Social Care: where next?

“Social care funding was still not agreed despite cross-party support for a cap on social care costs, however, this matter should be settled within this parliamentary session”, said Care Services Minister Norman Lamb.

Last night, LGiU and Partnership hosted a fringe event at the Liberal Democrat Party Conference that asked Social Care: where next?

Chairing the session was Jonathan Carr-West, Policy Director at LGiU. We were joined by the new care services minister Norman Lamb MP, Caroline Abrahams, External Affairs Director at Age UK, and Managing Director at Care Partnership, Chris Horlick.

Here are some key points and comments from both the panel and members of the audience:

– how do we insure health and wellbeing boards are adequately balanced between local government and health representatives and that they give an appropriate role for elected members?

–  how do we insure fairness in residential care? How do you approach the issue of self-funders cross-subsidising state-funded people in residential care?

– the impact of financial efficiencies on care quality

– the need for experimentation, but the lack of funding to do so

– hotel costs in residential care are not included in the Dilnot cap

– lessons could be learned from integrated services in Scotland. The aligning of budgets, as well as addressing the issue of different cultures in health and social care would be beneficial for integration.

– the dangers of an emerging gap between children and adult social care

– the need to ensure personalisation does not result in the wholesale move away from community activities and provision e.g. luncheon clubs.

A full write-up of the event is below.

LGiU inquiry into adult social care

The Chair opened by explaining the role of LGiU in supporting local government members.

He then went on to outline the findings of an inquiry into adult social care by the All-Party Parliamentary Group on Local Government.

The key findings centred around funding reform, as well as systemic reform focused on prevention, to create integrated, preventative health and social care services.

Good practice already existed in local government, said Mr Carr-West, pointing to local authorities helping with financial management, independent living and managing a market for social care.

Current social care system

Care Services Minister Norman Lamb began by outlining his new ministerial duties as he was not able to attend the later questions session.

There were a number of features that typified the current system, said Mr Lamb, which were in urgent need of reform.

Firstly, it was a fragmented system where local government and social care were separated from health care. He said the same was also true for mental health services and physical health services.

Secondly, it was a system that was widely seen to be unfair as many faced losing access to services despite having contributed by working throughout their lives.

There was also a problem of poor use of resources and sustainability of services, which was made even more difficult by the current financial circumstances and demographic changes. These issues were closely linked to poor quality of care, Mr Lamb added.

Self-funders in social care were another feature of the current system that needed to be addressed, he said, as they were not in the local government ambit and left without guidance or support.

Changes to the care system

The Health and Social Care Act had been controversial within the Liberal Democrat party and with the wider public, said Mr Lamb, however, it was important to now implement it in the best possible way.

A positive contribution of the Act was that public health responsibility had been brought closer to local authorities, he added.

Mr Lamb said that the lack of access to financial advice on social care needed to be addressed to ensure that all have access to information.

The Care and Support Draft Bill had been widely supported, he said, where carers were at the centre of the legislation and portability was improved by not attaching care packages to location.

The Dilnot recommendation for a cap on liability had cross-party support, Mr Lamb said, but added that a sensible solution for funding was necessary, alongside an informed public discussion.

Mr Lamb said he wanted to settle the issue of social care funding within this parliamentary session.

By shifting the emphasis on prevention, Mr Lamb said the aim was a more integrated care system where health and social care could be held within one trust. He pointed to the good practice found in Torbay.

Two main changes would be particularly relevant for local governments, Mr Lamb said. The first was the move towards personalisation, which gave power to individual service users to determine their priorities.

Secondly, commissioning needed to change from a focus on procurement based on price, to commissioning with the best possible care for patients in mind.

The Chair added that the LGiU would publish a report into outcome-based commissioning in October.

There was a wide consensus about what the problems around social were, said Ms Abrahams, with issues around un-met need, care quality and cost of care.

The solutions were centred around two key points; system reform and funding reform, she said.

Social care formed part of a series of complex problems, such as housing and employment, said Ms Abrahams, adding that social care involved a relatively low cost compared to those other issues.

Self-funders

The local government duty to inform all about care needs and services was a “massive step forward”, said Mr Horlick, pointing to the Care and Support Draft Bill.

Self-funders made up over 40 per cent of those currently in residential care, he explained, and added that currently self-funders had nowhere to go for information.

Mr Horlick said Partnership had responded to the Draft Bill by proposing the inclusion of specialist care fees advice, since financial advice was a key component of the information self-funders required.

He added that it was crucial that people understood that the Dilnot cap was not a lifetime cover and it was necessary that the details around care costs were made absolutely clear.

Questions

Integrated services

Responding to a question from the floor, Ms Abrahams said there were lessons to be learned from the integrated services in Scotland.

The aligning of budgets, as well as addressing the issue of different cultures in health and social care, would be beneficial for integration, she added.

Social care market

A mixed economy would continue in social care, said Mr Horlick, in response to a question about the different prices for those in public care and self-funders.

The care home market would remain, he added, as the Government would not be prepared to fund social care at a rate high enough to fund decent care.

Ms Abrahams later added that commissioning would not mean a “pure market”, with risk transferred out of the local authority to the individual or smaller providers.

Health and wellbeing boards

In reply to a question about health and wellbeing boards, Mr Carr-West said more local government influence was necessary through clearer involvement of elected officials on health and wellbeing boards.

Prevention

In reply to a question from the Chair about the statistical evidence of prevention, Mr Horlick agreed that it was difficult to prove prevention worked.

He added that they were reliant on funding from the Department of Health and the private sector to prove prevention measures worked, which would then be presented to the Treasury.