This week, George Osborne set out his spending plans for the rest of the parliament. Yet again social care is the poor relation of the NHS. Rather than committing any extra exchequer funds, the chancellor announced he was giving permission to town halls to raise a social care precept from council tax to bridge the funding gap.
The problem is that the precept will not bridge the gap. At best it will raise around £1.7bn a year by 2020, but because it is council tax it will raise the money in the wrong places. Poorer areas get much less money from council tax than their richer counterparts. Those councils most desperate for extra funding to meet the needs of their working-age disabled and frail older people will be left struggling to cope.
Worse than that, the chancellor has pulled off the classic conjurer’s trick of misdirection. While telling us to look at a 2% council tax rise, he hopes to distract attention from the 6.7% real-terms cut in local authority budgets. It’s a bit like sticking a plaster on a leaky bucket. The irony is that the NHS, with more unplanned admissions and delayed discharges, will feel the consequences that in turn will lead to higher social care costs – a classic false economy.
Earlier this year, the government postponed the implementation of the cap on care costs to ease the pressure on councils. But where has the money saved gone? Not into social care.
Despite the talk of more integration, the drive towards pooled budgets has stalled. The Better Care Fund is frozen for next year, so there will be no funding to plug the social care gap from that source. It is not until 2017 that an extra £1.5bn will be injected into the fund.
From the many conversations I have had over the past few months with NHS chief executives while gathering evidence for the NHS Providers Right Place, Right Time commission, it is apparent that it is the state of social care, particularly homecare, that keeps many of them awake at night. If hospitals hit gridlock this winter, the lack of homecare will be a critical factor.
Even under the most optimistic assumptions, there will be a shortfall in the care workforce of 200,000 by 2020, according to research into migration and the care workforce published by Independent Age and ILC-UK earlier this month. It is hard to see how the gap can be closed, so what plans does the government have to mitigate the impact? Or will family carers fill the gap by default?
Investors will have taken note of the chancellor’s social care commitments this week. They will have noted the absence of any mitigation for the cost of implementing the new national living wage and the uncertainty surrounding income from council tax in poor areas. Some care businesses were barely holding on before the chancellor got to his feet to deliver his statement – how many are now contemplating moving into the more lucrative self-pay market or simple walking away altogether? And how long before a big care company collapses?
When Southern Cross Healthcare went bust in 2011, the sector rallied round and took on the homes and the staff. I am not so sure the same goodwill is there today.
By the end of March 2016, the NHS will have wracked up deficits of close to £2.5bn. It’s going to take time to turn that around and to set in place the new models of care needed. The danger is that the NHS might turn in on itself and fail to build the relationships it needs with social care and housing.
So the outlook is bleak both on the money and workforce fronts.
But one approach with promise is incorporating technology into care. Technology Enabled Care (TEC) businesses and their suppliers gathered in Newport earlier this month to engage with the senior officials leading on TEC across the UK. What was striking from the event was the difference in pace and ambition between the four nations. England was behind the curve and too NHS-centric in its approach, it seemed.
Technology-enabled care has the potential to help people maintain their independence and increase the productivity and job satisfaction of health and care professionals.
But much of the solution to the funding and long-term sustainability of the NHS and social care lies beyond the control of local hospitals. The best hopes of long-term sustainability are models of care that combine mind, body and place. George Osborne’s spending review has not solved the social care crisis; it is only a matter of time before things become critical.
