The Spending Review has been a good example of how to give bad news: the government’s intention to cut public services and welfare had been signalled in such extreme form that the main headlines focused on how the cuts, which are deep and wide, are nevertheless not as bad as feared.
Once again, NHS England’s CEO Simon Stevens has played a strong game, with the NHS receiving £6bn of its £10bn increase earlier than expected.
And once again, social care has been left in crisis, despite the overwhelming evidence that this is already leading to a million older people and thousands of disabled people no longer getting support, many of whom are languishing in hospital for lack of the support that would enable them to go home safely.
The 2% ‘precept’ enabling councils to raise council tax in order to fund social care will not solve this problem. The maximum it could raise is around £2bn, but that is if every council takes the unpopular decision to raise local taxes, which won’t happen. Where the decision is taken, it will benefit wealthy areas (which can raise more in council tax on high cost homes) three times as much as poorer areas according the ADASS, compounding inequalities which have already seen some council budgets cut heavily whilst others get away relatively lightly. There is £1.5bn by 2020 for transformation in a new Better Care Fund, but this does not begin until 2017.
Whilst the NHS settlement recognises that investment in transformation is needed in order for services to become more cost effective, the social care settlement is lower than the amount all the sector bodies and experts agree is needed just to avoid the widespread collapse of social care providers (the gap is widely believed to be at least £700m a year plus around another billion to pay for increased wage bills when the National Living Wage comes in).
Earlier this year, the government announced it was shelving the Dilnot ‘care cap’ reforms which would have raised the amount of savings people can have before they start paying for social care (currently you pay all of your costs if you have assets or savings of over £23,250) and stopped families from losing all their assets to care costs if they require long term care in later life. This saved the government £6bn and councils welcomed the change on the basis that there were more pressing ways to spend £6bn on social care. But even taking into account the £1.5bn Better Care Fund promise, it appears that £4.5bn of that saving is going nowhere near social care, with councils encouraged to raise more taxes from local people instead. ADASS President Ray James today queried where this money has gone.
Social care badly needs that £4.5bn to stay afloat. But easily as it could be spent on just avoiding calamity, it is time for the social care sector to emulate the NHS approach: urging the government to release that money early in this parliament, and in return setting out how we could use it to develop the care models which will help our ageing population to live well. Our only hope of survival is to make a compelling offer on transformation.