So, after a lengthy wait the Government has finally published its Care and Support White Paper setting out how social care services will be delivered in the future. The Government has labelled the reforms the most radical in sixty years, but campaigners are disappointed that reforms on care funding have been pushed back to the next spending review. The fallout from this delay is likely to rumble on for many months. But will the reforms deliver on their ambitions of improving quality or will they be swamped by the demands of an increasing ageing population in need of care and support services?
The Do-Not Review
I have previously blogged on the challenges for the Government in implementing the Dilnot Commission’s plans. In getting commitments on funding pushed back until the next spending review the Treasury has clearly won the battle for now. However for stakeholders who are understandably critical of the Government’s lack of progress, they have won a concession. The fact that the Government has agreed in principle to introducing a cap on individual care costs so that costs are fixed is a positive step (although clearly not as positive as actually introducing one), particularly given that there were concerns voiced in some areas that the cap was itself unfair as it protects the assets of the richest part of the population. In addition, the introduction of a duty for local authorities to offer deferred payments to people who may not be able to afford care without selling their home until after death should stop the politically difficult scare stories about people having to sell homes immediately to fund their care.
It is also worth remembering that implementing Dilnot is by no means a silver bullet for the sector. As the new President of the Association of Directors of Adult Social Care (ADASS) Sarah Pickup has noted, implementing Dilnot would “not bring any new money into the system and so does not resolve the issue of the overall inadequacy of funding for care now nor the need to meet the needs of rising numbers of older people and people with disabilities.”
Show me the quality
With funding reform parked until the spending review, the Government’s main focus in the White Paper is to update existing social care law and update the delivery structures for services to improve quality and align them more closely with the NHS environment. As I have previously noted the issue of funding reform needs to be seen as a package of reform rather than in isolation.
The main proposals in the White Paper reflect the tenets of the Government’s NHS reforms:
- Quality – plans for a national eligibility and assessment framework are designed to address variations in quality as demonstrated in MHP Health Mandate’s recent Atlas of variations in social care report
- Outcomes – the proposals focus on the need to improve outcomes for users of social care services, measured through the Adult Social Care Outcomes Framework
- Personalisation – the White Paper reiterates plans to roll out personal budgets to all service users by next April and includes a right for users to claim a personal budget as a direct payment by 2015
- Integration – an additional £300 million will be transferred from the NHS to social care on top of existing commitments such as the Government’s re-ablement fund
- Bringing care closer to home – a new fund for home adaptations of £200 million, over five years, is included in the proposals to allow people with care needs to remain independent for as long as possible. This reflects other initiatives such as plans to roll out telehealthcare to three million people through the 3millionlives programme
- Efficiency – the White Paper notes that the Government is working with the Local Government Association and local authorities to deliver care services more innovatively and efficiently
- Information – plans for a national website setting out the care people are entitled to are welcome as are plans to invest in local sites that provide information on the services available in particular localities
- Effective regulation – the White Paper outlines plans to consult on proposals to introduce effective regulation to address provider failures, such as Southern Cross and ensure users have continued access to care
MHP Health Mandate’s recent report An Atlas of variations in social care highlighted the need for a greater focus in the debate on social care reform on the quality of social care services and the need to improve social care commissioning. The report uncovered widespread variation in service quality and revealed that additional funds assigned by the Department of Health to local authorities were being spent on maintaining eligibility criteria and access rather than to redesign services and foster new ways of integrated working with the NHS. The NHS Confederation’s poll today, which reveals that 92% of NHS managers have witnessed a rise in bed blockers, shows the urgency of the need to closer integrate health and social care services and redesign pathways of care to release local authority and NHS resources and improve care quality.
The additional £200m (over five years) for home adaptations announced will have a role in this. However it comes after the Department of Communities and Local Government last year withdrew its ring fence on local authority grants designed to support people at home, as part of that Department’s decentralisation initiative. The Department no longer collects information on how grants including the Supporting People Grant and Disabled Facilities Grant are being spent and local authorities have the opportunity to allocate such funds to other areas should they wish. As such it will be interesting to see the restrictions the Department chooses to place on how authorities can allocate these funds when they are introduced and how local authorities choose to invest the monies allocated.
Show me the money
The politics of social care are already bitter and today’s proposals are unlikely to change this. Bruised by pre-election accusations of ‘death taxes’ (are they now ‘death loans’?), Labour’s Shadow Secretary of State Andy Burnham has a very personal sense of unfinished business on social care reform. He has already accused the Government of “failing to face up to England’s care crisis” and of adopting a ‘pick and mix’ approach to Dilnot’s proposals, whilst campaigners and commissioners have lamented the further delay on funding reform. In relation to funding it was notable that Andy Burnham chose to point the finger at the Chancellor, rather than the Secretary of State, perhaps capitalising on George Osborne’s recent political difficulties. This may be a precursor to a wider Labour strategy, seeking to portray Mr Osborne as a ‘road block’ to reform (echoes of Gordon Brown here?)
For the Government the furore around long term care funding is drowning out its message of the need to reform a system that is a patchwork of complexity, inefficiency and variation and instead focus it on improving the quality and outcomes for those who use it. This is likely to particularly wounding for the Chancellor, ever sensitive as he is to the impact of policy on political narrative. Having struggled to sell NHS reform to a sceptical public and hostile health community, plans to improve social care services presented an opportunity for the Government and Health Ministers, particularly Liberal Democrat Paul Burstow, who has responsibility for this area, to bring stakeholders with them. Unfortunately it appears that until it delivers on funding, the Government will continue to face cries of ‘show me the money’.