All the talk this autumn is of social care being at a tipping point. Inspections, market analysis and a battery of data from regulator the Care Quality Commission (CQC) suggests that the adult sector in England is “approaching” the point at which it will fall over without more funding. Observers of the sector in the rest of the UK and, indeed, of children’s services, would doubtless say much the same.
But interest groups have been predicting disaster since austerity set in six years ago. Although the CQC’s unprecedented warning takes the threat level to a new and official high, and although senior NHS leaders have begun to speak up on social care’s behalf, there is little sign of the message being heard and understood at the Treasury.
More significant may be a potential political tipping point. When the Guardian recently carried a series of letters on the social care crisis, all of them calling for government action, one was conspicuous in that it came from a Conservative cabinet member for adult social care at Surrey county council, Mel Few.
Surrey’s need to spend an extra £24m this year on rising demand for care was “stretching resources to the limit”, Few wrote. Another £59m would be required over the next 20 years just to care for the growing number of people aged 65-plus. While ministers’ move to allow English councils to impose a special council tax precept (levy) of up to 2% in April had been welcome, it had fallen “many millions short of what is needed now, let alone in two decades”.
That was the unmistakeable sound of the Tory shires stirring. And while Surrey’s Conservatives are earning something of a reputation for speaking truth to power, if anything is going to prise open the Treasury’s cash box for social care it is pressure from within the ranks of the governing party.
Few warned his council colleagues a fortnight ago that he was heading for a £21m overspend on his £369m budget for 2016-17. He is funding a 7% rise in the number of care packages – average cost £18,500 a year for an older person, £30,000 for someone with a learning disability – and is falling well short of a £55m savings target, which was increased by 55% this year.
Surrey was among the great majority of councils that opted to impose the full 2% social care precept in April. But that raised just under £12m, only half the cost of rising demand. The outlook, said Few, is “quite frightening”; he is contemplating drastic measures, such as withdrawing the social care discharge teams that work at the county’s hospitals.
While Surrey stands to do well from government plans to allow councils to retain 100% of their local business rates by 2020, Few cannot see a way through the next four years. He is pressing local MPs, who happen to include the chancellor, Philip Hammond, to call for a review of the formula for allocating government grants – to better reflect the needs of Surrey’s population – and to not only confirm that the social care precept will be available next April, but to allow councils to set it as high as they choose.
“I have not had one resident complain to me or write to me about the 2% precept because it was ringfenced for social care,” says Few. “I think people are asking themselves: ‘My god, what’s going to happen to me when I get old?’”
There is some evidence the social care crisis is reaching the wider public. New research among 1,000 people aged 40 and over for Partnership insurance shows that only 16% believe the state will cover any care costs they incur in old age, compared with 51% who thought so in a survey in 2012. Just 19% believe the state should meet everyone’s care costs.
According to the research, 32% of people expect to live with their children when they are old – although only 4% have mentioned it to them.
Planning would be easier if the government clarified its position on reform of care funding. Hopes are fading that the proposed cap on individual care costs, set at £75,000 but postponed to 2020, will ever be implemented. If it is to be ditched, social care leaders want a review of all the options for long-term reform, though opinion is divided on the need for another commission of inquiry after a series of them since 1999.
Meanwhile the Local Government Association (LGA) representing councils, is calling for an injection of £2.6bn to get the adult care system in England through to 2020 – half to meet immediate presures and stabilise the sector, half to meet rising demand, inflation and the costs of the “national living wage”.
Izzi Seccombe, chair of the LGA’s community wellbeing board, says: “The care market cannot carry on as it is and widespread market failure is a real danger. Either care is properly funded or providers will pull out of council contracts or, in a worst-case scenario, go bust. The market for publicly funded care is not sustainable as it stands.”
While hoping that the chancellor will put his hand in his pocket for adult care in his autumn statement later this month, however, the LGA is also warning of a looming £1.9bn gap in funding for children’s services in England.
The National Audit Office spending watchdog reported last month that the number of cases of suspected serious harm to children had more than doubled over the past 10 years, yet services remained “unsatisfactory and inconsistent” despite attempts at reform. Councils face an unenviable choice of priority for vulnerable children or for vulnerable adults.
