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Rethinking the Cinderella service

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Social services directors are still often heard bemoaning the fact that theirs is a Cinderella service, unloved and underfunded in comparison with the relatively well off, much better appreciated NHS. So it is a sad irony that social care has finally been invited to the ball just in time for the worst economic crash in recent history.

The green paper published in July, Shaping the Future of Care Together, holds out the prospect of a universal, rightsbased National Care Service (NCS), replacing the cashlimited, make-do-and-mend social care of the past 60 years.

Health secretary Andy Burnham continues to sound upbeat about the paper’s bold aspirations, despite a gathering consensus that 10% will have to be slashed from public sector costs over the next three-year spending cycle and the government’s own reluctant admission that the soaring deficit will make cuts necessary to back-office services, if not the front line.

At the Labour conference ministers were sticking to their promise of a white paper early next year, although the ensuing legislation will inevitably be hostage to the outcome of the general election due by June.

Free personal care

Gordon Brown’s surprise conference announcement of free personal care in their own homes for older people with critical needs goes even further than the green paper. This initiative alone will cost an additional £670m annually, with £420m from the Department of Health and councils expected to find the rest from efficiencysavings. Since it would start next September, again much depends on the election.

It is a sad irony that social care has finally been invited to the ball just in time for the worst economic crash in recent history

Mark Ivory

The NCS has been welcomed as potentially putting social care on a par with the NHS, but it will have to be created against a looming funding gap between social care supply and demand. This is predicted to reach £6bn by 2027 as the number of over- 85s doubles and an additional 1.7 million people require care.

Perhaps not surprisingly the government has kept the financial modelling on which its proposals are based under wraps. What we do know is that the traditional “self-funder” would be a thing of the past as everyone would be entitled to have “possibly a third or a quarter” of basic care and support costs paid by the state, while the least well off would have all costs covered.

Reaction

The air of financial mystery has hampered responses to the green paper consultation, which ends on 13 November. The Conservatives’ abrupt reaction to the document as “long on options and short on costs and conclusions”, while doing nothing to shed light on their own intentions, has found an echo in the sector itself.

“Until we see the financial modelling that lies behind the green paper, some huge questions will remain,” says Stephen Burke, chief executive of older people’s charityCounsel and Care. “There’s no detail about the level of need at which the NCS will kick in, but, since the paper emphasises prevention, services would have to comein at lower levels of need than current eligibility thresholds.

“Given that the NCS is about some kind of service for everyone, including people who don’t currently receive any service at all, we need to look at how we’re going to pay for it all.”

Jenny Owen, president of the Association of Directors of Adult Social Services (Adass) and Essex CC adult social care director, agrees, pointing out the sizeable population of self-funders in many councils. Adass is trying to do some financial modelling of its own to get an idea of what adult social services departments would be letting themselves in for.

“This is a major overhaul of local government finance,” Ms Owen says. “We need to see whether the proposed extra money from insurance policies and disability benefits covers the gap between what we do now and what the green paper is asking us to do.”

A hard sell

To pay for the NCS the government proposes asking individuals to take out insurance to top up the state contribution and streaming “some elements” of disability benefits into social care budgets.

Both will be hard to sell. Despite the Departmentof Health’s ongoing ‘Big Care Debates’, the belief that social care is free on the NHS remains widespread. And many of the 1,600-plus responses on the Directgov discussion forum are from people with disabilities, worried about losing benefits.

The centrepiece of the green paper is a national assessment scheme, giving people the right to a portable assessment and entitlement to services. Among the most contentious issues for councils is just how ‘national’ the NCS will be.

One option is a fully national system in which central government decides how much funding individuals should get, a proposal that the Local Government Association sought to kill off when it met Mr Burnham last month.

“Our key concern is that it pulls funding out of local government and pools it at national level,” says Andrew Cozens, the LGA’s strategic lead for adult social care and health.

“The practical problem with this is that local government contributes 39% of the adult social care spend and the ideological problem is that the personalisation agenda is predicated on individual service design, which will vary from place to place and should therefore be a local matter.”

Mr Cozens thinks ministers are “getting the point” that the better option is the partnational, part-local one in which councils decide how much individuals should get to meet their needs. The green paper stresses the role of preventive services and there is growing evidence that these can save money to reinvest in social care. So will prevention be its saviour?

“No,” says Mr Cozens. “The saviour of social care will be more resources. I don’t see that happening in the current economic climate. We’re looking two Parliaments ahead to get the funding we need.”

Mark Ivory

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