05 January 2007
Happy New Year. If you are an adult with a disability you now have two years left to receive preventative social care that could stop your condition deteriorating further, the Local Government Association has claimed.
If trends continue, funding shortfalls mean that by 2009 only those whose needs are classified as 'critical' or 'substantial' – typically the bed-bound or those recuperating from an operation – will receive care packages from their local authority.
In fact, the LGA's figures are starker than that: doomsday has already arrived in almost seven out of ten English local authorities. They have stopped providing care such as help with meals, washing and dressing designed to improve wellbeing, prolong independence and prevent more costly hospital or care home admissions for those whose needs have been classed as 'low' or 'moderate'.
As Anne Williams, vice-president of the Association of Directors of Social Services, acknowledges, such a scenario is the 'opposite of the direction of travel outlined in the [2006] health and social care white paper'. This promised 'care closer to home' and to shift focus and resources from a 'sickness service' centred on the acute hospital sector to a more preventative 'good health' service provided by GPs, public health initiatives and social care.
This time last year social care leaders applauded those aspirations and looked forward to the Comprehensive Spending Review for the investment to make it happen.
Today, few retain that optimism. 'I think we're in for a very tough time,' Williams told Public Finance. 'Whereas there was a lot of money for growth in the NHS and education last time around, by the time the full impact of demographic change was acknowledged in social care there wasn't such a favourable financial position.'
By 'demographic change' Williams does not just mean the growth in life expectancy. This alone, according to the chancellor's Pre-Budget Report, will lead to a 38% increase in the number of over 85-year-olds in the next decade.
But on top of this, medical advances have enabled children born with severe disabilities to live well into adulthood, often requiring intensive levels of social care.
And although people are living longer they are also enduring disabilities and ill health for longer, again putting increased pressure on the NHS and social care.
Yet instead of providing new money to meet this rising need, Gordon Brown announced in the PBR that the CSR 2007 settlement will include an annual requirement to make 3% efficiency savings on budgets.
That will be a problem, says Williams: 'Back-room efficiencies alone will not deliver the 3%, especially given the amount that's already been taken out of social care.'
Efficiency in social care has been a bone of contention in recent months. In the autumn, Treasury value-for-money studies, intended as preparatory analysis for the CSR, used council PSS EX1 data returns to uncover huge variations in unit costs for the same type of social care. In inner London, the cost per hour of home care ranged from £7.41 to £17.40. Similarly large ranges were found across the country, with metropolitan councils paying between £9.18 and £18.11 an hour.
On the Treasury's reading, the variations suggested that significant savings could be achieved if all councils brought their unit costs down to the lower end of the range. Councils argued that the data was skewed by the different levels of care provided; councils that only provided care for those with 'critical' or 'substantial' needs naturally had higher unit costs, as the care provided was more intensive.
But when challenged by David Behan, the Department of Health's new director general of social care, councils also had to admit that much of the data was inaccurate.
Central government had not taken much notice of the PSS EX1 data returns before, and so their accuracy had been neglected. 'They're not worth the paper they're printed on', was how Behan put it.
The incident highlighted a major stumbling block for advocates of new money for the preventative services heralded in the white paper: the evidence, or rather, lack of it.
'We don't have as much evidence as we need to give to the economists about how early prevention really can not only make a difference to people's quality of life, but also makes far more financial sense,' social care minister Ivan Lewis told PF last month.
Government initiatives such as the DoH's Partnerships for Older People pilots and extra care housing are still in their infancy, and evaluations on costs and outcomes are not expected until at least 2008: too late for the CSR.
The evidence that has emerged suggests that any savings will be only over the medium to long term. While ministers talk about preventative care as a 'social justice' and 'progressive universalism' issue – the number-crunchers at the Treasury are said to be less convinced.
Without the evidence about how resources can be safely shifted from the NHS to social care, DoH financial controller for social care Paul Carey-Kent told a CIPFA conference in December that 'prevention is probably a longer-term issue'. Ministers had not made their final decisions, but he indicated to PF that the CSR was unlikely to bring new cash for preventative social care.
Yet the white paper has already pledged to introduce preventative spending targets for primary care trusts by 2008. For Paul Snell, chief inspector at the Commission for Social Care Inspection, such a regime could 'in principle' promote preventative care by doing for adult social care what Every Child Matters has done for children's services: 'one agenda across all services,' as he puts it.
But Williams doubts local levers will be enough in practice. 'The past year has shown that NHS deficits have put huge pressure on some of the partnership arrangements between health and social care and there's been some drawing back of local transfers of money,' she says.
She points out that while evidence on the economics of prevention is still awaited, 'there is an absolute evidence base in terms of the demographic', and more resources are needed just to stand still.
She acknowledges that some efficiencies could be made, through the use of IT to streamline care assessment, planning and procurement, for example.
'But,' she adds, 'these things in themselves will not solve the funding gap. The only other option is more money for social care.'
PFjan2007
