How have the last five years of austerity affected social care?

Social care and austerity: the impact so far, and what the future holds Read more

Kath Wallace, divisional manager for commissioning for adult services and health, Liverpool city council: “The most immediate impact that we have noticed is the reduction in preventive or non-statutory services. We all understand the need to invest in prevention and the Care Act reinforces this – however, when councils are under the financial impact that we’ve been under in Liverpool (£156m reduction over three years) then we naturally focus on how we ensure we meet our statutory duties. This has resulted in the withdrawal of some key preventive services, such as good neighbour schemes and community activities.

“However, what is emerging now is a much more collaborative approach with all stakeholders seeing how they can align their services to fill gaps. We’ve particularly seen this from the housing sector.”

Ray James, president of the association of directors of adult social services: “Last year’s Adass budget survey reported a 12% reduction in cash terms and a 14% increase in demand over the last four years, equating to a 26% real-terms reduction of some £3.5bn in spending on social care. Despite this, councils were doing what they could to protect social care, the proportion of the average council’s budget spent on adult social care increased from 30 to 35%. We see a range of approaches to commissioning, many increasingly personalised but significant challenges remain.”

Gareth Crossman, executive director of policy, communications and fundraising, The Adolescent and Children’s Trust (Tact): In terms of social care for looked-after children, on one level things remain largely unchanged. A child in care will be placed with a family for fostering, be placed in a children’s home or be placed for adoption. There have been changes, such as the government’s drive to increase the number of adoptions, but the model remains roughly the same.

“On another level the impact has been huge. It’s the access to additional services, such as Camhs [Child and Adolescent Mental Health Services], advocacy or leaving care services where the impact has been huge. As children in care are some of the most vulnerable in society due to their experiences before entering care, this has been very damaging.”

Nina Osborne, individual employer: “I think people have been working hard to find ways of maintaining and improving quality despite financial constraints. The focus on values-based recruitment as a means to up quality and retention by reducing costs is an example. I also think more employers are working collaboratively with financial and quality benefits. There is obviously much more to do but these are good signs.”

How do we raise the profile of social care?

Wallace: “How do we make social care relevant to everyone like the NHS is? Everyone uses the NHS and that is acceptable and seen as a normal part of society. However, not everyone will need social care and there are some strong misconceptions about what it is. Some local customer insight work we did in Liverpool showed significant differences about people’s perceptions about social care versus health. Basically people see it as “being taken into a care home”. Interestingly, some of the perceptions of the external organisations that we fund through commissioning were much more positive.

Richard Humphries, assistant director of policy at the King’s Fund: “It is encouraging that social care has a higher media profile than ever, it came up in the leaders’ debates and the Care and Support Alliance have done excellent work in getting this on the political radar. So it is really disappointing that most parties are saying so little in their manifestos about social care funding – it is the ghost at the feast in this election campaign. I wonder if the public are ahead of the politicians here.”

Austerity seems set to continue whoever wins the election Richard Humphries

Osborne: “I think the majority of us do need social care at some point in our lives, whether this is local authority type provision or not. However, the challenge is that when social care is provided in a timely and appropriate fashion most people do not give it a name. We need people to recognise that short-term, minimum-intervention help is as important as heart surgery and should be regarded and funded with the same gravitas.”

Peter Beresford, professor of social policy at Brunel University and chair of Shaping Our Lives: “Since the government seems to want to reduce spending on social care, it has been very reluctant to help inform people about it although it’s been long known that the public has little understanding of social care. The present organisational and funding divides between the NHS and social care are absolutely unsustainable.”

How has austerity affected service users, their families and carers?

Wallace: “I think the real impacts can still remain hidden in many ways. The withdrawal of the preventive services I referred to earlier was very challenging; however, we saw staff and service providers managing funding reductions in a way to protect frontline service users by withdrawing gradually. The introduction of services that may have previously been free when commissioned by the local authority are now still available by service providers but with an expectation that service users will pay themselves if they want to access the services.”

Sue Brown, vice chair of the Care and Support Alliance and head of policy at Sense: “Levels of unmet need are growing, vital support is being reduced or cut altogether. True, some providers are managing to protect services in the face of reduced budgets and some people are able to pay for support. Some people are still managing to innovate and deliver some really good things. But let’s not pretend there aren’t people really suffering at the sharp end because there are – lots of them.”

James: “Perhaps remarkably, satisfaction with social care (and local government as a whole) is up in recent years, a real credit to over 1.5 million dedicated social care staff. The impact on people who use services and particularly their carers is something we need to understand much better. To use a recent analogy, we need to do all we can to make sure that any steam escaping from the pressure cooker of social funding reductions does not harm those in need of care and support or their carers.”

Beresford: “At Shaping Our Lives, when our national user group meets as it did recently, all of us coming as service users from different parts of the country, we shared experience of how things are. The levels of difficulty, of unmet need, of things getting worse because support is being cut or can’t be accessed is a horror story. Amazingly, some good things are still going on, but at what price in general human suffering?”

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What is the post-election outlook?

Stephen Lowe, policy adviser on social care, Age UK: “There is nothing in the manifestos of the major parties to suggest that there will be anything other than continued cuts to local authority care. Whether this actually benefits the economy is a moot point – between 2007 and 2014 we saw a 66% rise in over-65s going to A&E services and it’s likely cuts to care and support contributed to this. I think we will see a succession of legal challenges to cuts using the Care Act, hopefully we will be able to use successful legal challenges as a lever to demand increased resources.”

Humphries: “Austerity seems set to continue whoever wins the election. We must hope the next government doesn’t make the same mistake as this one by protecting NHS budgets at the expense of local government and social care. Even with protection, the NHS, like local government, is heading for a financial abyss. We will have to be much more creative in aligning resources across these boundaries as the Barker Commission recommended but integration alone is not a panacea.”

Osborne: “The purse will never be as big as the aspiration, but I think the best protection for the sector lies in us all working together to recognise and support what is an outstanding workforce.”