Article from Care Talk Magazine, by Patrick Hall, Fellow at The King's Fund
April 2017
I have learnt to keep my expectations low when it comes to government action on reforming and sufficiently funding social care. But in the lead-up to the budget, I felt surprisingly positive.
Talking to people in and around the Westminster bubble, there was a growing consensus that the chancellor would recognise the damaging decline of social care provision. At the very least, he was expected to address short-term pressures before the arrival of increased improved Better Care Fund (iBCF). Here at The King’s Fund, we anticipated conditions to any new funding, possibly the extension of the CQC’s remit to local authority commissioning, a shift in the means test, or significant ties to Delayed Transfers of Care performance.
So the announcement of over £2 billion of new money for social care, promised as supplementary funding to the iBCF and to be distributed as £1.01 billion in 2017-18, £674 million in 2018-19 and £337 million in 2019-20, was not entirely unexpected. But it still felt rather surreal to see social care attracting headlines and receiving significant government support after spending so many years in the shadow of the NHS.
This funding comes on top of the previously announced measures to amend the social care precept and increase the Better Care Fund. Its purpose is to tide adult social care over until the iBCF kicks in at the end of this parliament. The rules around allocation look like a good attempt at using the iBCF to make sure those areas less able to raise money through the precept don’t miss out. These funds were, and are, very welcome.
Simon Stevens rightly called for any additional government funding to go to social care, while insisting that the NHS Sustainability and Transformation Plans won’t be responsible for the ongoing ‘financial pressures on their side’. As might be expected, NHS England and NHS Improvement quickly called for these additional funds to be focused on addressing delayed transfers of care affecting hospitals. Although nervousness among NHS providers is understandable (our recently published Quarterly Monitoring Report lays out the desperate state the service is in, with little financial room to manoeuvre over the rest of the parliament), social care is more than a demand management tool for hospitals. Prioritising delayed transfers over sustainable care for people in their own homes may lead to pile-ups at the entrance, rather than the exit, of hospitals come winter 2018. A balanced approach is needed, and the 2017-19 Integration and BCF Policy Framework supports this.
The chancellor has heeded warnings from The King’s Fund and others over the perilous state of social care, but this additional funding will only cover short-term sustainability, not long-term transformation. Real progress on rebalancing the health and care system toward the community and integrating care in people’s own homes requires political and systems leadership, not more short-term fixes. The Green Paper announced by the chancellor alongside the additional funding should now address the need for a transformed, social care system integrating with health, putting people at the centre of their own care, and maximising their natural support structures.
Of course, there are serious hurdles to long-term reform, not least the toxic ‘Death Tax’ debate, which threatens to become a zombie scuppering the chances of serious and sensible national policy discussion. But the Green Paper has the potential to put into practice May’s ‘country that works for everyone’ by succeeding where successive governments have failed on long-term, sustainable funding and transformation in social care. Maybe it’s the spring sunshine, but for the time being I’m staying cautiously optimistic that this Green Paper won’t end up in the increasingly full dustbin with the many consultations and papers published in the last few decades.
