Title

The national children and adult services conference takes place this week in Harrogate with the theme Rising to the challenge: Brighter futures for all. Andrew Couzens looks at one of the key current themes, the future of adult social care. It looks as though the future funding of adult social care is going to be a significant election issue next year. While there is no political consensus about what to do, it was evident from all the recent party conferences that it is an issue which can no longer be ignored. All three parties have committed themselves to a fairer system. The central message of the LGA's Fair care: Better now, fairer tomorrow campaign has, at last, hit home. Adult social care is not broken, it is chronically underfunded. As Paul Snell, the last chief inspector of the former Commission for Social Care Inspection said; ‘Councils are constantly raising their game and aiming high to continually improve, and provide the best-possible services for local people'. Councils' commitment to adult social care remains unswerving too. The most recent personal social services expenditure information shows that local authorities increased their gross spend by £791m to £16.1bn in 2008-09, an increase of around 5% in real terms and 3% in gross terms. But demography is racing ahead of even this increased funding. The Government's Green Paper, Shaping the future of care together, estimates that there will be 1.7m more people with care needs by 2026. More urgently, the LGA estimates, that the number of people aged over 85 will increase by around 2.5% a year, of whom one-quarter are likely to develop dementia, and one-third needs constant care or supervision. The number of people with a learning disability is expected to rise by 2% a year. Last year's spending on this group rose by 10% in cash terms. The system is under acute pressure but it is not beyond repair. Councils are reporting good progress with plans to transform the experience and delivery of care and support under the Putting people first programme, supported by the transformation funded allocated by the Government for this purpose. There was a 34% increase in expenditure on direct payments last year, albeit from a low base, and the numbers of people exercising choice and control through individual budgets is rising sharply. All parties' proposals build on these principles of personalised services. Andrew Cozens is LGA group strategic lead for adult social care The six parts of the proposed National Care Service offer: 1. Prevention services: The right support to help people stay independent and well for as long as possible, and to stop their care and support needs getting worse 2. National assessment 3. A joined-up service 4. Information and advice to find their way through the care and support system easily 5. Personalised care and support 6. Fair funding, meaning everyone who qualifies for care and support from the state will get some help meeting the costs. Source: Shaping the Future of Care Together (Department of Health July 2009) The experience of those who have made their way into the system is set to improve further The major problem is those outside who ought to be inside because of raised eligibility criteria, and the sharply-contrasting experiences of those ineligible because of where the current means test sits. It is a strange quirk of this market that a person buying their own services can leave them in a worse position potentially, than someone wholly dependent on public funds. It is not surprising that access to advice, information and, where needed, advocacy is a seen as a critical element of the immediate and longer-term transformation of adult social care. Councils are now required to put in place arrangements by April 2011 so that people are clear about where to go to get the best information and advice about their care and support needs. This is urgent. A survey conducted for the Right Care, Right Deal coalition found that 48% of people said they found finding out information about social care confusing, and almost half of all older people admitted they were unclear about how to inform themselves of where and how to get help. A survey of councils' progress with Putting people first found around half had some sort of service, but mainly for those eligible for funding from the council. How much general advice is available now? 23 – out of 150 – authorities are confident that it is widely available to everyone 77 councils have advocacy services available for all those eligible for social care funding 53 have services for those funding their own care Source: ADASS/LGA Putting People First progress survey 2009 Study recomendations LGA,IDeA, ADASS and Counsel and Care commissioned a study from Cathie Williams and colleagues to scope current activity and thinking. This looked at previous research, talked to directors of adult services and key organisations, and visited seven areas. Based on this, and studies of a number of current models, they concluded there was much to be done to bring together local and national activity into a more coherent picture. Care and support information cannot be easily separated from wider information about entitlements and services available to everyone nationally and in their community. The authors highlight three dimensions against which a framework needs to develop – managing the information; managing awareness and knowledge; and managing how it is delivered. Information and advice alone are not sufficient. These need to be closely integrated with how support is planned, how it is managed, and how the best interests of the service-user are safeguarded. They make particular recommendations at a national level about the navigation between DirectGov and local authority websites, and their relationship with key independent sector sites. They recommend more systematic mapping and modelling of the balance between national and local provision, based on what is applicable across the country and what is best delivered locally. Anticipating a growing market for support and services outside local government, the authors recommend standards are developed about affordability, availability, quality, cultural appropriateness and type. The report is intended to be a springboard to help the development of national and local strategies over the next year. To make a universal offer work, councils also need to know more about their local care and support market, and how well it might meet the needs and preferences of self-funders, as well as those using individual budgets. It also provides important evidence to understand the complexity of how a national assessment and entitlement might be promoted, and then drawn down by individuals at a local level. When the additional funding comes, as it must, information, advice and advocacy should be central to a truly national and local care service.

Title

What next for adult care

SUBSCRIBE TO CONTINUE READING