Rebooting adult social care budgets: Calling time on ‘Transformation salami’
This summer Capita launched, with Localis, a landmark report: Rebooting Health and Social Care Integration. It is seen as landmark, mainly because it breaks ranks with the misty-eyed view of integration as a cure-all.
Moreover, it starts to address the problem of local authority funding for social care from a practical basis, accepting that the £1bn of extra cost and demand each year in England is not going to be met from public funds and that real, locally led reform is needed. I hope the report is part of a fresh dialogue about the state of social care, where we recognise that local government is not wholly supplicant to national see-saws, but is responsible for acting decisively in its own terms.
In this blog, I want to focus on just one of areas of active decision making that Town Halls should now be focused on: budgeting. Councils have, to date, struggled with an impossible task – taking money out of social care at an average of 6% per annum, some for over five years now.
Annual budgeting for multi-year austerity (I am discounting what - in most places - is a pastiche of three year financial plans) has created some negative consequences. We are seeing – and I talk illustratively here as all councils are unique – local situations which include:
- Reablement reduced in both quantity and outcome, which has a direct impact on long term care costs
- Headcounts reduced which means packages can’t be monitored and best value and outcomes suffering
- Schemes developed to push assessment to the community with no tracking of outcomes
- Social workers being rewarded for economy and speed above outcomes
- Providers being incentivised to provide cheap, poor care; or no care at all
- In the face of austerity and complexity, local leaders losing sight of what adult social care is for and what they want to achieve.
I could go on. Of course this characterisation is to make a point. We all know that, amongst the bad things happening, in general there are good public servants doing good things in particular. But the point remains – on average, services are getting worse, morale is falling, care systems are creaking, prevention is losing to failure demand and we are about to hurl ourselves into a 2018/19 budgeting process which, on the basis of past performance, will entrench these issues and not resolve them.
So, how do we think about budgeting differently for 2018/19? I think there are there are three main things needed.
1. Reforming transformation
For councils that have up to 50 ‘transformation’ projects running, all laudable in their own terms, but conflicted and un-orchestrated, let’s call time. I believe there are only 6 main ‘reforms’ for adult social care – perhaps even that is too many. We used to criticise budget salami-slicing, we now have a more pernicious problem – ‘transformation salami’. It is time for some clear headed thinking within the budget process about what we are trying to achieve, when and why. That conversation should lead to a vision and ultimately a simpler recipe for success.
2. Investment not savings
Once the pillars of reform within a coherent vision are understood, it is time to invest. Yes, invest. Real reform of adult social care – one which results in a lower cost model in years to come will require at least a three-year cashflow. Whether it is digital technology, new skills, alternative delivery models or change resource, councils must spend to save.
3. Real reform
FDs should now be framing their reform of adult social care within a technology and property-rich capital programme. Almost every part of reform needed in care has a technology component, so why not, as Localis suggests, employ a ‘digital approach to service delivery to include the wider transformation, training and support programmes needed to ensure that technology is effectively used and its potential maximised’.
September to November is traditionally the time for tough conversations in Town Halls between services and finance. Instead of the usual push-me-pull-you of annual pressures and savings, perhaps this year we can have a different conversation? Go on, no one is stopping you.
Take a look at the full Localis report, Rebooting Health and Social Care Integration.