Like many other people involved with local government, at LGiU we have been talking about social care in increasingly anxious terms for many years.
We saw the Barnet graph of doom back in 2012. We have seen Dilnot come and maybe go. We have seen the faltering implementation of the 2014 Care Act, a slow but steady progress towards more outcome- focused commissioning and steps toward real integration between health and social care in Greater Manchester.
Now, finally, we are seeing real political visibility. Senior figures in local government have even been heard saying social care is now second only to Brexit in its political salience. Certainly it’s not been often that a key local government issue has appeared both at Prime Minister’s Questions and in the Budget speech which followed it.
But are we making any real progress? Our recent report, Paying For It: the human cost of cut price care reveals a system already in profound crisis, a system that serves no one well.
Hospitals are short of beds because the frail cannot be discharged. Care workers are undervalued and underpaid. People who need care do not always get the care they need when they need it. Local authorities are having their budgets slashed so mercilessly they are faced with a stark choice: ration care further or pay for care at a rate so low that providers will limp along until they can go no further.
This is a systemic crisis caused in part by years of underfunding. But it is not just about money. It is about focusing on time and cost at the expense of outcomes. It is about separating out health and social care and our cultural and political bias towards the health service when the reality is that more of us require more care.
As a single but telling example of that bias, consider the relative pay, terms and conditions and esteem of nurses compared to care workers.
In what turned out to be the less controversial part of his Budget, Philip Hammond announced a £2bn crutch for social care over the next three years. But as we all know, while every little helps, that is not nearly enough money.
To give government its due, it recognises this is only a short-term fix. The Government announced a green paper on care funding would be published ‘later this year’. That is welcome but there is a lot of work to do.
If we want to make serious progress, that green paper has to answer a lot of questions.
How do we address the instability in the personal and public financing of social care? Is Dilnot dead or not? If so, what replaces it? How do we provide public funding in a way that doesn’t further disadvantage areas with lower property values? How do we stimulate a market for financial products which help people fund their own care? How do we ensure working age carers can resume their careers and contribute to the economy? How do we address the problems within commissioning and the wider care market? How do we help authorities move towards more effective outcomes-based commissioning? That is a cultural change as well as a technical one, and needs to be supported through sharing best practice and training, not just regulation.
How do we better support the workforce? We need better pay and conditions, but also to think about career pathways.
How do we use technology to achieve greater impact? Whether it is the internet of things technology which can identify whether someone is feeding themselves, or social tech which helps people engage with their carers and community, technology has the potential to revolutionise care far more than it has done to date.
Historical precedent is not encouraging that the thinking presented in such a paper will ever translate into reality. But a lot of this thinking has been done already. There is no shortage of ideas and innovation in and around care.
If the Government is ready and willing to engage widely and rapidly, there is a window of opportunity to drive this agenda forward. But we need to emphasise the urgency of this. It is not a potential crisis, or even an imminent one. It is a crisis happening now and our actions need to reflect this reality.
Jonathan Carr-West is the Chief Executive of LGIU. This article was first published in The Municipal Journal.