Social care costs: carelessness costs more

Reading through the terms of reference of the inquiry into adult social care, it reminds me of a phrase from the legendary Terry Pratchett’s book ‘The Truth’: “If you throw something into the air, don’t you have to worry about where it bounces?”. This is exactly what’s happened with adult social care; changes to policy have been made without fully thinking through and preparing for the consequences.

Take the National Living Wage, for example. Designed to ensure that everyone is paid enough money to live on, but slammed by the UN Committee on Economic, Social and Cultural Rights as false advertising, this is going to have a big impact on social care budgets when it reaches £9 in 2020. This could mean an increase in costs of social care that may not be covered by the 2% council tax increase, but is also likely to be a big help to many community carers working long hours to pay the bills.

Take the Care Act 2014, which put more focus on an individual’s wellbeing and the wellbeing of their family. Though local authorities were already carrying out many of the tasks described in the Care Act, various new obligations were added in. Unfortunately, the ever-present limitations of budgets, the mischief-making miscreant that is miscommunication, and the new notions conflicting with tried and tested tactics mean that the aspirations of the Care Act – in short, everyone getting the care they need – haven’t happened.

Take the cutting of the Independent Living Fund (I can almost hear the placards being nailed together again). The controversial decision to shift the responsibility for funding the care of 18,000 people to councils was intended to reduce bureaucracy by there being less organisations doing the same thing. Instead, local authorities with already stretched budgets found themselves with a little more cash, but also more people to support and still not enough to go around. The results of this change on disabled people prompted campaign group Disabled People Against Cuts to try to break down a door at Westminster last year; but I can imagine many social workers, care managers, and finance officers would have joined them if they could’ve done it without putting their jobs at risk.

The problem with adult social care, and many other policy areas affecting disabled people which I keep a weather eye and ear on, is that it is thought about in isolation. Admittedly, “thinking holistically to break down a silo mentality and achieve savings through partnership working and innovation”, otherwise known as “putting things all together and figuring out how one bit affects another” is a statistical and logical nightmare, akin to tipping 4 pieces of Ikea furniture out of their boxes, jumbling them up, and throwing away the instructions before beginning assembly with a hot glue gun. It’s difficult to work out what’s what and you need a lot of glue to hold anything together.

This glue is called “evidence”, and we need more of it. We live in an age of big data, where cancer can be cured by a supercomputer, where almost every great book that’s ever been written is available online for free, where asking Twitter is the new directory inquiries, and yet there is so much that we do not know about how we take care of our present and future selves and each other.

I don’t know the ultimate solution to the crisis in Adult Social Care funding, though I do have a few ideas and observations I’ve sent. One thing I do know is that John Godfrey’s idea that people can re-mortgage to pay for their care will not work. A, it will make him and anyone who agrees with him highly unpopular with a key demographic of Conservative voters, and B, the smart money will sign the house over to the kids in their mid-50s. The smarter legal and financial advisors will make a mint making this happen.

Why shift the responsibility from public purse to individual purse? Why single out a former taxpayer from present taxpayers? Of course, it is not only older people who will be affected by any changes, however as the largest group of home owners receiving adult social care, they are likely to bear the brunt. What possible use could this serve?

Saving the taxpayer money is an answer, yes, but there is another. Mortgages benefit the mortgage lender. Insurance products benefit the insurer. Privately funded care benefits, yes, the care providers. Many care providers charge a higher rate for privately paying customers than for local authority funded packages of care. Therefore, releasing people’s savings to pay for their own care will result in better investment returns for those in the business.

Such a plan could be terrible news not only for the re-mortgagers, but for all who receive care. If this comes to pass, any current disparity in the quality of care between those who pay and those who cannot could significantly widen.

Instead of passing the buck and pleasing investors, further research could show which models of care deliver the best quality of life for the best price. Adaptations, equipment, physiotherapy, and other simple short term support options have already been shown to delay future increases in social care need and directly benefit the individual, but estimating how much should be spent where is left to individual local authorities and CCGs with limited guidance.

One idea I would like the inquiry and any professional person reading this to bear in mind: we could talk about impacts on the economy, on business, on the NHS, on welfare, on employment, on public trust, on legal precedent, but before any decision is made any impacts on people need to take priority.

By Fleur Perry

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