The New Care Covenant

In any policy way forward in Social Care we have to be aware that, as an issue, the general public don’t rate social care on the radar screen at all. Indeed as it’s so complex in its purist form, social care only, they have little understanding of the detail of those complexities unless, and until, they exercise it at the sharp end.

Not even then!

When you add in health care and possible integration then that becomes even more of a challenge for their understanding.

There is also the misconception that such care is for the elderly only but that is not so when 1/3rd of those being supported are disabled of working age. That is missed in Liz Kendall’s position statement.

So as a national issue “it is not one at all.”

It is a local Council issue in the public’s mind but not one of the first tier ones either coming in probably below such matters as waste collection, highways etc.

Then there is the difference in assessment between pure social care of means testing and health care of universality.

Central to the discussions is the “F” word which is not directly commented on, directly, in the paper although the reference to integrated models and co-ordination of actual working innovations are usefully made.

I shall have more to say about this letter.

All this must be seen in the framework which has been outlined by this government in its Welfare policy which is discriminatory, some would say taking it back to Victorian values, to those at the bottom end including disabled people, poorer families and therefore disadvantaged communities. One has seen this more recently in the cap for social care being set at £72,000 rather what Dilnot suggested as £35,000 which, I believed, has a certain consensus but we see now not.

In making any policy changes it’s not just what innovations come forward in the UK but also what we can learn form our advanced European neighbours but that is not referred to either.

Best practice exists across in Europe and we should evaluate it.

What part will technology play in the future in delivery? As new forms are coming forward all the time it gives more support for people staying in their homes but their will still be the need for community interaction.

Let’s have a look at some controversial areas.

Firstly the fragmentation of the social care sector is well known as are some of the celebrated fallouts involving say Winterbourne and Southern Cross but for each one of these CQC, even in its limited quality application of the 23,000 plus individual businesses that make up the sector, does not seemingly have remit for the profits being made which are not reinvested into the business model, staff knowledge and skills or indeed simply staff salaries. Being paid a pittance only attracts those at the bottom end who are n need of higher individual standards.

That is not a denigration of those who form an important part of the care sector but of the quality of leadership an outputs.

Secondly there is the funding gap which is real and growing. Pilot schemes, as Liz intimates, are occurring which do involve healthcare and social care integration but also community budgeting.

However whilst there is massive fragmentation the model is the wrong way round in that their needs to be more effective local regulation, providers need to be part of the solution but on different terms with a direct partnership role with Local Authorities.

We must rid the sector of those who wish to make money, pay little and drive down standards and who are not innovative either.

Local Authorities should be in the driving seat in that change.

So let’s look at the funding gap issues.

ADASS in its analysis of the funding gap for social care have calculated that something like £3.3 billion in cuts have been applied in social care in the last 3 years. Over the next 6 years, in current projections, another £6.5 billion is going to be applied in Control Period 6. This will put Local Authorities in an invidious position and almost life and death decisions to support from supporting people to wider social care.

A central question aimed at Local Authorities is do they know what the actual direct and direct costs of social care support are? Is support better over 30 mins than 15 mins? Does travelling time form part of the financial equation? Have they done the evaluation of integration?

What is the position in end of life care?

The innovative health care and social care combined budget models detailed in Liz’s paper can be added to by say Wigan. The difficulties come in professionalism, culture and different outputs and delivers but can it really ever work?

It surely needs to which is why the pilots are important.

As for community budgets the Local Government Association already has seen an initial report by Ernest and Young on the possibilities for community budgets as part of the total place concept which I support. Those individual pilots are about prevention, are about new forms and support for personalisation and their outcomes covering all eventualities from part time work to new forms of involvement whether on a personal or group basis?

Have Local Authorities considered a fundamental review of their day centres which are a 50s concept but may not now be suitable for the “baby boomer” generation?

Resources could be better allocated and delivered but would still be subject to the caveats that I have outlined earlier.

What all this does say is that the covenant outlined by Liz is fine in concept but for delivery we come back to the usual outcomes of Finance, integration and the regulatory reform of the sector but with local solutions led overall by local authorities.

As Andy Burnham has already stated it’s all about putting the person at the front of the policy and delivery and all that that entails.

Cllr Mike Roberts