Social care is the hidden loser of the Spending Review – and it will hit the most vulnerable

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Social CareBy Richard Stevens

A BBC survey of English local authorities revealed the fear of many councils that spending cuts will hit care services which help elderly and vulnerable adults live at home.

Worrying the results may have been, but the coverage was welcome. As a political issue social care doesn’t always get the profile it deserves. Not fitting neatly into the domestic policy boxes marked “health” or “education”, it isn’t accorded the column inches offered to what are perhaps seen as sexier policy areas. Moreover, social care provision is delivered by local authorities and primary care trusts (for now), and not by central government. This makes it an unusually ripe target for ideologically driven spending cuts. The spending review made full use of this political cover, passing huge cuts on to local authorities to implement while speciously claiming to have protected funding.

On the surface, social care appeared to have emerged relatively well. Under a banner of “fairness”, the spending review trumpeted an extra £2 billion of “additional funding”: a £1 billion increase by 2014-15 in the Personal Social Services grant (the current Department of Health grant to local authorities for social care); and another £1 billion over the same period to fund better integrated service provision between the NHS and local authority social care departments.

More joined-up working between health and social care professionals is a laudable aim. Navigating the complexities of social care provision by the NHS on the one hand and local authorities on the other is a common complaint of care users and their carers. But the £1 billion “extra” in NHS support isn’t really additional: it’s a transfer from the health capital budget to health revenue, so from one pocket to another. (Interestingly, this transfer blows a hole in the coalition’s loud promise to protect NHS funding in real terms. As the Nuffield Trust has pointed out, the real-terms change in NHS funding, net of the social care transfer, becomes a reduction of 0.5% over the next four years.)

Drilling down into the social care funding settlement for local government reveals a far murkier outlook. Prior to the review, the Association of Directors of Adult Social Services (ADASS) warned the government of a significant shortfall in adult social care funding. In its formal submission ADASS pointed out that:

“No one has identified how savings of almost £6 billion from adult social care could be achieved. Without a change to statutory responsibilities, achieving savings on the scale of 25-40% is simply not feasible. Any attempt to get close to this sort of reduction would have significant adverse effects on very vulnerable people. It is also important to recognize that the vast majority of adult social care is spent on those who have either limited resources or no resources to pay for their care themselves.”

Perhaps the coalition’s loose talk of up to 40% cuts to local authority budgets made some all the more grateful for the crumbs that appeared on the Chancellor’s table on 20 October. Responding to the SR10 announcement, Richard Jones, ADASS’s president, welcomed “the profile and priority that Mr Osborne’s review has given social care.”

It’s difficult to agree with that conclusion. The extra £1 billion pledged in central grant funding to local authorities will probably not be enough to keep pace with the demographic pressure of an ageing population over the next few years, never mind plug gaps.

But it gets worse. The money is not ring-fenced and so it is difficult to know how much will ultimately find its way to the social care budget. And, crucially, all of this has to be set against the spending review’s local government settlement, which left local authorities facing 26% reductions in revenue. As ADASS itself has pointed out:

“This is in the context where councils spend significantly more on social care than the revenue support grant allocation [from central government]. Adult social care is the largest area of controllable spend in most councils, so it is going to be extremely difficult to protect current spend when the loss of funding to all services is so great.”

So in yet another area, the Tory-Lib Dem Spending Review gives the lie to the claim that we’re all in this together. The reality of the social care settlement is that the most vulnerable in our society – the elderly, and those with physical and learning disabilities – will be hit harder than most.

Osborne’s political sleight-of-hand in masking savage cuts to social care with the cherry of “extra” funding and the icing of “fairness” was typically cynical. But it’s a strange world that we live in when the Lib Dem care minister, Paul Burstow, can support the plans with that peculiar brand of scolding contempt that Nick Clegg has injected into his party’s public discourse:

“It is wrong to scare people about “cuts”. The coalition government has prioritised social care… This extra money means no councils need to reduce access to social care if they improve efficiency and drive forward with reform to make services more personal and preventative.”

Taking policies that are unfair and deeming them otherwise seems to be the main public function of Lib Dem ministers serving in the coalition, from Clegg downwards. It’s a disturbing rhetorical development in British politics. But on a policy level, Paul Burstow clearly sees the personalisation of care budgets – introduced under Labour – as a way of saving money, rather than producing a better and more tailored delivery of social care services. There is a danger that the personalisation of care budgets becomes, in the wrong hands, a tool to lop money off the social care provision rather than improving the quality of care.

Labour must be attuned to this on a local level. And on a national level, we cannot let the Tories and Lib Dems get away with the notion that the settlement for social care in the spending review is fair or progressive. It isn’t.

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