The Comprehensive Spending Review needs to be genuinely comprehensive: and that means investing in social care

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The clue to what needs to happen in this year’s Comprehensive Spending Review (CSR) is in the first word of its title. While some areas of public spending have been largely protected in the past decade, others, including local authorities and adult social care, have seen heavy cuts. As social care reels from the impact of Covid-19, it is time to redress some of that balance and make public spending more comprehensive, focusing not just on health services but on care, and not just on spending by national government but by local government too.

The CSR is the opportunity to do that. It is happening at a time of obvious uncertainty, generating specific financial pressures in local government that must be addressed and making a long-term perspective harder. That may mean a pragmatic decision to limit the CSR to a one-year timeframe, and this may even be an advantage for social care if it is backed up with money to help the sector survive while long-term plans, and their cost, are worked out.

'As social care reels from the impact of Covid-19, it is time to... make public spending more comprehensive, focusing not just on health services but on care, and not just on spending by national government but by local government too.'

For there certainly will be a cost. The need for additional funding, for local authorities in general and social care in particular, is surely irrefutable. The Institute for Fiscal Studies (IFS) suggests that councils need an extra £3.2 billion in real terms in 2024–25 to maintain services at their 2019–20 level. This number reflects both the impact of Covid-19 and the longer-term pressures on adult social care that come from having more older people living longer, the increased need from working-age adults and the rising costs of delivering care.

As the IFS notes, that number is likely to be an underestimate, for several reasons. First, local authorities are underpaying for social care services by an estimated £1.2–£1.5 billion per year, thereby threatening the sustainability of an already fragile provider market. Second, this additional money would only return funding to its 2019/20 level, inadequate after a decade of cuts which has seen more people seeking social care support but fewer people getting it.

Finally, crucially, it includes none of the costs involved in properly reforming the current system – a pledge that successive governments have made and failed to keep (a dismal sequence that this government came into power explicitly promising to end).

Of course, having an irrefutable case does not guarantee that case will succeed: HM Treasury is infamously hard-hearted when it comes to social care. So arguments about spending precedents and the moral case for investment may not, in themselves, be enough. How then can these issues be addressed?

Well, parts of HM Treasury’s own stated priorities for the CSR chime with the need for investment in adult social care. Better social care would indeed ‘improve outcomes in public services, including supporting the NHS’. It can prevent admission to hospital, it contributes to reducing delays in discharging patients from hospital and, through preventive activity, it can reduce demand for both health and other social care services.

'The Institute for Fiscal Studies (IFS) suggests that councils need an extra £3.2 billion in real terms in 2024–25 to maintain services at their 2019–20 level.'

Adult social care can also ‘level up economic opportunity… by investing in people’, partly by ensuring that people who use it can play a full part in their communities, including by working. This argument also applies to family carers, where it surely cannot make sense for people to be forced to give up work to care for relatives (unless of course they choose to do so). Better social care can therefore create not just opportunity but also workforce efficiency. Economic opportunity is also created through employment in the social care workforce, particularly for those who might lack formal education qualifications. Properly funding social care – and a better paid workforce in particular – would indeed spread opportunity by providing a route to valuable, meaningful employment and – with reform – structured career paths.

Yet trying to demonstrate the need for social care investment in economic terms, speaking the language of HM Treasury, provokes at least one major challenge for the sector itself. The Treasury’s priorities for the CSR talk about not just spreading opportunity but ‘maximising productivity and improving the value add of each hour worked’. Social care needs to be much more willing to engage in the discussion about productivity and to challenge data that appears to show a long-term decline in productivity in the sector. This may be a quid pro quo for the extra investment needed.

These would be complex and difficult issues at the best of times (not for nothing has reform of social care funding been passed over for 20 years). The Covid-19 crisis amplifies those difficulties still further. Yet the issues will not resolve themselves and it is critical that this reflected in the CSR.

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Comments

George Coxon

Position
Care home activist,
Organisation
Various inc care home owning
Comment date
22 October 2020

There is such anxiety amongst social care providers the likes of which has never been seen or felt before. It’s obviously massively compounded by the fears we have about life during a global pandemic but equally was being felt by the sector way before February / March this year.
At risk of antagonising some of my fellow care home provider colleagues and sounding both a little naive & complacent in the same breath - many care homes who are ‘plugged in’ with positive relationships with commissioners, NHS partners, family loved ones and who have trusted loyal staff in dare I say smaller homely care homes - aren’t doing to badly. Those who have been lucky in parts of the country so far less traumatised by covid may, like us, be still thinking we can ride this out - a vaccine perhaps, a weakening viral load as has been speculated by some of the hugely varying opinion of our scientist experts? But really ? Can we really endure another 8 months? Another 12 months ? More ?
As an ex senior NHS commissioner I totally understand the concept of ‘more for less’, ‘living within your means’ and containing costs, long term forecasting against short term spending in a crisis. I spent so much time saying no to the most senior and eminent cardiac surgeons and others asking that their internationally renowned specialist expertise be rewarded with above tariff funding to incentivise the work they were doing on the most complex cases. I took no pride in doing that. But tough decisions, ‘not a popularity contest’ and all the justifications we were forced to use were a necessary evil was to deliver somewhere near financial balance at year end
Perhaps it’s the same and more so now We are paying a modest but moderate (affordable) uplift above minimum wage to our staff, we are staffing up to give us ‘wriggle room’ to cover shifts should we need to this winter, we are injecting pace, energy, fun and innovation in my care homes not just by me - though I do enough of that I could claim (check my tweets for real time examples of what hands on leaders do in care home land @coxongeorge) but also in appointing new ‘20 somethings‘ roles aimed at generating greater vibrancy, individualised curiosity focused life in everyday life for our most deserving members of our communities.
So as to the CSR. Yes it’s so vital we have a 10 year long term plan like the NHS, a viable safe & secure 24/7 care for predominantly our late 80s /90s population living with advancing frailty & often dementia and isolated loneliness, neglect & worry relying on inadequate care packages & huge family responsibility. Parity of esteem with our health colleagues too of course but a recognition equally there are serious fault lines in the care sector - we must face them and call them out It’s wrong to say the only sustainable model for long care care is one where industrial scale silos of older people living in artificially constructed so called ‘person centred’ institutions with standardised room sizes are the only viable option. It’s not about profit, offshore banks and shareholder investments and servicing debts & brinkmanship it’s about honest passionate frontline kind, enthusiastic care where owners work amongst their staff and know really know the people they are responsible for looking after
Great prompt from you as always Simon. Take care, be strong and keep speaking up on our behalf

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