The budget includes the promise of £2bn of new money to fund social care over three years. This is a welcome response to the current crisis in social care which is seeing care homes, home care businesses and other crucial forms of support for adults and older people going bust, or suffering unacceptable levels of failure. The gap between what is currently spent on social care and what is needed is more than £1bn, so this will not on its own bring back support for the 1.2m older people who no longer get support (an increase of around half in recent years).
The money is a grant so, according to Richard Humphries at the King’s Fund, is unlikely to be ongoing and is likely to have ‘strings attached’. I have mixed feelings about this. On the one hand, councils, particularly in the poorest areas where cuts have been greatest (according to the cross party Public Accounts Committee), badly need the freedom to prop up existing services which are collapsing under the opposing pressures of budget cuts, increasing numbers of older and disabled people and increasing costs of providing care (not least the hundreds of millions needed to fund the – very welcome – national living wage in this traditionally low-pay sector). But on the other hand, the Better Care Fund experiment showed that well-intentioned but un-ringfenced money put into a stressed system results in little transformation: the crisis subsides and then reappears. Our forthcoming report on the national picture of Shared Lives development will show widening divergence between places investing heavily in Shared Lives because it offers them a sustainable model which fits with people’s lives, and areas apparently unable to invest in anything new.
Already the HSJ is calling for the new grant to be allocated to initiatives which focus on getting older people out of hospital. A narrow focus on what forms of social care will immediately alleviate the current pressures in the NHS will not ultimately achieve its goals. The models which work are those co-designed by social care providers, including the voluntary and social enterprise sector, and the people and families who make most use of services themselves. They are built around goals like wellbeing, independence and resilience. By putting people’s needs (and capabilities) at the centre, rather than services’ needs, they ultimately lead to benefits for the NHS which would not be achieved if benefiting the NHS was the starting point.
The budget also promises a Green Paper which will consider how to put social care on a sustainable footing. It is impossible to answer that pressing question without giving equal consideration to the question of what the money will be spent on in future. This cannot be ‘a more efficient version of what usually do’. It must be a social care system built around serious ambition for the scale and effectiveness of community-based models which have been considered add-ons for too long. As this SCIE paper outlines, it’s time for the models with most chance of success to become core business.
Escaping the invisible asylum 