As the crisis in social care funding continues, the government is due to publish a much-delayed green paper in autumn 2018 on how it plans to make the care system for both older people and working-age adults more sustainable.
When giving evidence to the Public Accounts Committee about this earlier in the year, the permanent secretary at the Department of Health and Social Care, Chris Wormald, told MPs that there was enough money in the social care system to meet all of its statutory obligations. Many of the MPs struggled to reconcile this with the savagery of the cuts since 2010 and the realities facing a service said by its leaders to be in crisis and at a “tipping point”.
The truth is that Wormald probably didn’t have the first idea how much resource the service requires. That is because the system operates as a perfect circle – a need is only a need if there is resource to meet it. In this way, there can never be unmet need and “statutory obligations” are always met. It makes no difference how large or small the budget or how much it contracts. It’s a very convenient device for political leaders confronted by a service with high fiscal risk but low public value.
It forces a view of need that places emphasis on what people cannot do, which incentivises dependency. And it fails to match what resource is available to what really matters to people.
The consequences for the people who rely on the service are devastating. If their needs don’t fit the council’s idea of what a need is, the council turns its back. The person’s own views of their needs are trashed. While the service boasts about how it “empowers” people, giving them “choice and control”, the truth is that it alienates them.
Luke Davey is a man in his forties who has severe physical impairments. He has lived in his own accommodation since his early twenties. His local council, Oxfordshire, had assessed him for 20 years as needing round the clock support. The council paid about 60% of the cost with the remaining 40% paid for by a separate government fund.
In 2015, that fund was closed, leaving Oxfordshire to foot the whole bill. Soon after, the council decided Davey did not, after all, need round the clock support. Social workers from Oxfordshire said it could be good for Davey’s autonomy for him to spend more time alone. This was presented as a genuine change of mind and not a decision about money. Davey was left with a life of heightened anxiety and isolation resulting in lower well-being.
There are countless similar stories the length and breadth of the country.
From eligibility to affordability
Not all councils work to the same eligibility criteria. In reality, the criteria are quite meaningless. The key judgement is whether a need will have “significant impact” on the person’s well-being. Such a loose phrase enables councils to apply it however they want. And they apply it to suit their budget resulting in gross inequity. The highest spending 10% of councils spend an average of £20,000 a year per service user. The lowest-spending 10% spend just £11,000. Such huge differences make a mockery of the eligibility criteria.
But as former social worker Colin Slasberg and I have argued, it doesn’t have to be this way. Councils do have a right and proper responsibility to spend only the money the democratic process has made available to them. Yet, they could do so by carrying out honest assessments of needs for well-being and then making honest decisions about what can be afforded and what cannot. In other words, eligibility of need would be replaced by affordability of need as the way to control spending.
This would not have resulted in Luke Davey retaining his round the clock support, at least, not in the short term. But it would mean that the injury to him was not made worse by the insult of an authoritarian decree about his needs when he understands his own needs so much better. It would mean he would know the true source of the problem – the democratic process had not made sufficient money available. Instead of pursuing a futile judicial process against the decision, he would have known to direct his representations to his political representatives.
This is more than a simple shift in wording. Being told by an official that you don’t need the help you believe you do, just so as not to create an inconvenience for them, is not semantics, it’s deception. There is not sufficient money in the system.
If every Luke Davey was treated in the same manner, Wormald and his successor would be in a position to tell the government how much money social care requires to make good on the responsibility introduced by the 2014 Care Act for councils to promote the well-being of older and disabled people in need of care and support them to a level that is reasonable for them to expect. With four out of five MPs said to be in favour of increasing funding for social care, there is a measure of political will for reform. What they need is solid information about what social care is about, and what it would cost to do the job well.
The law supports this alternative. The key question is whether political leaders will face up to an honest appraisal of how much money the system actually requires.