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The care sector has been cast adrift

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Autumn bookends the adult social care year with the annual gathering at the National Children’s and Adults Services Conference and the State of Care report from the Care Quality Commission.

It provides a useful chance to test the temperature of the sector.

Delegates at NCAS were dismayed by the absence of cabinet level representation from education and health. This is unprecedented and was widely interpreted as proof that they either had nothing new to say or were delaying more bad news until the spending review.

Care minister Alistair Burt, the one minister who spoke, reviewed policy positions largely developed by the coalition. Indeed, he said he was in the dark about future funding and would hear when we did. Meanwhile civil servants peppered the event with emerging guidance and good practice examples from Care Act implementation work.

Media coverage of the CQC report focused on failing hospitals. However, in her rousing speech to the conference, Andrea Sutcliffe, chief inspector of social care, acknowledged the acute funding pressures on the care sector. She counseled against despair and explored the dilemma for CQC of wanting to celebrate what was excellent in the sector while having to publicly rate poor services. She highlighted the 94% correlation of a good or outstanding rating for a regulated service with a similar judgment for leadership.

As part of its work on sector-led improvement, the LGA reported its sampling of the things causing most stress to directors of adult services. While pressures on their budgets featured strongly, they were equally concerned with the state of their local markets and the implications of business failures. Many were worried about the position of key health partners, their own organisational capacity and how their frontline staff were coping with their demanding workloads.

There were divergent views on the significance of the two major big ticket policy items on offer at present. I detected scepticism about the future of the better care fund in the context of the NHS’s financial woes, and many different takes on organisational integration with the NHS. Richard Humphries of the King’s Fund summed this up in suggesting people ask what the question is that integration is the answer to.

There were animated discussions too on the scale and scope of devolution proposals submitted to the Treasury. Around half seem to have a strong health component and many questioned whether it would be delegation rather than real local flexibility allowed, particularly where the health economy was fragile.

I had the strong sense of a sector cast adrift, floating quietly out to sea, and holed beneath the waterline. Meanwhile on deck, people were busy plotting the journey and making sure passengers were comfortable.

Andrew Cozens is an independent social care and health specialist



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