21 September 2007
Councils are being urged to begin candid discussions with their residents about the imminent possibility of cuts in social care services following next month's Comprehensive Spending Review.
But the warning of further cuts in the short term came as Public Finance learnt that the Department of Health and the Treasury are preparing to announce a new green paper on adult social care alongside the CSR. However, it will focus only on funding options beyond the 2008/11 period.
Sir Simon Milton, chair of the Local Government Association, wrote to all council leaders in England on September 19 about the expected CSR settlement for social care.
He warned that if fears of a 0% real-terms increase for the three-year period proved correct, councils were duty-bound to explain to residents the damaging effect it would have on services.
'If the settlement is at the lower end of expectations, it is likely to result in tighter criteria for free or subsidised elderly care services, cuts in services or both,' the letter stated.
'It seems likely the coming years will see a period of austerity that councils will not have seen for more than a decade,' it continued.
'It is vital that local people are helped to understand what this will mean in terms of the probable reduction [in] services.'
Behind the scenes, the LGA is lobbying ministers to switch 0.5% of the NHS's expected budget, approximately £500m, to social care.
That has prompted an angry reaction from the NHS Confederation, whose chair, Bryan Stoten, said: 'It is simplistic to suggest that taking money away from one public organisation – the NHS – and giving it to another – local government – is the solution'.
Stoten acknowledged the 'huge demographic challenge' posed by a rapidly ageing population and admitted that it was 'sensible' to invest in preventative services.
But he added: 'The NHS not only deals with the longer-term problems of preventative care, it also deals with the immediate health care needs of the local population. Partisan solutions will not work.'
PF understands that the question of transferring resources from the NHS to preventative social care remains the 'sticking point' in discussions over the green paper, which is expected to be published next spring.
Sources said that DoH discussions now centre on the adult social care funding model proposed by Sir Derek Wanless in his report for the King's Fund last year.
Under his plans, a 'partnership' arrangement would guarantee a basic free service to all, with the state matching pound-for-pound personal top-ups, up to a defined optimal care package, to promote greater personal spending.
But charities are concerned that the government could choose 'Wanless-lite' instead.
Last year Wanless costed his model at a net £1.7bn of extra public spending a year. But the government could cut the cost by setting the basic free minimum package lower, by offering lower co-payments, or by defining a sub-optimal maximum package.
Early proposals to follow Scotland's free personal care policy, or to extend pension premiums to facilitate saving for long-term care, are now thought to be off the table.
Sources also told PF that calls to bring health and social care under the same governance structure had 'effectively been ruled out' by Health Secretary Alan Johnson's recent pledge to refrain from further organisational change in the NHS.
But although governance arrangements might not change, work under way at the Office for National Statistics could establish the case for a shift of resources from the NHS to social care.
This week the ONS published its update report on productivity in adult social care. It found that although outputs increased by 2.2% a year between 1996 and 2005, inputs increased by 4.4%, implying that productivity dropped by 2.1%.
However, the ONS admitted that the figures were not yet able to take into account changes in the complexity and quality of care packages.
A framework for that was under development, according to Aileen Simkins, head of the ONS's centre for the measurement of productivity, and would include 'looking at the economic and quality value social care has on the NHS as well as on informal carers'.
That would pave the way for assessing claims made by Wanless that every pound spent on preventative social care could save 30p on the NHS's bill.
PFsep2007
