Written evidence submitted by the North West Association of Directors of Adult Social Services (NW ADASS) [FSC 093]
1.1 The Branch brings together the region’s 23 Directors of Adult Services, their staff and various stakeholders in the common pursuit of better outcomes for people. We strive to work cohesively, learning from one another and collaboration where possible to improve services and the lives of people in the communities we serve. We aim to channel this energy through our bespoke approach to Sector Led Improvement that helps create a culture of transparency and honesty on what things are proving successful and where there is room for improvement.
1.2 Please also refer to the submission from ADASS, the national charity which represents our sector and promotes high standards of social care services. As the NW ADASS branch we wish to highlight the following particular comments and to also discuss our recent Regional Care Markets Analysis Project.
Question 1: How to fund social care sustainably for the long term (beyond 2020), bearing in mind in particular the interdependence of health and social care systems.
1.3 We agree with our national ADASS response. This clearly states that how we fund and deliver the essential care and support services that more of us will need at some point in our lives is one of the most pressing domestic policy challenges of our generation.
1.4 We acknowledge recent funding into social care through the likes of the Improved Better Care Fund. However, our work on NW care markets (discussed below) suggests that we are at a “tipping point”, reinforcing just how critical long-term funding solution for adult social care is.
1.5 It is important to recognise that we cannot achieve long term sustainability, without appropriate investment in prevention and early intervention, whilst also recognising the urgent and immediate funding crisis. Our 23 local authorities and sub-regions are currently delivering transformative and innovative work which we aim to showcase as an evidence base for reform. Given financial pressures transformation funding has been essential to secure the capacity to deliver this work.
1.6 With regards to the question, necessary “sustainable long term settlement” will need to address:
a) A long term approach based on independent forecasts within a workable financial settlement for local government as a whole. Adult social care budgets cannot be considered in isolation from wider LA allocations, given that adult social care budgets typically represent around a third of overall Council spend and rising.
b) Adequate and stable funding so that local authorities and providers can plan ahead; meet legal responsibilities (Care Act); and ensure investment in a fragile market (discussed in more detail below).
c) Understanding the potential inequalities associated with increased localism, with a lower tax base in less wealthy areas. A solution to this would be for Government to offer additional grants based on deprivation and local care and health needs to stabilise those areas less well off. As a general principle, funding should be formula-based and needs-driven.
d) Understanding the potential inequalities and impacts associated with shifting the balance of funding between service users and the state. The introduction of a cap and/or increase to capital limits would shift funding from individuals to local authorities, impacting upon local authorities at different rates due to levels of homeownership and assets. This would need sufficient additional funding from Government, whilst not contributing to existing and future cost pressures attributable to increasing demand and the rising cost of care. Also, to address the issues off ‘top ups’ and the interconnected recommendations made by the Competition and Markets Authority Care Homes Study – published in November 2017.
e) A scope wide enough to include the needs of working age people. The ADASS Budget Survey as well as our NW ADASS Care Markets Analysis Report highlights learning disability and working age as the biggest areas of financial growth and budget risk as present.
f) Addressing challenges associated with self-funders. If the Government want all people in care to be charged by providers at the same rate irrespective of whether they self-fund or are placed by a Local Authority, this will be a significant extra cost.
1.7 We are also keen to discuss a recent important review carried out by NW ADASS. In order to understand the risks and challenges with current care markets, and projected expenditure over a five year period, we reviewed the regions care markets for older people’s and learning disability services.
1.8 Our review found that the region cannot continue to support the same number of people, for the same amount of time using the same support models as now. To attempt to do so will not be affordable under any of the scenarios we tested, except for a hypothetical scenario which was calculated to demonstrate the level of change that would be needed for a financial break-even position to be achieved after five years. Our scenario that most exemplified the tipping point showed that costs could quite feasibly raise in the NW by as much as £843m (a 43% increase) between now and 2022 if policy and practice does not adapt and improve to effectively address the cost pressures that exist.
1.9 The clear conclusion – which we expect will be common across the country – is that the region is at a “tipping point” where incremental improvement is no longer enough. Despite the existing fantastic work in our region, showcased via our Sector Led Improvement programme, the only way that the demographic and cost challenges being faced can be met affordably will be through system wide transformation. Both immediate adult social care funding and a long term settlement need to support this scale of transformation. Additional conclusions from our review include:
a) Inflationary pressures – rather than demographic pressures – are potentially the greatest single financial risk for Councils, and challenge local authorities’ ability to meet obligations under the Care Act.
b) The Adult Social Care financial challenge needs to be understood with regards to learning disabilities (and other care groups) just as much as older people. The Economist reports today (5 March) that although twice as many over 65s receive social care as working age adults, spending on the two groups is almost equal at about £7bn, with spending on working age adults growing faster.
1.10 We are happy to discuss our work further and have recently shared our Final Summary Report with the Local Government Association (LGA), ADASS, NHSE, NHSI and other national partners and stakeholders.
Question 2: The mechanisms for reaching political and public consensus on a solution
1.11 We support the comments made in our national submission that five previous independent reviews over the last 19 years have set out the options for paying for care.
1.12 We support calls for cross-party co-operation to help agree the process for delivering long-term reform, based on responsible and evidence-based debate about the choices and trade-offs between funding options.
1.13 We agree that the public do not have a strong understanding about the “as-is” system of care and potential liabilities for care costs. Accordingly, it is hard for the public to assess the benefits of new proposals. This is particularly important regarding the individual vs the state’s responsibility, with previous suggestions that individuals take out special insurance policies to fund care in their old age. As a result, NW ADASS suggests that the voices of people who receive care, carers, and the workforce need to be elevated, and as far as possible proposals should proceed on the basis of true co-production.