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The battle begins

Steve Carefull

Local Government News

9 July 2014

The widely reported impending financial crisis in adult social care is unsurprising given it is the inevitable consequence of several well-understood factors. The recent comments by the President of the Association of Directors of Adult Social Services, David Pearson, indicate that the social care system is on the verge of becoming unstable.

So, is it time to encourage a more honest debate about the sustainability of state funded adult social care?

The post-war baby boom, combined with unprecedented (and welcome) increases in life expectancy alongside improved management of long-term complex conditions, has led to an alarming increase in demand for social care. At the same time, spending constraints mean that adult social care departments have less money to address this demand – the Local Government Association estimates the funding gap will be £1.9bn by March 2016.

To date, the majority of local authorities have absorbed significant cuts without threatening the core services to the most vulnerable, giving the debate the air of a phoney war.

The real battle is now starting however, as local authorities are, for the first time, contemplating failing to meet all their statutory duties. As the election approaches, a concerted campaign for more resources can be expected from the sector.

But, would simply pumping more money into the system really solve the underlying problem? With escalating numbers of potential service users and increasing expectations, can a state funded social care system ever hope to meet all the latent demand? It is time for an open and informed debate about what the state can, and should, do for older people.

One would think, with the Health and Social Care Act in 2012 and now the Care Act, that there must have been such a debate already. Undoubtedly, many important changes will flow from this legislation, so why is there still a sense that the problems are getting worse not better?

Part of the reason is that some steps being taken to deal with the growing imbalance between supply and demand are unconvincing. Government’s current focus is integration of health and social care, with its flagship initiative, the Better Care Fund. But integration is a weakly defined and speculative bet. There may be a strong ‘patient experience’ case for it, but there is little evidence that it will deliver the scale of savings required.

Perhaps the only sustainable paradigm is that older people will have to do more for themselves because there will be less state-funded care. However, this may be so politically toxic that it cannot be spoken aloud. It might help if we made clearer distinctions between adults who have no alternative to state support, and those who have other options to address their needs.

What alternatives are there to traditional state help? The Office for National Statistics estimated the value of informal adult care in the UK was £61.7bn in 2010 – around four times what the state spends on paid-for social care each year. 

There is growing evidence that more widespread use of assistive technology can help people live independently in their own homes for longer; improving their lives and saving the council money. Hampshire County Council’s telecare programme, for example, asks service users to identify ‘nominated responders’ who will attend when an alarm is triggered. This helps to build social capital around the service user and reduces unnecessary ambulance call-outs.

The emergence of ‘social prescribing’ – with its emphasis on prevention – is another example of how positive outcomes can be achieved by harnessing community support.

Perhaps if we were more honest about the importance to individuals of building resilience for old age, we could focus more openly on supporting informal carers (a Care Act priority) and systematically putting in place ‘enablers of independence’.

Ultimately, this would help us to reimagine a social care system in which the state is not always the first port of call. If more older people are helped to look after themselves, the diminishing resources of local authorities could be directed at providing good quality support to those who really have no alternative.

Steve Carefull is a specialist in adult social care at PA Consulting Group

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