After months of pressure from local government, campaigners, charities and others, Philip Hammond provided an extra £2bn for social care. It has been accepted by everyone, including by the government, that this is a short term solution to a complex system that in the longer term requires a wider solution, which is another story. The big question is: where is this extra money likely to be going and what could it achieve?
The simple answer is no one really knows, and so I wish to explore where the money could be going.
The way to do this is by firstly exploring where the money is unlikely to be going. When people talk about a ‘social care crisis’, they may actually be talking about one of any number of completely separate issues. It is important we explore what these issues are and why the money is unlikely to be used to resolve them.
The first issue is the potential collapse of small and large care home providers, because of squeezing costs etc. A lot of care homes merely attract custom from individual and families who pay for care themselves, referred to as self-funders, and do not have any involvement with local authorities. There is firstly no legal duty currently to protect care home providers from going bankrupt. It can also be argued that as the needs and desires of service users change, the solutions they seek will change, and therefore if market forces indicate a decline in the desire of care homes, the government should not interfere. Therefore, none of the money is likely to be spent here.
The second issue is supporting self-funders directly. While the Care Act has a provision to put a cap on the amount of money an individual has to pay for care during their lifetime, the government has put this on an indefinite hold, because of the strain it would place on social services in terms of cost and extra assessments. The government’s proposed green paper on social care is likely to be another attempt at trying to ease the burden of self-funders, as well as other issues, but right now, the money is unlikely to be spent here.
The third issue is what can be seen as meeting the needs of people who need support but are not assessed as at risk of serious and immediate harm if their support needs aren’t met. For example, this could be a person who is unable to do up buttons, or a person who finds it very exhausting to carry a full laundry basket to the washing machine. Often, people with moderate needs can have their needs met who the use of a whole range of assistive technology or by relying on family, friends or paid for services where social care fails to meet their needs. Social care investment will not be going here, as no one is left at risk if and when cuts are made, though the impact on families and individuals day to day living is significant.
The final two issues is where the money is likely to be going. These are local authorities existing commitments under the Care Act, and relieving pressure in Accident and Emergencies Departments. While the latter issue is likely to occur, that discharging patients is delayed because of social services, it is likely to be a major issue in terms of everything local authorities do, and it is important that social care is not simply seen as the servants of the NHS in reducing hospital admissions, reducing its ‘social’ role in terms of social inclusion.
So local authorities will get the bulk of the money to continue to do what they are already doing without much explicit direction from central government. The public and service users are unlikely to really notice any difference, and certainly nothing that can be pinpointed. The money is unlikely to halt any already planned cuts; it will sadly simply be used to prevent further cuts that have not even been thought of yet, making the evidence of what the money will achieve harder to demonstrate.
So basically, the money will provide limited benefits but the public and service users are unlikely to notice any changes, large or small, as it is a matter of business as usual.
By Simon Stevens