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    Michael Patterson Looks at the Implications of Public Expenditure Cuts & the Personal Care at Home Bill

    People have been very concerned in the past year or two about the loss of the Supporting People ringfence and the potential loss of funding for preventative and enabling services as a consequence.

    The removal of the ringfence is what the Government has always intended. The policy intention is to reduce the amount of separate revenue streams and their associated eligibility criteria and to pool this revenue for a wider set of local needs enshrined within a Local Area Agreement. If you’re not familiar with your Local Area Agreement, you can click here and download it.

    The response which central government expects from providers of housing support and social care services, including those which receive Supporting People funding, is that they should remodel, diversify and appeal to a wider range of commissioners as per the requirements of their Local Area Agreement. This would make them more likely to appeal to the commissioners who control Area Based Grant (the bigger pot into which Supporting People money is being pooled).

    The “selling points” for the kinds of preventative and enabling services that housing support & social care providers are that they improve the quality of life of vulnerable individuals and of communities, are strategically relevant, they reduce the need for expensive statutory interventions and they save a lot of money as can be seen from the CapGemini report on the financial benefits of Supporting People. As long as providers focus on the economic benefit in their discussions with commissioners there is a good chance that the lifting of the Supporting People ringfence won’t matter. It will be necessary for providers to consider remodelling and diversifying what they do to reflect Local Area Agreements and the emerging Personalisation agenda though.

    But now there is a threat. The Personal Care at Home Bill was introduced in the run up to a general election. It presses all of the right buttons for voters but isn’t properly funded. The Personal Care at Home Bill is intended to provide free care at home, regardless of means to the 400,000 or so people in the UK with the highest levels of need. The government is promoting this Bill as being the basis for a National Care Service based on rather similar principles to the NHS (equitable, free at the point of delivery, funded through tax etc.) and as part of its strategy to deal with the demographic time bomb in social care costs.

    It also reflects the government’s preoccupation with preventative and enabling services by earmarking £130m for “enablement and prevention” so that people can remain at home for longer. This would be cheaper than bringing those people into hospital or residential care settings, which would be a good thing on the proviso that such people positively choose to stay at home and were safe in so doing.

    The problem though, and the threat to the sorts of services which are or will be funded through Area Based Grant, is that councils will feel obliged to take money from non-statutory budgets to fund this new statutory obligation. It’s a bit like not fixing the fence at the top of a cliff to save a bit of cash only to have to pay much more to get ambulances to the bottom of the cliff to pick up those who fell down through a lack of preventative investment.

    In the words of the LGA: “More pressure will be placed on people with significant but not critical needs.” The LGA has also argued strongly against the imposition of further efficiency savings to fund £250m of the cost of funding free personal care at home:

    “This is clearly a new burden and, as such, should be met fully from central government funding, or via the lifting of other existing burdens on councils,” the LGA stated. “Councils …are already taking difficult decisions to meet a 3% efficiency requirement for 2009-10, rising to 4% for 2010-11. Councils do not have further efficiency savings sitting waiting to be used on new initiatives.”

    The LGA also warned that if free personal care would only be available to people with the very highest needs, then without adequate funding, “more pressure will be placed on services for people who have significant, but not critical, needs.”

    A number of provider agencies and representative groups, including Age Concern and Carers UK issued a joint statement welcoming the principal of the Bill, pointing out its limited potential impact and the need for it to be properly funded: “The care and support system is in need of a complete overhaul, and this Bill does not come close to solving the inequalities, inconsistencies and profound funding challenges of our creaking care system,” the charities stated. “However, the principles set out in this Bill are a vital first step in reforming social care, and we urge all parties to come forward with a firm commitment to rapidly deliver proposals for an ambitious vision for a well-funded, transparent, fair care and support system. As we move ever closer to a general election, we need the better funding of social care to be high up on every politician’s agenda.”

    July 14, 2010 by Michael Patterson Categories: Issue 10

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