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| Chancellor's new money for adult social care is crumbs from the table | |
| (35 minutes later) | |
| On the face of it, this year’s budget was good news for social care. The chancellor recognised the immediate pressures facing local authorities and has announced £650m new grant funding for 2019-20 and another £45m this year for the disabled facilities grant. | On the face of it, this year’s budget was good news for social care. The chancellor recognised the immediate pressures facing local authorities and has announced £650m new grant funding for 2019-20 and another £45m this year for the disabled facilities grant. |
| But closer scrutiny of the detail paints a different picture. The £240m previously announced to help relieve NHS winter pressures this year will be repeated next year, with a further £410m to bring the total up to £650m. But this sum is expected to cover children’s social care as well, requiring councils to exercise the judgment of Solomon in prioritising the intense demands on services for disabled people, older people and children and families. | But closer scrutiny of the detail paints a different picture. The £240m previously announced to help relieve NHS winter pressures this year will be repeated next year, with a further £410m to bring the total up to £650m. But this sum is expected to cover children’s social care as well, requiring councils to exercise the judgment of Solomon in prioritising the intense demands on services for disabled people, older people and children and families. |
| The amount available purely for adult social care next year is just £240m, falling way short of the £2.3bn estimated by the Association of Directors of Social Services as the minimum requirement for next year. Even this amount could be imperilled in the event of a chaotic no-deal exit from the EU. | The amount available purely for adult social care next year is just £240m, falling way short of the £2.3bn estimated by the Association of Directors of Social Services as the minimum requirement for next year. Even this amount could be imperilled in the event of a chaotic no-deal exit from the EU. |
| So Philip Hammond’s declaration that austerity was “finally coming to an end” invites, for adult social care, the riposte “but not just yet”. | |
| The scene is set for a struggle of titanic proportions between spending departments | The scene is set for a struggle of titanic proportions between spending departments |
| In the context of the significant fiscal windfall available to the chancellor through higher than expected tax receipts, the new money is crumbs from the table compared to the relative largesse given to the NHS. It continues government policy, now five years old, of responding to what is essentially a long-term problem requiring a long-term solution with a succession of ad hoc and usually short-term initiatives. This makes sensible medium or long-term planning impossible and helps to prop up and perpetuate a broken system that too often results in poor services. There also appears to be no new investment to reverse previous cuts, in local authority public health, which would help to reduce future demand for health and social care. | In the context of the significant fiscal windfall available to the chancellor through higher than expected tax receipts, the new money is crumbs from the table compared to the relative largesse given to the NHS. It continues government policy, now five years old, of responding to what is essentially a long-term problem requiring a long-term solution with a succession of ad hoc and usually short-term initiatives. This makes sensible medium or long-term planning impossible and helps to prop up and perpetuate a broken system that too often results in poor services. There also appears to be no new investment to reverse previous cuts, in local authority public health, which would help to reduce future demand for health and social care. |
| Where to go from here? Expectations that the forthcoming green paper will set out an ambitious and exciting prospectus for radical reform are fading by the day. Now delayed four times, it is doubtful that the paper’s hoped-for pre-Christmas appearance will offer much seasonal cheer, with funding proposals more likely aimed at ameliorating the worst excesses of means testing rather than a new, more generous public funding settlement. | Where to go from here? Expectations that the forthcoming green paper will set out an ambitious and exciting prospectus for radical reform are fading by the day. Now delayed four times, it is doubtful that the paper’s hoped-for pre-Christmas appearance will offer much seasonal cheer, with funding proposals more likely aimed at ameliorating the worst excesses of means testing rather than a new, more generous public funding settlement. |
| Few expect any thinking about fundamentally recasting the system towards a more universal and largely tax-funded model like the NHS; it seems more likely that the focus will be on recalibrating the boundaries between individuals, families and the state in how care is provided and paid for. At a time when integrated care is a key government objective, the division between universal health care and tightly-rationed, means-tested social care is set to deepen – hardly joined-up policy making. | Few expect any thinking about fundamentally recasting the system towards a more universal and largely tax-funded model like the NHS; it seems more likely that the focus will be on recalibrating the boundaries between individuals, families and the state in how care is provided and paid for. At a time when integrated care is a key government objective, the division between universal health care and tightly-rationed, means-tested social care is set to deepen – hardly joined-up policy making. |
| At best the green paper could offer a positive vision of a transformed system that promotes independence, exploits the benefits of technology and offers a different model of person-centred care that joins up with health and other key services. There are many local examples but, as Alex Fox has cogently argued in A new health and care system: Escaping the invisible asylum, it is hard to see any kind of social care system, ravaged by eight years of austerity, that can deliver this everywhere and for everyone without more money. | At best the green paper could offer a positive vision of a transformed system that promotes independence, exploits the benefits of technology and offers a different model of person-centred care that joins up with health and other key services. There are many local examples but, as Alex Fox has cogently argued in A new health and care system: Escaping the invisible asylum, it is hard to see any kind of social care system, ravaged by eight years of austerity, that can deliver this everywhere and for everyone without more money. |
| Where does this leave people who need publicly-funded care and support and those who commission and provide it? | Where does this leave people who need publicly-funded care and support and those who commission and provide it? |
| All eyes should now turn to next year’s spending review, which the government has indicated will settle the long-term spending profile for adult social care. The scene is set for a struggle of titanic proportions between departments across public services, including prisons, schools, defence, housing, benefits and pensions and, not least, other local government services including children’s social care and public health. That the NHS has had its share in advance will make it harder still. | All eyes should now turn to next year’s spending review, which the government has indicated will settle the long-term spending profile for adult social care. The scene is set for a struggle of titanic proportions between departments across public services, including prisons, schools, defence, housing, benefits and pensions and, not least, other local government services including children’s social care and public health. That the NHS has had its share in advance will make it harder still. |
| The prospects for adult social care hinge critically on the ability of the sector to articulate a compelling and imaginative case without the same political and electoral clout enjoyed by higher profile services. That will be tough, but few dispute that sorting out social care remains one of the most pressing policy challenges of our time. | The prospects for adult social care hinge critically on the ability of the sector to articulate a compelling and imaginative case without the same political and electoral clout enjoyed by higher profile services. That will be tough, but few dispute that sorting out social care remains one of the most pressing policy challenges of our time. |
| • Richard Humphries is a senior fellow at the King’s Fund | • Richard Humphries is a senior fellow at the King’s Fund |
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