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Michael Burton reports on how the issue of funding adult care has already become a general election battleground. Adult social care is such a hot potato in a general election campaign that it was scarcely surprising main political parties were rumoured to have come to an agreement not to make it an electoral issue. That strategy was scuppered last week, when more than 70 councillors with adult care portfolios wrote to The Times newspaper saying the Personal Care at Home Bill was simply unaffordable. They argued that while ministers said the 400,000 people with the highest needs would, as a result, be able to stay in their own homes, the bill for councils would actually be far higher. The letter provided the newspaper with a front page story. The next day, it had a follow-up front page after allegations that Labour councillors had been leaned on by their own party managers to withdraw their names from the list. A major complaint is that the Bill's proposals for funding personal care at home should form part of the wider review of long-term funding of adult care, outlined in the Government's Green Paper last year. Indeed,Suffolk CC is one of the counties most concerned about the real costs of matching the Bill's commitments on home care. In its response to consultation, Graham Gatehouse, its director of adult and community services, and Colin Noble, the cabinet member for adult services, jointly argue that the Bill ‘does not add up.' They add: ‘Suffolk CC has an excellent track record in achieving efficiency gains. Over the last three years, the county has made efficiency savings of £4.6m. Of that total, £25m relates to adult care. ‘However, already faced with a budget deficit of £6.8m in 2011/12, to identify a further £3.875m [to meet the extra £10.391, for free home care] will inevitably and unavoidably mean service reductions elsewhere in adult care.' They also estimate the £670m earmarked by the Government, of which £250m has to come from local authorities through efficiency savings and the rest from the NHS to meet free personal care, equates to £37 per person a week – or around two to three hours. This, they add, ‘falls considerably short of the level of care that people with high care needs require, typically nine to 20 hours a week.' They also point out that the Government ‘is silent on funding after the first full year', and wonder whether it will simply be transferred to general grant. The row about whether local government can afford its share of the bill and indeed, the Bill, estimated by ministers at £250m but set to be far higher, coincided with the first annual report from the year-old Care Quality Commission (CQC) last week. The CQC concluded that health and care services need a radical shake-up because of the looming public sector budget squeeze. In its first annual report to Parliament, the CQC said there needed to be a greater focus on personal care and more joint working to increase efficiency against a backdrop of spending cuts. Its report, however, appears to contradict complaints from councils that they cannot afford to meet free home care. Pointing out that this was the first time an independent regulator had looked simultaneously across both health and social care, the CQC's interim chair, Jo Williams, said: ‘We all know that the context is changing. ‘Trends such as increasing demand and rising expectations will be exacerbated by pressure on finances. That means we cannot go on as we are. To cope, we need some radical changes in the way that we organise and deliver services. ‘This means shifting the culture away from a one-size-fits-all approach to care that puts the needs of individuals and carers at the centre of everything.' Its report said that 63% of NHS trusts, 77% of adult social care providers, and 5% of councils were rated ‘good' or ‘excellent' last year. But there is a large variation in the time it takes to discharge older patients, and the CQC argued that if hospital admissions could be produced and care provided at home, hospitals could save £2bn a year. The Government also claimed that up to £2.7bn a year could be saved by enabling people with long-term conditions, such as diabetes, to manage their condition better, and by avoiding unnecessary hospital visits. Last year, 86,000 adults used direct payments from councils allowing them full control to choose and purchase their own social care, but this is only 4% of the overall gross spending on care. In 53 councils, fewer than 5% of people receiving care use direct payments. The CQC was created last April and brings together regulation of health, mental health and adult social care, previously carried out by the Healthcare Commission, the Mental Health Act Commission and the Commission for Social Care Inspection.

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Adult care becomes an election hot potato

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