Short-termism can be expensive

By Iain MacBeath | 04 November 2020

There is no dispute that COVID-19 has had a huge impact on adult social care. In the initial months we saw our care staff battle against an invisible foe that no-one understood, putting their own health at risk to support the people they care for. Some care homes had major outbreaks and some avoided the virus completely. And as we learned about the virus and its spread, more protections were afforded to people and staff, the population was locked down and outbreaks subsided.

Because of the legalities of local government budget setting, directors of adult social services are now looking to set recovery strategies, budgets for 2021/22 and provide messages of certainty in the most uncertain of times. And the second wave of COVID-19, winter and Brexit will all happen concurrently.

The Government’s intentions on reform are not clear. The recent report from the Health and Social Care Select Committee about social care funding and workforce recommended £7bn be injected into a fragile care sector. It bears very similar hallmarks to the report of the House of Lords Economic Affairs Committee from a year earlier.

And for several years now, I have worn my Association of Directors of Adult Social Services (ADASS) hat and every summer reminded Government officials that if any new monies for social care for the following year are not announced by the autumn, directors up and down the country will be asked to make budget cuts. Cuts that will have real impacts for people who need support and on the wider NHS which affects everyone. To the Government’s credit, they heard this last year and provided £1bn for adult social care which was subsequently confirmed as recurrent funding.

It is now November 2020 and no new funding for 2021/22 has been announced, despite it being reluctantly accepted by the Treasury that the ageing population who need care combined with a level of pay increase for low paid care staff are real pressures. No date has been set for a one-year finance settlement, let alone the promised comprehensive spending review or social care reform.

This short-termism costs money. Directors cannot properly engage in meaningful negotiations with their local care sector on commissioning the right levels of care at the right rates when the financial situation is so ambiguous. Nor can they develop new models of care, asking businesses to invest in a new skilled workforce, technology or housing solutions, without any certainty of investment or any level of guaranteed revenue. This results in many councils buying the same services at ever higher costs to no-one’s satisfaction.

Next year’s situation feels as precarious as ever. The sector’s fragility was dealt a blow by COVID-19. Care homes are hugely under-occupied and care agency staff turnover is higher than ever. The latest instalments of the Infection Control Fund, based on staff absence during August when the pandemic had eased, is totally insufficient to cover the costs. The National Living Wage increase next year may not happen and in the UK German supermarkets are expanding in numbers, offering higher wages.

And we must not forget that directors have already signed up to financial savings from care budgets in the current financial year – which have not been achieved because care providers and commissioners alike have rightly focused on preservation of life. That hole in care budgets remains. And what’s the nature of those savings? So many aspired to developing new locality solutions, asset-based community development and strength-based practice, at a time when most local groups are still closed as ‘non-essential’ and people who need support and their family carers have endured seven months indoors. It will take many months to rekindle that community spirit and foster the positive risk-taking that we were all signed up to.

I also believe that there is pent-up demand in our communities, being masked by worried people under-reporting their circumstances, families doing even more for their loved-ones, not to mention the unknown impacts of long-COVID and what kind of care people may need for their mental and physical wellbeing.

But let’s not end in despair. By knowing and thinking deeply about these challenges, we will find innovative ways forwards. Our relationships with the NHS have never been closer – this is the time to take a risk and develop those integrated services we’ve aspired to. If we can carve out a small amount of investment, communities will rally. It’s time to accelerate that switch to even more people staying in their own home by planning more flexible care and community support. And our staff in the care sector remain magnificent, committed and surprise us every day with stories of love and humanity.

Let’s amplify our voice and demand reform! The Association of Directors of Adult Social Services’ (ADASS) nine statements to help shape adult social care reform light the way. 

Iain MacBeath is strategic director, health and wellbeing at Bradford City Council and honorary treasurer of ADASS

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