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Adult Social Care Crisis

January 29, 2018 8:56 AM

Adult Social care

A joint report in September 2016, by the Kings Fund and the Nuffield Trust, looked at the state of social care services for older people in England.

It found that:

  • Social care for older people is under massive pressure; increasing numbers of people are not receiving the help they need, which in turn puts a strain on carers.
  • Access to care depends increasingly on what people can afford - and where they live - rather than on what they need.
  • Under-investment in primary and community NHS services is undermining the policy objective of keeping people independent and out of residential care. The Care Act 2014 has created new demands and expectations but funding has not kept pace. Local authorities have little room to make further savings, and most will soon be unable to meet basic statutory duties.

It also found that:

  • The social care system in its current form is struggling to meet the needs of older people. Six consecutive years of cuts to local authority budgets have seen 26 per cent fewer people get help.
  • Local authorities have sought to protect the most vulnerable older people with the highest needs, while at the same time encouraging others to be independent, drawing on the resources of their families and communities, and to reduce dependence on support from the state. For many people the experience of needing to find and pay for care comes as an unpleasant surprise for which, in general, they are unprepared. Unpaid carers are also expected to do even more.
  • Access to care depends increasingly on what people can afford - and where they live - rather than on what they need. This favours the relatively well off and well informed at the expense of the poorest people, who are reliant on an increasingly threadbare local authority safety net - especially if they live in areas where local authorities have been least able to sustain spending levels and who are at a higher risk of declining quality and provider failure.
  • The situation for older people has been compounded by pressures elsewhere in the NHS. Cuts to social care should not be viewed in isolation from overstretched general practice and community nursing and the uneven distribution of intermediate care beds.
  • The most visible manifestation of pressures on health and social care budgets is the rapid growth in delayed discharges from hospital. This imposes a significant cost on the NHS and is taking an unacceptable toll on older people, their carers and families.
  • The funding outlook for the next five years looks bleak. The measures announced by the government will not meet a widening gap between needs and resources set to reach at least £2.8 billion by 2019. Public spending on adult social care is set to fall to less than 1 per cent of GDP. The potential for most local authorities to achieve more within existing resources is very limited and they will struggle to meet basic statutory duties.

Norfolk's Approach

Norfolk County Council's approach to this crisis has been to use the promoting independence model to create sustainable adult social care by enabling individuals to retain their independence therefore reducing or delaying the need for formal care services.

Norfolk County Council is committed to deliver savings of £50m savings in Adult Social Care over the next three years. The majority of this saving will come from reducing demand for formal care services whilst ensuring people's needs are met.

Demand for Adult Social Care services will be reduced by:

a) Improving the advice and 'signposting' available when people contact Adult Social Care so that people can make good decisions that help them remain independent

b) Improving preventative services that either address lower level needs effectively, or help people to quickly get back on their feet after a crisis, without the need for long-term formal care

c) Supporting community and personal resilience and availability of a broader range of community-based support options as an alternative to formal care

d) Commissioning or providing good quality, cost-effective, personalised and integrated support for those people that still require formal care.

Speed and Scale of Change

Norfolk County Council used iMPOWER Consulting Ltd to create a target demand model to help the Council to understand the scale and nature of the changes that will be needed to make to deliver the required savings.

When you look at iMPOWER adult social care work they have had success with local authorities:

  • Warrington where they were looking for approximately £6m of savings a reduction in demand of 11%.
  • Sheffield City Council looking to find £10.3m of savings
  • Bristol City Council looking to find savings in the medium term of 10% (£11m) to 15% (£17m)

But what is striking is that these projected savings are a long way short of seeking £50million from an overall Adult Social Care budget in Norfolk of £250million. That is a 20% cut in just three years. And is on top of £90m of savings since 2010.

Coming back to the Kings Fund and the Nuffield Trust report it stated that an increasing number of older people with multiple health conditions and more acute levels of need suggests that more older people should be getting social care, not fewer.

Rising levels of complaints to the ombudsman about adult social care - up by 18 per cent since 2013; 55 per cent of claims were upheld. In 2014/15, complaints about home care rose by 29 per cent. That a high proportion of these - 67 per cent - were upheld by the ombudsman is consistent with the concerns about the state of home care that have emerged from our research. The upward trend in complaints suggests that councils are finding it harder to meet people's needs and expectations.

A common theme across all the local authority interviews was that people with lower-level needs were not simply being turned away from services, but redirected towards other sources of support, such as voluntary organisations in the community.

But it was striking that there were no obvious sources of information about what was happening to those no longer eligible for statutory services: 'We just don't have the resources to do follow-up studies on everyone that we signposted away'.

There was less confidence about the impact on people among interviewees who worked outside the local authorities. When asked whether the system could still completely miss people with high levels of need, a social care provider reported that they got calls 'every now and again' to assess people in their own homes and sometimes found people living in 'appalling' conditions. In the same area, an interviewee from the voluntary sector claimed that there had been a significant increase in the numbers of people being found dead in their own homes, but did not attribute this directly to a reduction in services.

A recent report to the Council's Adult Social Care Committee found that:

  • The care workforce is not stable and Norfolk has significant gaps in key sectors such as nursing and homecare
  • The implementation of the Promoting Independence strategy requires more reablement/enablement focused services across all types of care
  • Care Quality Commission and benchmarking data shows that the quality of services, while improving, needs to improve further.

It also said that there is a growing risk of market failure as demand for care increases and the cost of providing it (particularly in the most rural areas of Norfolk) increases beyond the Council's ability to fully fund all cost increases in all cases. Failures can range from insolvencies at one end of the scale (with potential permanent loss of capacity) to temporary interruptions in supply caused in the main by quality and performance issues at the other all of which increase the risk of being unable to secure the care that people need.

Trying to do all that the Council wants over just three years from this evidence looks too risky and is likely to put an overwhelming burden onto a care system that is already in crisis.

Liberal Democrat View

Photo of Brian WatkinsLiberal Democrats are urging Norfolk County Council to be more cautious about implementing a new social care plan so quickly. The Council's new 'Promoting Independence' strategy aims to reduce demand on the county's acute services by moving away from investment in direct care towards supporting people in their own local communities.

Adult Social Care spokesperson, Brian Watkins said, 'The council hope to save nearly £50 million over the next three years, but that will be hugely challenging. I am worried that there is just too much of a strain on existing resources for this to be achievable. It's a good approach, but we've got to get it right. There is a strong case for slowing down the pace of change to allow more time for implementation, said Councillor Watkins.