Social Care – will we only miss it when it’s gone?
One of the aspects of the spending settlement announced to be announced by the Chancellor on 25th November which I will be most interested to scrutinise will be that relating to social care. I have both a professional and personal interest in doing so.
Social care has been an area which has already suffered as a result of austerity. Over the last 5 years budgets have been cut substantially and this had an inevitable impact on services and the people using them. As someone running a NHS organisation it is clear that this has had a significant effect on the numbers and acuity of cases presenting to our services. Most NHS leaders would, and do now regularly, say the same.
Social care is an elusive concept in the public consciousness (that is part of its problem) but in essence it exists to support individuals who, whether because of disability, age or other issues of vulnerability, need additional help with aspects of daily living. It includes (rightly or wrongly) those who need care in a nursing or residential care home and it also embraces safeguarding and the crucial role of the state in protecting children at risk of harm. My personal interest relates to the position of my ageing parents and disabled brother whose need for support from social care is likely to become critical in the next couple of years.
The social care system has suffered from a number of disadvantages. It is a child of the traditions of the Poor Law and it has been means tested while health care has been free at the point of delivery. It does not have the glamour of health care and the powerful voice of the medical and scientific establishment to help argue the case for resources. Finally it has been connected with issues such as frailty, disability, family breakdown which can at times be issues which we struggle to talk about as a society in a comfortable way.
Yet despite all of this social care in this country has done much in the last 70 years it can be proud of. It has helped to support many of the most vulnerable and disadvantaged people in our society enjoy a better quality of life. It has increasingly promoted a philosophy of respect and independence for disabled people and it has made much more progress than the NHS in involving people in decisions about their care and support. It has done this for growing numbers of people as a result of the success of the NHS in enabling growing numbers of us, and in particular growing numbers of people with disabilities, to live for longer.
Since 2009 the social care systems has been under unprecedented financial pressure. Social care, unlike the NHS, has not been ringfenced and has spending has fallen by an average of 2.2% each year since then. This is despite substantial transfer of resources from the NHS recognising the absolute interdependence of the two systems. Without this the drop in spending would have been as much as 3.6% each year. Given the news, this week, that the Department of Communities and Local Government had settled its position already in the Spending Review, accepting a 30% cut in its budget over the next 4 years, it is only to be supposed that spending will continue to fall at least this rate for the foreseeable future. Whatever Local Government can do to rationalise back office and other administrative functions reductions on this scale cannot be made without substantial cuts to front line services. To what extent the NHS, with its own financial pressures, will be able to help, as it has done for the last 5 years will have to be seen. I am not hopeful.
If we continue to decimate social care budgets in this way there will inevitably be consequences.
A first consequence will be for families and carers. The nature of social care is that, to some extent, it can be substituted by informal care. Indeed the vast majority of social care is indeed, already provided by 6 million family members and other carers (including more than 160,000 young carers), an effort valued a couple of years ago, as equivalent to £110 billion per year. But the formal social care system can make a crucial difference to the lives of those informal carers by providing help with difficult tasks such as personal care, providing periods of respite and when, needs become too great, offering access to long term care. When formal care is limited already in many places to those with the greatest needs it is hard to imagine how much more can be absorbed by informal carers without significance consequences for their health and where younger, their ability to participate in economic activity.
A second consequence will be for disabled people. We have, as a society, made important steps forward, in changing attitudes to people with disabilities and in enabling them to participate as full members of society. Social care plays a key role in providing the support which enables that independence. As services and support are cut back there is an undoubted impact in narrowing the opportunities and choices available to those people.
A third consequence will be for the NHS. As is already clear reductions in social care impact directly onto the NHS when the services and help which allow a frail elderly person to stay in or return to their own home are not available or take much longer than should be the case to arrange. Similarly cut backs in the resources available to work with looked after children and at risk families will impact on the demands for CAMHS services. Of all the assumptions which underpin a vision of a sustainable NHS the level of social funding is key. While there is some hope of making progress through better integration of budgets there is a limit to what can be achieved unless social funding receives some level of protection.
Finally there will be a consequence for society. How we look after older people, people with disabilities and vulnerable children are fundamental to the values of civilised society. If we cannot, as a society, afford to sustain a decent level of social care provision we run the risk of seeing many more distressing cases of neglect and abuse amongst those groups which as a society we should be doing the most to protect.
The saddest part of the story about social care cuts has been the lack of political debate about the value we place on social care. I hope it doesn’t become the case that we only really value social care once it’s disappeared.