The Local Government Association’s initial response to the adult social care green paper, in which we warned against a wholly national system of funding such services, has attracted some criticism.
Our response was not an attempt to skew the debate about the green paper’s proposal to establish a National Care Service (NCS).
It reflects the fundamental point that the bedrock of the care system is local and inextricably linked with building sustainable communities, tapping in to the full range of activities needed to support independence.
The paper, appropriately entitled Shaping the future of care together, rightly recognises that any sustainable solution needs to bring together the interests and contributions of future users and carers, service providers and central and local government.
How to balance these responsibilities is a key dimension of the ‘big care debate’ that is taking place across the country.
What the green paper proposes, through the concept of an NCS, is a system that is fair, transparent and portable.
The accompanying contribution from public funding will follow a standardised national assessment and, when users’ needs exceed those for which services are free, will help them keep or regain their independence.
The green paper rightly builds on the social care transformation programme councils are implementing across England as part of the central/local government concordat, ‘Putting People First’.
Through this, every new and eligible service user will be offered an individual budget and everyone with care needs will get help to navigate their way through planning their own care and support.
Standardising national assessment arrangements and ensuring a consistent proportion of care costs are met will help the national government get a real sense of the true costs of care and trigger a realistic allocation of funding.
This is in line with the LGA’s Fair Care campaign. A national care service will also require more transparent and consistent application of continuing healthcarecriteria, again something the LGA has campaigned for.
But a prerequisite for the national care offer and for personalisation is the right local offer. Councils are working closely with the NHS to develop prevention and re-ablement services. A complex pattern of family, neighbourhood and community is needed to support these arrangements.
The local nature of care and support could be overlooked
Those using personal budgets are looking for flexible, local solutions that dip in and out of formal care and support services. Good housing, transport, leisure and community safety are integral.
Four other important preconditions for the success of the NCS are managing the market and developing the workforce, together with good information, advice andadvocacy and support for carers. The latter two are critical and cannot be standardised against a blueprint.
While there should be greater consistency in how your share of public funds is calculated, how you choose to spend them will be a personal and local decision.
We do not yet fully understand either how services will adapt and grow under a truly personalised system. What we anticipate is that these services might be smaller, more organic, and cross the boundaries of health, care and housing. We know, too, that costs will vary enormously in regional and subregional markets.
Without pre-empting the national debate, the LGA fears that the local nature of care and support could be overlooked in the technicalities of how funding should be aggregated to support the national care offer.
The local offer is a delicate balance of people’s own resources, community support, the love and goodwill of carers and the contribution of a wide range of local services. These and the council tax subsidise any allocation of care funding through the revenue support grant.
The NCS offer should bring entitlement and transparency into the care equation and, critically, more funding. But it should not be over-prescriptive. Any disruption tothis careful local ecology will be damaging and unnecessarily costly.
Andrew Cozens, LGA group strategic lead for adult social care