In its Pre-Budget report for their Adult Social Care inquiry today, the Communities and Local Government select committee calls for The Chancellor to bring forward £1.5bn funding from the ‘Better Care Fund’ to plug the hole in social care funding in the year ahead (2017/18). The Better Care Fund is a national funding pot which was intended to be spent on improving adult social care and bringing social care and health together, easing pressure on hospitals and the NHS. It has been announced but is not due to be released until 2019-20, despite the current crisis in social care funding which is seeing care homes and home care businesses closing and worrying signs of quality and safety dropping. The Committee also calls on the Government to commit to closing the funding gap for the rest of the Parliament through to 2020.
We gave written and oral evidence to the Select Committee about the role which innovations like Shared Lives and Homeshare could play in transforming social care. I agree with the committee that the Better Care Fund should be brought forward. But this would be to plug a current gap between what is being spent and what would be needed to achieve anything approaching minimum standards. It would not result in ‘Better Care’, but a slightly eased crisis. For better care, we also need a national vision for social care which has real ambition, which is prepared to take some sensible risks in scaling up the most promising models and significant additional investment. Programmes like Nesta’s Realising the Value and our work with SCIE and PPL on Total Transformation point the way towards a health and social care system which would work and be affordable long term, rather than relying on crisis handouts year after year. We all deserve better than that.
A letter to the Prime Minister from the chairs for three select committees calls for cross party talks and consensus on a long term settlement for social care. Having given evidence to the recent Communities and Local Government Committee on this issue, I ‘m heartened to see the three committees coming together to call for positive change.
We have been here before of course. There have been cross party talks and the beginnings of consensus, but they have either gone nowhere or unravelled as pre-election party politics put point-scoring ahead of doing the right thing by older and disabled people. The Dilnot reforms gained cross-party support but were an early victim of austerity.
The temptation will be to aim for big, simple, government-sized announcements, like the complete integration of heath and social care. These will not solve the issue, and could even do more harm than good if, for instance, the whole system is integrated around the power bases of the big local hospitals, at a time when we need desperately to shift power and resources into the community. There is clearly a need for a big injection of funding to avoid widespread catastrophe and whole care industries such as home care collapsing completely. But again, short term funding is necessary but not sufficient, if it is spent only on the things we spend it on now.
So by all means let this lead to more money and more joined up health and care systems, but the more important and much trickier challenge is to use this moment not simply to shore up today’s approaches, but to invest in scaling up the most promising community and family based initiatives. The goal should not be integrated bureaucracies but unified goals: a health and wellbeing system which aims to create and sustain wellbeing, which connects people and supports family carers, which values resilience. It has never been more appropriate to take some risks. We have of course been calling for ambitious investment in initiatives like Shared Lives and Homeshare which have demonstrated they work. But we also need to be prepared to scale down bureaucracies and organisations whose unresponsiveness demonstrates they are too big, through accelerating approaches like personal budgets, personal health budgets and the involvement of voluntary, community and social enterprise organisations in designing and delivering interventions in people’s lives which are focused on health, not just illness and which are social as well as genuinely caring.