Allocating social care funds: difficult decisions ahead

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Talented but troubled footballer George Best once reminisced, ‘I spent a lot of money on booze, birds, and fast cars. The rest I just squandered.’ The choices facing local councils in how to use the extra £2 billion for adult social care announced in the Spring Budget are somewhat starker.

The £1 billion available next year would, said the Chancellor, ‘enable councils to take immediate action to fund care packages for more people, support social care providers and relieve pressure on the NHS locally’. NHS leaders, having altruistically championed the case for any new money to go to social care and not into their own coffers, were quick to stake their claim. A key component of the Next steps on the NHS five year forward view delivery plan is that part of the money will be used to free up 2,000–3,000 hospital beds. So it was inevitable that there would be strings attached to the new grant, fuelled by suspicions that with councils facing monumental pressures from other services – from potholes to parks – it might not end up in adult social care.

The draft conditions for the new money have now been summarised in the Integration and Better Care Fund policy framework 2017-2019. It will be paid to councils as a direct grant – this is not NHS money, unlike the existing Better Care Fund (BCF), but it must be pooled into the local BCF and so is subject to an agreed local plan signed off by the health and wellbeing board. It must be spent on adult social care and to reduce pressures on the NHS, including hospital discharge, and to support the local social care provider market. It must not be used to offset the NHS contribution to the BCF, which will be maintained at £3.58 billion next year. Councils must submit quarterly reports to the Secretary of State. In short, councils will have some flexibility – but not much.

With delayed discharges relating to social care up by 37 per cent in the past year, it will be very hard for councils not to use some of the new money to reduce this number. But how? There is wide variation between places, in both the extent of the problem and the underlying causes. It is not just about money. Setting aside the fact that 57 per cent of delays remain attributable to the NHS, closer examination of the reasons for the delays reveals that waits for packages of care at home have soared by 51 per cent over the same period. This suggests that in many places, shoring up the fragile home care market and investing in a more sustainable service model might be a better bet than simply throwing money at the immediate bottleneck in hospitals. The pressures on social care run deeper than those on hospitals, which generated less than 20 per cent of new requests for help last year. Prioritising faster hospital discharge at the expense of people with care and support needs in the community – alongside under-investment in community health and primary health – may well blow back into the NHS through higher A&E attendances and hospital admissions.

Another call on the new money will be the National Living Wage, which adds more than £600 million to costs this year and could easily the absorb the lion’s share of the £1 billion available next year. Some councils will find this a bigger challenge than others, with fresh evidence that places with high levels of need have seen larger cuts in spending. Many council social care budgets are already overspent, with some councils dipping into reserves to fulfil their legal requirement to achieve a balanced budget. Councils have a broader set of statutory duties to support people with a diverse range of needs and circumstances to live as independently as possible, to promote their wellbeing and to protect individuals in vulnerable situations. This extends way beyond offering a bed-clearing service to the NHS, important though timely discharge is. The Next steps plan acknowledges that demand for social care is affected by the availability and effectiveness of NHS services such as stroke rehabilitation and other primary and community services provided to people in their own homes and care homes. The NHS and social care relationship is a two-way street.

So the demands on the new £2 billion are many and varied, and it is unrealistic to expect that they can all be met. Inevitably judgements will need to be made about how to balance these competing needs and priorities. This cannot be mandated through central guidance but will depend on mature local relationships between local authorities and their NHS partners, working with independent care providers, in reaching shared judgements about how to make the new money go as far as possible.

But as the Barker Commission concluded, the hard choices about placing the funding of social care as well as the NHS on a more sustainable footing cannot be ducked. The government has itself acknowledged that longer-term reforms are needed and has promised a Green Paper later this year that will set out options for consultation. So in this context, the extra £2 billion for social care is best viewed as a down payment, in the hope of further instalments to come.

Comments

Lenny Kamau

Position
Support worker/Student,
Organisation
Gettalife ltd
Comment date
07 April 2017
I would like more information in regards to social care and its relationship with people with learning disabilities.
More related to how budgets cuts has affected them.
As well as working, im finishing a degree course in social care and politics.
Thanks.

awaters

Position
Digital Communications Assistant,
Organisation
The King's Fund
Comment date
07 April 2017
Hi Lenny, you might like to get in touch with our Information and Knowledge Services team, who will be able to help you with finding further information on this subject and any research queries you have: https://www.kingsfund.org.uk/library/got-question.

You can also subscribe to our email newsletters to receive updates on  our latest work on social care: https://www.kingsfund.org.uk/about-us/get-latest-news-kings-fund.

George Coxon

Comment date
11 April 2017
Wise words as ever Richard. It's a case of a 'bone thrown into a hungry dogs home' (one of my oft repeated expressions). All of this assuming we will see any sign of the additional funds at the frontline that is. I've been a senior commissioner in the NHS, I know about double counting, top slicing, process delays, infrastructure costs, agonising debate on who is most worthy, the need to set in place much admin & management costs in order to both deploy then monitor / audit / evidence & report initiative impact - I could go on. There's always slippage too of course - the time it takes to 'do it properly' - impossible to argue with but will always creates unnecessary delay in getting the bone into the kennel!!!! By which time many will starve (like we are seeing week after week) We've had 3 care homes close in Teignmouth in the last 12 months and are spending time this week salvaging staff & equipment from the last nursing home now closed in Newton Abbott!!

So alas I'm being less upbeat & positive in this response to your comments. - my tendency is to cling to the core of our ethos enshrined in our Devon Care Kite Mark collaborative of care providers - 'we're in it together, we want the same things, we embed pride, kindness, keenness in a spirit of Sharing To Learn' Difficult decisions ahead for sure. I fear where our success / survival strategies will rely more on another of my oft repeated mantras ' our view is one of frustration at the state of care but determined to maintain great care, a can do culture, and enthusiastic atmospheres in our work'

Hope to have you down to see us first hand Richard soon. Keep up the great work as spokesman of sense.

Richard Humphries

Comment date
12 April 2017
As ever I appreciate your comments George. Good care depends on people like you who champion the right values and high standards - so when you feel less upbeat and positive I worry! Yes I will definitely come and see you this year.

George Coxon

Position
Various,
Organisation
Various
Comment date
10 July 2017
A welcome reminder of this blog and it's question on 'the difficult decisions on social care funding' and the promised extra funding for social care. So much or so little has happened since the budget announcement of the

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