A sharp government focus on delayed transfers of care is a “failure of thinking” and growing demand on stretched social care services is threatening the viability of councils and providers, as well as the wellbeing of vulnerable people, the new president of the Association of Directors of Adult Social Services has told LGC.
Glen Garrod warned the delayed transfer of care targets imposed on councils in July last year as part of the better care fund guidance had “skewed investment and behaviour” by ignoring wider pressures in the system.
He added growing demand on services and rising costs caused by factors such as the national living wage and deprivation of liberty assessments – which have risen tenfold in most councils since the Cheshire West & Chester ruling in 2014 – meant many councils would struggle to cope ahead of any reform proposed in the forthcoming green paper, particularly in those areas with lower revenues from the social care precept.
Mr Garrod said it is believed the green paper will feed in to the comprehensive spending review with any further funding arriving in 2020, leaving a perilous gap in the existing baseline in 2019-20.
“A number of councils are in very difficult financial circumstances, with some expected to reach a tipping point next year,” he said.
Mr Garrod said he did not expect delayed transfer targets to “go away anytime soon” and called for “a better system understanding”.
He added: “[Targets] have certainly skewed investment and behaviour.
“There have been improvements but my worry is, if you apply a microscope to a landscape that needs a wider understanding, you ignore what is going on around the microscope and that is a failure of thinking.”
Mr Garrod is concerned about the capacity in the system and warned many care providers will not be viable if they are required to cover the costs of sleep-in shifts, following a tribunal ruling in May last year. At the time, charities estimated the ruling could cost care providers £400m for backdated payments over the past six years and create a £600m funding gap over the next four years. The government in November announced providers would be able to opt in to a new social care compliance scheme, which would give them up to a year to identify how much they owe workers paid below the minimum wage for sleep-in shifts.
Mr Garrod said: “Most providers [offering sleep-in shifts] are dealing with profoundly disabled working age adults who are very vulnerable and the options available to secure alternative provision is limited.
“The worry is whether a person receiving the service they need will continue to get that service.”
Mr Garrod added if councils are unable to pay increased rates for general social care services more providers will refuse council contracts and focus on self-funded provision.
“It is a legal responsibility on us to supply a service to meet an eligible need – that is a real worry,” he said.
Mr Garrod said councils are not currently considering declaring that social care services simply cannot be provided, but admitted more people may have to be placed in cheaper provision further from their homes and support networks.
“We are limiting choice. That is legally sustainable but you have to question whether it is the right thing to do,” he said.
Mr Garrod said Adass has been particularly concerned about the quality of commissioning in some areas.
Health and social care secretary Jeremy Hunt recently mooted the idea of introducing an inspection regime to drive improvement. If such a system was introduced, Mr Garrod said he would be worried if it did not build on existing sector-led improvement.
He added: “There is more to be done but it is a really good baseline and there is a lot of secondary gain from it because the people who do sector-led improvement are people from other systems who take a lot back to their councils.
“In an inspection where you basically come in, as a bunch of inspectors, do your job and leave, that doesn’t apply.”