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Make or break time for adult social care?

Des Kelly OBE, executive director at the National Care Forum, discusses whether the next couple of years will make or break the adult social care sector. David Stevenson reports.

One the eve of the chancellor’s final budget, prior to the dissolution of Parliament, the Association of Directors of Adult Social Services (ADASS) issued a stark warning to politicians of every party: the next two years following May’s general election will “make or break” adult social care. 

It also published the ‘Distinctive, Valued, Personal – Why Social Care Matters: The Next Five Years’ report, which sets out the organisation’s vision for social care in the context of further integration between health and social care. 

Looking to the future, the report raised two critical issues: government must protect social care funding and align it with the NHS; and all parties must focus on making sure that the quality of services remains high, and that no services cause harm. 

PSE asked Des Kelly OBE, executive director of the National Care Forum (NCF), which promotes quality care through the not-for-profit care sector, whether the next two years will make or break the sector. 

He said it is “very hard to judge”, but explained: “About 50% of all of the funding comes from local authorities, so pressure on local authorities immediately has an effect on the care sector. If we carry on in the way that we are now, it is very had to see a scenario that doesn’t paint a bleak picture about the way that services might develop.” 

He said the NCF welcomed the leadership David Pearson has given to ADASS over the year he has been president and said he has “certainly raised the profile” of ADASS, challenging the ways policies have been implemented and the cuts in public sector funding.

Kelly added that councils cannot carry on cutting funding to social care budgets without harming services – and that providers can only go so far in drawing other income into the sector, such as ‘self-funders’, to offset the effects of public sector cuts. 

“This is not a sustainable and long-term method,” he explained, “and it is not going to guarantee the future of the sector.” 

Biggest uncertainty  

Kelly told us that one of the biggest uncertainties facing the sector at the moment is the Department of Health’s consultation on capping lifetime care costs, as part of the 2014 Care Act. 

The consultation, which only closed on 30 March 2015, after Parliament was dissolved, states that: “From April 2016 the cap will be set at £72,000. This means the maximum amount anyone will have to pay for care to meet their eligible care and support needs from April 2016 onwards will be £72,000. 

“In many cases, particularly with the extension to the means test, people will pay less than this before they reach the cap. This is because those receiving help with their care costs from the local authority will not pay the full amount themselves, but the total cost of meeting their eligible needs will accrue towards the cap.” 

However, this figure is more than double what the Commission on Funding of Care and Support, led by economist Andrew Dilnot, recommended. His original report said: “This cap should be between £25,000 and £50,000. We consider that £35,000 is the most appropriate and fair figure.” 

Kelly said: “Dilnot didn’t pluck the figure of £35,000 out of the sky. It was designed to be the fairest way of funding across the whole sector. Once you start playing around with those figures and saying ‘we can’t afford that, we have to set it at a different level’, it becomes a different set of arrangements. 

“But we won’t know the result until after the new government is formed in May. This is because the consultation closed when Parliament had been dissolved. Yet the next phase of this is expected to be implemented in April 2016. 

“It is going to be quite an uncertain time to know quite how that will be implemented. Will it be implemented in the way we’ve been told up until now? Or will it be changed by the new government? What sort of impact and consequences will it have when it comes into effect? All of these things will have a significant impact on the way services might develop over the next couple of years.” 

Ring-fenced funding 

The latest ADASS report stated that the funding gap for social care is estimated to reach £4.3bn by 2020, alongside the estimated £8bn gap in health service funding over the same period. 

The organisation added that the case for a single, shared funding settlement, through the next spending review, that covers social care as well as the NHS and where social care is protected, is “overwhelming”. 

“We would certainly support the ring-fencing of social care funding,” said Kelly. “The trick is, how do we pull that off in a context where money is so tight? 

“Whenever you see services that are not protected it is possible for local authorities to erode them, and that is what we’ve seen,” said Kelly. “Whenever something else arises it is easy to marginalise social care funding. I know that it is a big part of spending for councils as a large amount of it goes on older people and, given the demographics we are facing, those pressures are going to continue for quite some time. But we can’t keep cutting back.” 

PSE was told that the adult social care sector has been underfunded by around 20% for quite some time, with some councils protecting services better than others. 

“One of the difficulties is that across 152 different local authorities we have 152 different ways of doing things,” said Kelly. 

“There are examples of very good commissioning arrangements, where providers sit round the table and work out what the strategy per future services is going to be. In other local authorities, it is the complete opposite; where the council decides what it wants to do and that’s what it puts out. 

“Sometimes you end up being in what some people have referred to as a ‘race to the bottom’: what can be done for the lowest possible amount of money? But that is also not a sustainable position for the long term.”

 Fears over quality 

The executive director of NCF, which represents 86 member organisations providing not-for-profit care and support services across the UK, added that while his organisation represents a minority of the sector’s service providers – no more than 20% – there are major dilemmas facing his members. 

“The largest proportion of the sector is represented by the private for-profit sector. Our worry is that not-for-profit providers, because of their commitment to quality, are saying they can’t deliver to the quality they think is acceptable at the price available,” he said. 

“You can offset some of that by drawing in private funding, such as people who fund their own care, but you can only do that up to a point. 

“A few of our members have said they are concerned about their own charitable aims, such as being able about support people who don’t have the necessary means themselves. Many say they don’t want to be in a business that is just drawing in people who pay a lot for their care in order to offset the fact that local authorities don’t pay enough.” 

He added that if there is only one lever – price – then there will be some providers willing to compete at lower prices. This is usually because they are big enough and have the economies of scale, which ends up making large corporate providers the inevitable solution. 

“And that, to us, does not give the sort of choice and flexibility to consumers. It is certainly not in the long-term interest of having a mixed economy,” said Kelly. 

One reason the sector needs a better and more sustainable funding arrangement is so providers can reward staff in the “way that they deserve to be” and to “ensure quality”. 

“But the only way we can reduce the problems of recruitment and retention, valuing staff, training them and investing in them, is by dealing with the problem with what is paid to care,” he explained. 

“The ADASS report is a good opening shot. It is trying to set out the next five years. It is clearly a plea to the incoming government to sort out adult social care and how it relates to healthcare and the NHS. We’d support that, it is a credible account. I don’t think it is overly ambitious. You could always want more, but it is realistic in recognising that we are in a difficult situation in terms of finances. 

“If we don’t deal with this problem it will be  a problem for society generally.”

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