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By Debbie le Quesne

Archive for June 2015

The state of the nation with social care

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Whether we like it or not, we are beset with humongous financial problems in social care. It’s a fact of life for us and the problem is not going to dissipate overnight.

To sum up the ADASS budget report for 2015, John Jackson, co-chair of Resources Network, presented Adult Social Care in an Age of Austerity: the impact and some thoughts on the future John Jackson.

So much of what ADASS says in their comprehensive report is, in my opinion, a true representation of what’s happening in the care sector. I’m impressed too that publicity drives by the body have not been, to quote Mr Jackson, “shroud waving.”

The budget analytics have not been skewed to win public opinion – they are served cold, but nonetheless are still very worrying.

In a PowerPoint presentation, let me include this pane from Mr Jackson:

What do the budget surveys tell us? Impact to date?

  • Total annual savings from adult social care of £3.53bn by March 2014 – 26% of net spending
  • 12% reduction in spending combined with 14% increase in demand
  • Most of the savings are through “Efficiency savings” but significant pain involved: providers squeezed on prices; care packages reviewed and often reduced; services outsourced; providers changed

Research also shows (another PP pane):

  • Councils have protected adult social care rather than targeted it for extra savings
  • Investment in prevention stayed the same at just over £900m
  • Funding 83% of demographic pressures (£391m)
  • As a result 35% of council spending in 2014/15 now spent on adult social care compared with 30% in 2010/11
  • Including children’s social care means that almost half council spending is spent on just over 2% of the population

Remarkably, despite savage cuts, 87 per cent of councils claim quality of life for service users had not been lowered. Just 6% of local authorities said care quality had fallen. However, numbers of those supported with social care fell by 18 per cent between 2010/11 and 2012/13, with further decline in 2013/14 of 5.8%.

An input of £1.1bn from the NHS for adult social care has stopped things being worse.

As for the future?

Let’s look at this PowerPoint pane:

  • 14% councils think quality will be lower
  • 48% think that fewer people will be able to access adult social care services in two years time
  • 47% fear that people will be getting smaller personal budgets
  • 55% think providers will be facing greater financial problems
  • 59% anticipate more legal challenges (big increase from the previous year)

With the summing up of the report comes a clear warning over Government fiscal policy and its impact on care. These directors truly believe the cuts are now at their limit.

I quote: “Adult social care services in England will soon be unsustainable if current budgetary pressures continue and significant measures are not taken to inject new money into local social care economies,” – ADASS.

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Government spending review may offer hope to social care

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A critical spending review to determine medium term plans for Governments department will provide a platform for ADASS to air its concerns over funding for social care.

The review has to take place this summer because there are no detailed spending plans in place for the next financial year. Already private discussions are taking place and ADDAS is feeding the key issues into the agenda.

Quoting John Jackson, co-chair of Resources Network, the outcomes of the review could be:

  • Health and social care will be seen as a single entity
  • This will provide some protection for adult social care (but remember that health is not being funded to meet increased demands)
  • It will be accompanied by a requirement to pool budgets (probably under the control of Health and Wellbeing Boards)

So what are the implications for local government? Here are Mr Jackson’s thoughts:

Any new government or ministers will want to pursue eye catching ideas – some of them will be good (e.g. Health and Wellbeing Boards) but others not and will lead to considerable change at a time when systems are under huge pressures

Sadly, he predicts that some local authorities (and some local health and care systems) are under significant risk of falling apart in the next two years. Oh, yes!

Change is paramount if adequate social care is to continue

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Local authorities are assuming significant reductions in social care budgets. They’re also assuming the cuts will be “ongoing”. Just what I want to hear (not).

The recent ADASS Budget Survey 2015 report shows that this year, as last, 35 per cent of council budgets relate to adult social care. Councils, ADASS notes, have tried to protect social care spending at the cost of other services but are running out of ability to do this in the future. I believe this to be true in many instances.

The report goes on to says that In the context of the NHS, health funding has increased from £97.5billion in 201-11 to £116.4billion in 2015-16, an increase of 19.3per cent. Over the same period, social care funding has decreased from £14.9billion to £13.3billion, a reduction of 10.7 per cent and “more in real terms when demography is taken into account.”

Significantly, “the money being transferred from the NHS is not enough to mitigate these spending reductions.”

This surely must be in the ears of David Cameron.

Senior NHS leaders have already publically shared concerns about the funding for social care services to support people in greatest need. They have added their voices to a growing chorus of concerns over the much-heralded £8 billion NHS funding gap figure that’s being forecast.

In an open letter to the Prime Minister, the NHS Confederation said in May 2015:

“Our deep concern over social care funding must be addressed if we are to meet people’s needs, never mind the impact that social care has on the ability of the NHS to provide safe, quality and timely treatment to those who need it.”

I applaud the fact that ADASS wants to see a social care system that is protected, aligned and re-designed.

To achieve this, ADASS is calling upon the Government to urgently ensure that social care funding is protected and aligned with the NHS, including making provision for the social care funding gap alongside the funding gap for the NHS.

This is brave, campaigning talk and I wish every success on those who are left to do the hand-to-hand fighting in Parliament.

ADASS concludes by saying: “This is paramount to securing adequate health and wellbeing outcomes for individuals and their carers and to ensuring that councils do not run out of money.”

The truth, the whole truth and nothing but the truth . . . I really do hope that this latest document, which shows a falling barometer on the state of the nation’s care, will impact the decision makers to reassess the austerity course we are on – and particularly how it impacts our most vulnerable people.

Should social care survive this ordeal by fire, should the good times ever roll again for care providers, should there ever be a season of plenty, perhaps local authorities could not be so eager to financially squeeze care businesses, thus allowing reserves to build for such a time that we might just have to navigate this way once again.

A window on the future marketplace

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The majority of adult social care directors (70 per cent) believe pay pressures will drive up residential’/nursing care costs in 2015/16.

Some 39 per cent believe that local market issues, lack of capacity and competition, will be a major driver in dictating the market trend.

About 50 per cent of Directors do not think that overheads and a premium to cover winter pressures and quality are key for increased unit costs, and only 14 per cent of directors believe that a reduction in cross-subsidisation – the differences between council and self-funder rates – will be a key in changing the costing structure for residential/nursing care “units” in 2015/16.

I note in the ADDAS Budget Survey 2015 report, that councils received only 5.9 per cent (£41m) of the £700m allocated to the NHS to respond to winter pressures in 2014/15. That’s fair, isn’t it!

Why on earth should I feel disgusted by this financial nugget? Stop it, Debbie!

‘No more savings’ by squeezing prices on care

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Councils have kept provider fees frozen for a number of years, so says the ADASS Budget Survey 2015 report.

At best increases have not anywhere met the real economic price of services rendered.

This year the annual budget report notes only £32 million of efficiencies will be found through this route (just three per cent of overall savings).

In the context of providers selling up, staff turnover, quality, wages, and the need for a million more care workers in the future, maintaining a caring, compassionate and trained workforce in a sustainable provider market is now a key concern.

Some 56 per cent of directors report that providers are facing financial difficulties now.

Additionally there are concerns about the quality of care. The report states that in CQC’s published data in April 2015, 8.7 per cent of adult social care providers inspected were rated as inadequate and a further 31.9 per cent as ‘requiring improvement’.

Most local authorities are not going to be able to make further savings by squeezing the prices that providers are paid, the council bosses say. Indeed, it is likely, they add, that many are going to have to pay more if providers are to be able to attract workers as unemployment falls.

The survey asked Directors to detail any percentage increase, percentage decrease or no change to independent sector provider fees inclusive of inflation in 2015/16 compared to 2014/15.

In total 67 per cent of councils increased provider fees, 31 per cent of councils made no changes and two per cent decreased provider fees in 2015/16.

Anyone ever tried a G&T for breakfast. Feels like I should be giving myself a shot of anaesthesia to welcome my day at the office.

Savings will have impact on care – and that’s now official

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Tell us what we already know . . . 83 per cent of Directors report that over the next two years there will be impacts as the result of savings being made.

It’s a significant hike on the 54 per cent of Directors reporting in the ADASS Budget Survey 2015 that the savings they are making to date will have an impact (the document fails to say whether such an impact would be negative or otherwise).

Surprisingly, it is noted that a number of Directors (45 per cent) are reporting that there have been no, or minimal impacts to date, but this falls to only seven per cent believing this over the next two years.

ADASS reported that its members think that the savings to date will not affect their ability to meet their essential statutory duties. However, the scene changes dramatically over the coming two years, with increasing scepticism that savings can be made (down from 81 per cent to date to 39 per cent) believing planned savings can be made met.

Sadly, this view is further confirmed with 50 per cent of Directors reporting that they believe fewer people will get access to services, and 58 percent believing personal budgets will shrink over the next two years.

Directors think that there will be more legal challenges and 17 per cent think that quality of care will worsen also over this period.

The view of Directors correlates with a recent report by Carers UK (State of Caring- May 2015) which noted of the 4,500 carers responding to survey, 55 per cent say that they are worried about the impact of cuts to care and support services over the next year. I

AgeUK last year estimated that 900,000 people in England between the age of 65 and 89 have unmet social care needs, Experts at the charity now believe the figure is closer to one million.

Quite what analysis says about society’s commitment to the sick, frail and vulnerable, I dread to think.

Cue relaxing music, light scented candles . . . soothing head massage, please.

Directors trying to grasp the nettle of deeper cuts

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After a night’s sleep, coffee, golf and the therapy of good company I’ve return to the ADASS Budget Survey 2015. Help!

The big question we’re all asking is how more savings in the industry can be made. It’s a question that’s been lobbied in Parliament and the offices of Whitehall and the responses have been . . . poor.

However, local authority directors are now attempting to grasp the nettle and in responding to the question of how they would make savings, for both 2015/16 and for 2016/17 onwards.

This is their published reply: “Directors report increasing reliance upon integration in making savings going forward (71 per cent as from 2016/17 onwards), and a continued focus upon early intervention and prevention (73 per cent as from 2016/17 onwards).

“There is also an increasing emphasis upon what was described as stopping ‘unnecessary’ services and shifting activity to cheaper settings, along with better procurement.

“The majority of Directors do not see controlling wages or increasing charges as areas of importance in making future savings. This can be explained by firstly that most of adult social care budgets are spent with external providers, many of whom pay staff at or close to the minimum wage and therefore decisions about the level of the minimum are not within the control of local authorities nor providers; and secondly, the survey analysis illustrates that there is limit to how much further councils can increase charges.

“On the contrary, the majority of Directors have reported that wage pressures are key drivers for increased costs of residential & nursing care and home care services in 2015/16.”

Are we all clear on that? Well, not really, Integration reliance – I’m assuming integrated care – is as fantastic concept for efficiency and good delivery of care. It’s joined-up thinking with all care elements coordinated and seamlessly meshing together.

The World Health Organisation noted last year, however, the initial problem of carving up the monies is one of definition.

“A key challenge,” it said in its What is the evidence on the economic impacts of integrated care? document, “remains the lack of common definitions of underlying concepts; as a consequence there is a plethora of terminologies that have variously been described as ‘integrated care’, ‘coordinated care’, ‘collaborative care’, ‘managed care’, ‘disease management’, ‘case management’, ‘health/ social care service user-centred care’, ‘chronic care’, ‘continuity of care’, ‘seamless care’ and others.”

It’s true. Until the borders are care streams are defined – of what’s in, and what’s out – the arguments over who gets what in the budged pool will remain.

And finally (for now). . . How confident are the Directors in making further savings?

Whilst 45 percent of Directors were fully confident that planned savings for 2015/16 would be met, this confidence falls sharply away beyond 2015/16 to only five per cent being fully confident that savings will be met in 2017/18.”

More coffee, please!