by Ian Shires on 10 September, 2019
Senior fellow at the King’s Fund analyses what Sajid Javid’s one-year spending review means for adult social care
It is a marker of how complex the funding streams for adult social care have become that it takes a fair bit of work to decipher the effect of last week’s spending round statement.
The statement promises a roll-forward of grants which were due to end this year, along with an additional £1bn grant (for both adults and children), £500m of spending power through an extension of the social care precept and confirmation that the minimum clinical commissioning group (CCG) contribution to the Better Care Fund will increase by 3.4% in real terms.
Overall – dependent on local decisions taken by councils – we estimate that amounts to growth of about £1bn for adult social care. That’s obviously welcome but it is around the minimum required to patch things over until 2021, given that demand for adult social care is not static but increases by an average 3.7% a year.
Nor does the nature of the funding alleviate any of the fundamental problems facing the sector. In fact, in some ways it entrenches them.
The social care precept is a fundamentally regressive funding mechanism, both for the individual paying it and the councils who raise money with it: the local authorities with the highest need have the least capacity to generate income (so it’s critical that the distribution of other social care funds allows for some equalisation between need and spending power).
The extra money via the minimum CCG contribution to the Better Care Fund is welcome but continues to create tensions between local authorities, who have the legal duty to meet social care need, and NHS organisations with often narrower objectives around delayed discharge. And, of course, the joint grant for children’s and adults’ services will continue tensions of a different sort within local authorities as to the most pressing priorities to meet.
The short-term nature of the funding is also a major issue, preventing local authorities from taking action to deal with fundamental, structural problems within the sector.
Councils cannot ‘shape markets’ without knowing the shape of longer-term funding. The providers they are commissioning need to have greater clarity on future fees and contracts, and staff employed by those providers need to know they will have jobs that will pay them enough to pay the bills. Otherwise they will understandably drift into better paid jobs in retail or take their experience to the NHS, with its more attractive terms, greater security and better career prospects.
This funding short-termism is even more concerning given the glacial progress on wider, long-term reform of the social care system. The chancellor said only that “more fundamental reforms” would be set out “in due course” – language suggesting that longer-term priorities and strategy, and surely plans to engage with the public and social care sector over them, are still some way off being articulated.
This is a depressing continuation of 20 years’ failure – by successive governments – to get to grips with social care.
Overall, the spending review was the equivalent of putting a bit of extra fuel in the tank when the car urgently needs a full service. Only the next 12 months will see whether that extra fuel has been enough to keep the car on the road.
Simon Bottery, senior fellow at the King’s FundLeave a comment