The weather was kind to the delegates attending the National Children and Adult Services conference (Ncas) earlier in October. It was calm and mild. Perhaps it would have been more symbolic of the state of social care if the Bournemouth International Centre had been battered by winter storms.
Inside, the mood was business-like but pessimistic. Councils are contemplating further cuts to their budgets of between 25 and 40%. There was a sense of resignation that Whitehall was not going to come to the rescue.
But amid the sombre tone and the clear warnings from the president of the Association of Directors of Adult Social Services, Ray James, were signs of hope, of a fight back.
The spending review on 25 November is unlikely to close the funding gap for social care. At best, the Treasury will offer some mitigation for the cost of implementing the rebranded national minimum wage; after all, the Treasury reaps a saving in benefit costs.
Of course, there is the funding pencilled in to implement the Dilnot cap on care costs. But if this saving does find its way to adult social care, what strings will be attached and will it be ring-fenced?
The storms are gathering. NHS providers have reported deficits of £930m in the first quarter of 2015/16. Eighty percent of all trusts are in deficit. But town halls cannot run deficits to protect their single biggest budget, social care.
The signs of stress are not only financial. Last winter, breaches of the four-hour A&E waiting time and growing numbers of delayed discharges hit the headlines. Cabinet committees were convened; NHS and social care leaders were hauled over the coals. A mild winter, a lot of hard work and a shift in the news agenda and the pressure went away. But the reality on the ground did not change.
If the spending review does not deliver a single funding settlement for health and social care, with the £8bn promised to the NHS by 2020 frontloaded to support transformation, then the consequences will be felt. The NHS will grind to a halt for want of the capacity to keep people out of hospital and get them home safely.
At both Ncas and then again last week at the Oval, where members of the UK Home Care Association (UKHCA) gathered, the talk was of just how fragile care markets are becoming. The Department of Health’s Jon Rouse told Ncas delegates that there are more new providers entering the market than exiting, but how many are entering just to meet the growing demand in the self-funder market – rather than to provide local-authority funded care? It is clear that for many NHS chief executives contemplating this winter, it’s the fragility of homecare providers that is keeping them awake at night.
Ray James was right to challenge the Treasury to be more transparent in their accounting for social care. In my reports on home care and residential care I called for open book accounting. It is still not the norm, but it is essential to achieving a common cause between commissioners and providers and exposing the gap between the need and the money.
It would be easy to shroud wave, to be a victim. But that was not the mood at Ncas. There is a fight back.
In Bournemouth, the most popular sessions were those highlighting the energy going into reimagining and redesigning care. I wrote last month about Shropshire’s innovative work changing the front end of adult social care. The focus has shifted from assessment and case management to assets and social connections. The goal is to help people maintain and regain a life rather than become dependent on services.
Beyond the conference circuit, in the past week I was struck by the rigour of the work Kent county council is doing to understand and manage demand for social care across the county. Working with Newton Europe they have extensive information about the flow of people through the system. In the design phase of the project in Ashford, they managed to halve the percentage of people receiving ongoing care. If this result were replicated across Kent there would be 1,000 fewer people receiving a care package every year – a new national best practice standard.
For me, the message of these conferences and of the practical work in Shropshire, Kent and other places is the vital role of good leaders, people who can articulate a compelling vision and translate it into a practical reality.
What these leaders need now from government – setting aside the money for one moment – is less stick-wielding and more enabling.
