Adult social care – Group Leader's Comment – 6 October 2017

Following much work by the LGA and partners, the Chancellor announced in Spring 2017 an Improved Better Care Fund, adding £2bn to be paid on a reducing scale over three years. Councils also work hard on prevention and increasing people’s fitness and health, but the problem of the financial shortfall remains unresolved.

The Next Generation training for Independent Group councillors starts this weekend, as does the Green Party Conference. The main LGA Independent Group conference takes on Friday 24 November at 18 Smith Square, Westminster, formally known as Local Government House. You might want to get colleagues together and make a long weekend of it from Thursday night.

With our council budget submissions currently being considered by Government, and new targets being set for November, I hope you agree that adult social care is worth a closer look in this week’s bulletin.

Funding adult social care
There is an outstanding bill of £1.3bn to stabilise the care market plus £1bn for demographics by 2019/20, according to the LGA Autumn Budget Submission 2017. There are increasing numbers of frail older people needing care. In addition, the number of adults with disabilities is increasing as they are now living longer and the cost of their care has just overtaken the cost for older people’s care.

Following much work by the LGA and partners, the Chancellor announced in Spring 2017 an Improved Better Care Fund, adding £2bn to be paid on a reducing scale over three years. Councils also work hard on prevention and increasing people’s fitness and health, but the problem of the financial shortfall remains unresolved.

We are concerned about the delays to signing off BCF plans and particularly with the addition of challenging delayed transfer targets when the guidance was published so late in the day.  

Since councils have to get under the level set by November 2018, there is little opportunity left to improve sufficiently before the deadline. The LGA is fighting this threat hard, at the highest levels.

Nationally, delayed transfers of care have increased since 2012
In June 2017, nationally, 38 per cent of the delays in getting out of hospital were due just to council support not being available quickly enough. That is too high, but considerably less than delays due to failings in the NHS. This is after taking out people whose transfer out of hospital is delayed due to their choice.

Delayed days during the month, all, per 100,000 population aged 65+ (raw values) (from September 2016 to July 2017) for England compared with England

Delayed transfers of care, average weekly rate (delayed transfers per 100,000 people) (from 2004/05 to 2008/09) for England and All England regions 

Delayed transfers of care from hospital (per 100,000) (from 2010/11 to 2015/16) for England and All England regions 

Those who are performing the worst, perhaps because they are short of money, are currently expected to reduce delays in transfers of care still further, making the task ever more difficult. 

We all want to reduce delays, but the Government’s emphasis means the money being spent on the few delayed in the NHS, in preference to supporting the much larger portion of people who need care at home or in homes.

You can use LG Inform to see how your own council compares. Delays are lowest in the North East. Reasons for delays in getting out of hospital over 2016/7 are explored on LG Inform. The biggest problem is a 23 per cent increase in patients waiting for housing and a 19 per cent increase in those waiting for equipment or housing adaptations. In addition, there is a 12 per cent increase in those waiting for public funding. Clearly, a further reduction in funding will only make the situation worse.

Improvements have been in patients not waiting for a nursing home place, perhaps because they are going home instead, better availability of home care packages and quicker assessments. This brings a combined 15 per cent improvement from councils, saving over 15,000 bed days in this way.

Although the overall picture is currently little improved, we can see why.

So what can a council do?
Firstly, in many councils, adult social care is about the only budget to have increased, while all others have decreased. In Lincolnshire, we are close to the performance target we need not to lose funding.

We first tackled the delays in assessments, reaching the targets set for percentage assessed on time. We have “trusted assessors” who double up in assessing the level of care needed and the suitability of the person for particular homes. The financial assessment is still separate, but doesn’t hold up the process.

Next, we stabilised home care. This involved letting 12 block contracts to ten suppliers, each covering a geographic area, with some additional payments. Thus the rural transport is massively reduced, making the job more affordable and a lot more pleasant for carers.

We also increased the percentage of people on direct payments, managing their own care and carers. We provided more reablement as a stop-gap when coming out of hospital and to help provide emergency care to help keep residents in their own homes. As I am sure you have seen, good reablement also means residents need less care as their disabilities are reduced.

Is it funded sustainably?
In some councils, the adult social care budget has been rising by 3 per cent year on year, to match the increasing number of older people needing care and whilst putting these improvements in place. This probably isn’t sustainable as reserves are depleted. Nationally, we at the LGA have launched our bid for proper funding from Government and a “fairer funding campaign” for councils.

Councils have a contributions policy to recover some costs from individuals accessing care. These are set by the councils themselves.  Councils do take their assets into account, including their home. Charges for residential care are set by Government on a sliding scale depending on your assets. However, for home care, it is up to the council. The Conservatives got into hot water suggesting that people in care should lose their homes, but it seems we already “take those assets into account” when calculating the charges of home care; a subtle difference methinks!

Because of the significance of this issue to our members, I have negotiated an extra place on the Community Wellbeing Board, currently held by Claire Wright from Devon. Independent Group Member, Mayor Kate Allsop of Mansfield, is Deputy Chair of the Board, working with colleagues, staff and councils to draw together the case on our behalf. Colleagues and I have supported it through the LGA Executive and Leadership Boards and to members of both Houses of Parliament and to Ministers.

Together we are making our case very clear to Government, calling for the tools to do the job, no less than our residents deserve.