and the NHS to spend on integrated services that are designed to keep people out of hospital. Current government funding for social care is £14bn.
Pearson, however, says the scale of the challenge far outstrips any benefit that may come from integration. “It is not the directors’ job, but that of the country as a whole and its politicians, to debate how much, in times of the most severe adversity, vulnerable people should be protected from the consequences of that adversity by the introduction of new money into social care.”
Norfolk gives a flavour of the challenge. The county’s population is projected to rise 25% by 2033, but numbers of those aged 65-74 will increase 54% and numbers aged 75 or over will soar by 97%. Much of this growth will be in isolated rural communities in the north of the county.
Norfolk’s adult social services department already reports growth of 53% in referrals over the past five years, together with a near-tripling of demand for intensive homecare support of 10 hours a week or more, at the same time as it has been making £72m savings, which includes cutting the numbers of social work posts and paring back preventive services. Nevertheless, it says spending on frontline care has been protected.
With further cuts of £59m in Norfolk social services planned over the next three years, however, continuing to protect care is no longer realistic. Some £14m is coming out of people’s personal budgets, £6m from support for people with learning or physical disabilities and £4.5m from the contract with the council’s own residential care company.
Asked what the future holds, Sue Whitaker, Labour chair of Norfolk’s adult social services committee, says: “I have a feeling that trying to provide anything on top of what is required statutorily is going to be exceptionally difficult, if not impossible.”
This reflects the national picture painted by the Adass survey. Based on returns from directors in 144 councils with adult social care responsibilities, 95% of the total, Adass calculates that another £266m (1.9%) is being taken out of services in 2014-15, making a total 12% real-terms cut in spending since 2010 while demand for services has risen 14%. The net effect, therefore, is said to represent total savings since 2010 of 26% or £3.5bn.
Questioned about the likely impact over the next two years, 47% of directors say people who used services would get smaller personal budgets for their care and support; 48% say fewer people would be able to get services; 50% forecast greater pressure on the NHS; 55% expect care providers to face financial difficulty; and 59% anticipate receiving more legal challenges to cuts.
With most provision of care these days outsourced, 19% of directors admit not knowing if all their contractors paid the national minimum wage and only 3% are confident that all paid the higher, unofficial living wage. As many as 75% say they commission some homecare visits of just 15 minutes, although 90% of them say such visits were simply to check on an individual’s wellbeing or medication.
Richard Humphries, assistant director of policy at the King’s Fund thinktank, says the survey rings painfully true. “This is the consequence of the 2010 spending settlement that supposedly protected the NHS but left the social care system totally exposed,” he says. “It was all entirely predictable.
“What we are seeing now is a double whammy with both the NHS and social care simultaneously facing a crunch year next year. Most people cannot see how to get beyond this without extra money – not just money for more of the same, but for transformation of services. The Better Care Fund is OK, but it’s a very small step towards much bigger measures that are needed.”
Back in Oxfordshire, Jackson thinks the county council has a sustainable – if unpalatable – four-year plan for social care. His political boss, Conservative cabinet member Judith Heathcoat, has told the Oxford Mail she is “as comfortable as I can be” with the planned 38% cuts in housing-related support, which are part of a £64m savings package across the authority over four years.
Other savings will come through cheaper support for people with learning disabilities, moving them either out of residential care or perhaps from two-person flats to shared accommodation for five. Older people will also be hit: those attending health and wellbeing centres may next year be charged £20 a day.
Jackson’s fear is that growing numbers of legal challenges will be incurred over people’s statutory rights to care. “In the end we cannot not meet people’s care needs” he says. “We would want to do that morally anyway, but the law is very clear about it. We don’t need the courts to tell us that.”
This article was written by David Brindle, for The Guardian on Wednesday 2nd July 2014
Source – Welfare News Service, 02 July 2014