Only an MP since 2010, she was appointed by Ed Miliband to rethink adult social care and negotiate a grand bargain with the government on how to pay for it. She’s at the table in the all-party talks based on the findings of the Dilnot Commission on social care. But that exercise is mainly aimed at agreeing a system to pay for the future care needs of an ageing population, and, she says, the need to re-engineer social care goes far beyond that.
The figures are daunting: by 2030 there will be 15.5 million people in Britain over the age of 65, perhaps 6 million of them over 80. By 2025, the current system will cost £11.5bn a year. The cost implications of Dilnot’s proposals will add another £3.3bn to that figure. And delivering the full suite of personal care services she’d like to see would add a further £7.7bn.
Which is why integrating NHS care with social care – always a dream of policy-makers – is beginning to look like an urgent necessity for the age of austerity. Kendall believes that without a settlement for social care, the pressure on public spending will be unsustainable. And that
settlement has to go beyond some version of the Dilnot prescription for charges on clients – a cap on the overall amount people have to pay, set somewhere between £23,350 and £50,000, plus a means testing threshold which means people with less than £100,000 don’t have to pay
towards their care. (Kendall won’t comment on the progress of the all-party talks on charging, because they will only succeed if confidentiality is maintained until proposals emerge).
Just as important, she says, is shifting the focus of services towards supporting people in the community. With the proper mix of services, elderly people can avoid the kind of health crises which put them in hospital – falls, complications from diabetes, or the like. And she is particularly keen not to ignore mental health issues and provide people with support to help prevent the lonliness and depression that dog many elderly people – something as simple as a social group can make all the difference. Quality of life is improved and NHS costs are cut.
The trouble is, Kendall says, the modest progress of recent years toward integrated services is being reversed. With local authority budgets under increasing pressure, care services, the biggest discretionary spend, are inevitably being squeezed. Kendall says they have now reached breaking point. The kind of preventive care that keeps frail elderly people, for example, out of hospital, is especially vulnerable. Delayed discharges from hospital have increased by 16 per cent since August 2010, she says, at a cost to the taxpayer of £500,000 a day – the direct result of a lack of the support services which could have allowed the patient to return home safely.
And the Community Care Trusts which have proved effective in coordinating services are to be abolished, along with all the Primary Health Care Trusts, under the Health and Social Care
Bill, currently before Parliament. Kendall believes the proposed new Health and Wellbeing Boards could have a positive role in bringing the different strands of services together, but
doubts that the Clinical Commissioning Boards and Clinical Senates will be able to deliver the changes she thinks are essential. Indeed the abolition of PCTs may be dispersing the very
staff needed to make integration work, the ones who know the local landscape and have the trust of the various agencies.
The problem is that integratng support services usually involves local authorities spending money in order that the NHS can save it. The key, says Kendall is for the councils, the NHS and voluntary sector to pool budgets and design services together, and to give users and families genuine control. But her experience as a special advisor to Health Secretary Patricia Hewitt, and as a policy wonk in the health sector, has made her wary of trying to force cooperation on the organisations which would have to be enlisted, and even more wary of imposing a structure from on high.
“I’ve criticised successive governments for continually changing structures rather
than services,” Kendall says. She insists the radical shift of services that is needed can’t be imposed. She offers an example of how the system should work: “we know that older people with long term conditions like heart disease or diabetes or both will be increasingly frail and in danger of having falls. GPs can identify them to local social services, who in turn can put together a package of support: the local authority might provide home adaptations and the NHS regular visits from community nurses to help them manage their conditions, take their medicines and do exercises. In the ambulance services there were people who’d call 30, even 50 times a year. This way they don’t end up having to dial 999 and go to A&E and then find themselves stuck in hospital because the services to support them at home don’t exist.”
She’s also keen to see better, clearer information about the services available. Families or carers are too often left bewildered by the range of different agencies they have to deal with. And she warns that there must be clarity about exactly what services will be covered by the contributions cap – people will need to be reminded that it will be a cap on the total cost of the core services the care system would provide and would not necessarily cover everything they wanted. Otherwise, she fears the cap could become a trap, if clients believe a particular service is included in the cap, and only discover later that it is not, when a hefty bill arrives.
Getting real integration, she adds, depends on more than the administrative structure – in fact the structure matters a lot less than other factors. “Where people have achieved integrated services, it has been because of a long term development of relationships, where all the agencies understand what each brings to the table.” Hospitals for example, have to be confident that the community support for patients is good enough to ensure that they won’t be at risk when they are discharged. Kendall describes how one hospital’s concerns were dealt with by using its former staff to deliver support services; they knew they were dealing with competent people. And crucially, she adds, all the agencies have to share in the cost savings which come from integration, local government included.
“Many local authorities are aren’t waiting; they’re getting on and doing it,” she says. “They must continue making changes and delivering better services for elderly people and their families – and delivering better value for money, because they’re facing cuts of a third. At the same time many PCTs are working to integrate services and that must be the way forward.”
But while Kendall is enthusiastic about local services, she is also concerned about the present “postcode lottery” on who is eligible for care services and believes there has to be a move towards more standardised criteria to avoid serious injustices. But, she adds, they have to be workable and affordable. She doesn’t offer any specifics about how that can be achieved – but it’s a fair bet that this is one of the major subjects at those all-party talks. One thing Kendall does say is that she wants legislation on a new social care settlement in this Parliament; she’s frustrated that the government is still talking in terms of White Papers and “progress reports” when she believes a move to a new system is urgent now.
Beyond the immediate policy task is the wider role of setting out a new vision of what a 21st century social care system should look like. Because almost all voters have a stake in social care, and the party with the most compelling ideas about how it should work in the future can expect to reap a big electoral dividend.
Mark D’Arcy is a Parliamentary Correspondent for BBC News.This article first appeared in Cllr April 2012
As Andy Sawford blogged on here last week, the long awaited local authority resource review has been announced. It seems like there had been a delay in agreeing the scope of the review, with reports (unsubstantiated) that Nick Clegg had wanted a wide ranging review which would consider options for new local taxes and charges and a radical reform of formula grant. The review now in place is narrower in scope, focusing on the distribution of business rates, but it has potential for radical, and contentious, change. The government is considering how to deliver “the optimum model for incentivising local authorities to promote growth by retaining business rates, whilst ensuring that all authorities have adequate resources to meet the needs of their communities”. Councils collected £20 billion in business rates in England in 2009-10. Around a third of councils would no longer need government grant if they could retain their business rates. Westminster, for example, collect around £1.1 billion in business rates, but only keep around £150 million. Liverpool, at the other end of the spectrum, received £280 million from redistributed business rate but only collect £178 million. Those councils that could gain greater financial autonomy will understandably support the reform. Local government has largely welcomed the direction of the reform and for the acknowledgement that financial freedom has to be a central part of localism. The review, however, seems to suggest that the government is not going to give councils the ability to set the business rate locally – or, if there are changes here, they will be constrained. The major contentious issue in the review then is equalisation. It is clear that there will still be an element of redistribution between wealthier and poorer councils, but not how any mechanism would work. The huge variation between councils in their ability to raise income from business rates and council tax cannot be ignored, nor their different capacity to increase economic growth. Councils currently encourage growth, even without the incentive of retaining most of their business rate, and, no doubt, their performance, as well as their capacity, varies, but success cannot be attributed just to council's performance, or even primarily to it. Allowing some councils to retain more or all of the business rate they collect will reduce the funding for others, so how will the government fill the gap? Would the government be prepared to accept a bigger divide between councils in the interests of localism? Perhaps Eric Pickles will have to reconsider his caution about bringing in a range of new local taxes and liberalising fees and charges. It is likely that the business rate reform will be linked in some way to incentives the government will bring in to encourage growth, particularly in poorer areas – so that business rates income could increase (even if the rate was lowered). Lifting planning restrictions in the budget tomorrow is part of this agenda. Again, this is bound to be controversial. It is clear that the local government finance system we have now is the opposite of localist. It could be said to hinder economic growth – at least, it does not encourage it. Reforming local government finance has proved a poisoned chalice before – and successive governments have retreated from major reform as a result. Reconciling the contradiction between greater financial autonomy and equity is never going to be easy. Local authorities will want to have their voices heard, individually and collectively, over the next few weeks. This post is based on a LGiU members briefing written by Janet Sillett. Briefings are available through individual subscriptions and accessible to all officers and elected members of our member authorities. For more information on joining the Local Government Information Unit please follow this link.