By Jenny Owen and Bill Hodson
Can the promised new deal for social care services weather the economic storm
A bleak picture is emerging of how the harsh economic climate is affecting the most vulnerable members of our communities. On almost every measurable count, older people and those with disabilities are starting to experience real pain.
Adult care services, already seriously stretched, are feeling the squeeze. Budgets are at best standing still and at worst going into the red, according to a recent study by the Local Government Association and the Association of Directors of Adult Social Services.
All this reminds us of the context in which the government’s long-awaited green paper on funding adult care is likely to be published, and of the enormous demographic and economic challenges that it will be designed to face.
The new secretary of state, Andy Burnham, earned a first-rate reputation at the Department of Health during his previous incumbency, and has already set his marker as someone who well understands the intricacies of funding elderly care within a health and social care setting. Both his and care minister Phil Hope’s commitment is beyond reproach.
But the real challenge will be to accommodate those known demographic pressures within a far more challenging economic and fiscal environment than ever could have been foreseen. It does not mean, as some doom-merchants have claimed, that service users are being abandoned. It doesn’t mean that the same people have been denied access to a wider range of council facilities because fewer and fewer have been eligible for social care services. Nor does it mean, as the Commission for Social Care Inspection warned in its death throes, that the radical move towards personalised services might come unstuck.
But it has meant that thin services have been stretched more thinly, training budgets have been threatened, and possibly even the desired and desirable emphasis on preventative service might have received less attention than it deserves. And this when the long time lag between cause and effect is better understood than ever before.
Green shoots by 2010? Maybe – but the demand for social care services is likely to increase in volume and intensity in the next two or three years.
It’s worth remembering some of the factors that caused our present woes. By the end of 2008, we had witnessed a 63% reduction in mortgage loans, a 31% increase in mortgage arrears, and a 68% increase in repossessions. There is some evidence that the recession in the housing market might have bottomed out but the recovery is still expected to be very gradual.
Unemployment, however, has continued to rise. In the three months to November last year, it rose by three-quarters of a million and is still forecast to exceed 3 million by the turn of the year. More than 4,000 companies went bust and 500 pubs called last orders for the final time. These trends are predicted to continue for some while.
There have also been well-publicised increases in the number of children entering the care system in the past six months – an expected consequence of unemployment and increased poverty. But the totals might have been influenced by social workers exercising greater professional caution in the wake of the Baby Peter case.
Whatever the truth of the matter, based on previous recessions, levels of domestic violence can be expected to rise – an important consideration since these episodes will affect both adult and children’s services.
So, the bad news first: what discernible effects were departments of adult social services recording in March this year? The brute percentages speak for themselves. More than 60% of authorities recorded a rise in general welfare advice queries; almost 30% experienced higher demand for mental health, drug and alcohol misuse services; and 17% reported an increase in referrals of adults due to concerns about their safety – known as safeguarding referrals.
However, the latter figure needs to be treated with caution as, again, the survey was conducted at the height of fears over the death of Baby Peter.
Disturbingly, just over 60% of authorities also recorded fewer opportunities for employment for disabled people within their localities, while 30% were aware of third sector agencies closing or reducing the services they provided for local people. More than a third reported a rise in homelessness and the use of temporary accommodation.
When asked ‘Has your budget for adult social care for 2009/10 been reduced by more than was expected as a consequence of the recession, almost a fifth of respondents answered ‘Yes’. In another study, conducted in March, even though directors agreed that recession had not had a substantial impact so far, most had taken steps to anticipate it.
But the survey results were not all gloom and doom. There was no evidence of a reduction in activity within the domiciliary care market. Only 2% of respondents indicated that there was, although 19% thought that services were being inhibited by the closure of independent sector homes.
At the time of the survey, three months ago, there had been no significant effect on personnel, with only 4% of directors reporting a reduction in staff or a freeze on recruitment. Matters might have got worse since then but as yet there is no evidence one way or another.
So, at the time the survey was completed, the vast majority of adult care directors were fairly optimistic about the impact of the recession on the workforce. For example, 86% thought that the impact was positive, as there had been an increase in the numbers of suitable applicants for each post advertised.
A trend that might have intensified since was only barely caught in the headlights this time round: there was virtually no drop in income to departments from service users defaulting on social care charges. Just 7.5% experienced this. However, a much larger number (26.5%) recorded a drop in income from two other sources: property sales and residential and nursing care contributions, as fewer people were eligible for charges.
What is encouraging about this economic downturn, compared with others, has been the emerging agreement that local authorities have an active role to play in helping mitigate the worst excesses. Our recession survey shows, for example, that 81% of local authorities have developed a corporate or departmental strategy to address the impact of the downturn. And, where the corporate role is stressed, some 60% of adult services directors are playing a leading role.
That figure, encouraging though it is, should certainly be higher given the range of services directors of adult social services have to put into the pot. They are increasingly responsible for a far wider span of services than ever before – most of which, if properly orchestrated, can play a significant part in combating and alleviating the harsher aspects of recession.
More than half of directors manage their local social housing – a major aspect of any local authority-inspired fightback against recession. Most invest substantial sums one way or another in local voluntary agencies; many others run sports and cultural services including libraries and museums – all can be put at the service of communities in a variety of creative ways.
But these are, perhaps, the more ordinary responses that social care has offered. Many more creative innovations are emerging throughout the country, such as welfare advice agencies and credit unions. Regional commitments to buy and invest locally and pay promptly have also helped small businesses, retailers and bigger suppliers keep abreast of the recessionary tide.
In the Northwest, there has been a deliberate attempt to ‘get upstream’ of events through healthy eating initiatives, energy saving ideas, targeted skills training aimed at encouraging local apprenticeships, boosting volunteering and trying to prevent people coming into the health/social care system in the first place.
One inner-London authority – Camden – has decided that, for them, this will be a ‘long and deep’ recession. It has worked with the NHS, GPs and jobcentres to identify vulnerable people – especially those newly unemployed – and offer individual, tailored services where appropriate, such as information advice and guidance, training and employment.
According to Michael Scorer, acting director of housing and adult social care with the London Borough of Camden, some 300 tenants in a number of estates had been identified in this way. The council is also attempting to improve tenants’ financial situation. It has financially assessed 800 tenants and is ‘working to maximise their incomes’ while linking them in to partner agencies providing debt and money advice.
Another borough’s main strategic aim was ‘to stop services going in different directions’. Other authorities have: invested in ‘credit crunch fairs’ to support people affected by newly discovered hardships; provided guides to cheap and healthy eating; and, with the help of the Department for Work and Pensions, encouraged users to take up all the benefits they are entitled to.
Directors have spoken of simple practical measures: creating more shelters to accommodate newly homeless people and investing more to help people not entitled to public funds, such as newly unemployed east European nationals facing unanticipated hardships.
There is though, throughout the services, a fear that with all the new investments directors are having to make, some will be unable to meet their 2% efficiency targets this year. There is also a clearer commitment to not repeating the ‘slash and burn’ policies of the past. In earlier recessions, service cuts and redundancies were applied across the board but there is now at least a hope that we can do it better this time.
Perhaps some of this is unduly optimistic: there seems little chance that local authority spending itself won’t become a victim of the credit crunch, and that some of the optimism with which service directors have faced the recession might be wiped out by a harsher economic reality. In reality, neither Chancellor Alistair Darling nor his shadow counterpart George Osborne are denying that serious restraints will have to be put on public expenditure in the short to medium term.
The argument will be where and how, not whether.
For its part, Adass will continue to monitor and publicise the effects of the downturn as well as sharing information about schemes and projects that have worked. It doesn’t all have to be bad news, but it will be unless we take active steps to prevent it.
Jenny Owen is president of the Association of Directors of Adult Social Services, and Bill Hodson is co-chair of the association’s housing network
