The announcements made by the Treasury in the June 2013 Spending Review could have a profound impact on the welfare state for years to come. Not least affected will be the adult social care system, which supports over a million disabled adults and older people across the country. For adult social care, one major decision has just been settled and another is expected soon: how the care system will be funded going forward and who’ll be able to access it.
For far too long social care has been a Cinderella service: under-funded and under-loved. Has anything changed?
Yes and no. To begin with, the Government has stated that an additional £3 billion will be made available for jointly-commissioned health and social care spending by 2015/16. This is a big step in the right direction for a system that has suffered from decades of chronic underfunding. As Lord Sutherland points out, the post-war arrival of the modern welfare state saw the establishment of a National Health Service, free at the point of delivery, while social care was destined to become healthcare’s poor relation.
Fast forward to the present day, and the Treasury has clearly heeded the clamouring calls for integration of the health and social care budgets. The argument for joint commissioning is simple: investing in social care interventions can prevent people’s health needs from escalating and obviate the need for more costly interventions in the future. In fact, new research by Deloitte suggests that for every £1 spent on ‘preventative care’ (early interventions) for disabled people with lower-level needs, £1.30 is generated in terms of cashable benefits and future savings to central and local government, the NHS, and individuals. The PSSRU found similar savings in its evaluation of older people’s services.
The economic case for investing in preventative care has slowly gained momentum, and it’s no surprise that the Government is listening. But let’s not forget the real value of social care. At its simplest, social care supports people to do the basics in life, such as getting washed, getting dressed and getting to work. The report of the Dilnot Commission has made everyone focus on the ‘cap’ to an individual’s care costs. For many people, though, a cap on social care costs is meaningless if they’re not deemed eligible for social care in the first place.
Under the current system, local authorities carry out assessments to determine who’s eligible for social care. The Fair Access to Care Services (FACS) framework employs four neat bands – low, moderate, substantial and critical – to categorise the ‘level’ of people’s needs. Amid ongoing funding pressures, however, the number of local authorities that provide social care to people with at least ‘low’ or ‘moderate’ level needs has declined dramatically: from 41% in 2005/06 to just 15% in 2012/13.
According to Norman Lamb, the current care minister, the Government is set to introduce a national minimum threshold for eligibility as part of the regulations accompanying the new Care Bill. Early signs suggest that the new threshold will be set at a level equivalent to the ‘substantial’ FACS level. But in the long run, a restrictive threshold can only lead to more costly interventions in the future with adverse knock-on effects for other areas of public expenditure.
If we wanted to support the tens of thousands of disabled adults and older people with ‘low’ or ‘moderate’ needs who currently receive no support, estimates by the PSSRU suggest that we’d need at least £2 billion annually to make up the shortfall. This is much more than the £3 billion the Chancellor has pledged over the next three years. The need to address this funding gap will only be exacerbated by cuts to local authority funding if action isn’t taken soon.
We need to move away from a residual model of care towards an outcomes-based model that promotes people’s independence and wellbeing. In principle, the Government’s Care Bill puts wellbeing at the heart of care provision, but surely this can only be achieved through a sustainable funding settlement, which supports a more inclusive eligibility threshold? The Spending Review has brought welcome news to adults currently receiving social care. But for the thousands of adults who aren’t supported by the system, there’s still a long way to go.