Our latest post this week is by Dennis Holmes, Deputy Director of Adult Social Care.
His third ‘deputy blog’ post talks openly about how the Leeds £ could help protect health and social care services.
Deputy Blog, April 2014
This month I want to try to offer some thoughts on money, or to be precise, lack of money….
I’ve reflected previously on social care values and how important they are now and will be in the future. But I suppose that while the oversight of social care is still an important part of my job, overseeing the money has gradually overtaken that in terms of where my attention needs to be.
The reasons for that are pretty straightforward. Adult Social Care (ASC) services spend about 34% of the total Leeds City Council budget, in contrast to say 10 years ago when council spend was growing and ASC could expect to grow itself. The picture over the last four years has been very different with many councils, particularly cities in the North, experiencing significant year on year real term cuts in the amounts of money they receive from central government to support them.
To use a popular analogy then, for the past four years as the local government cake has shrunk. In Leeds, ASC has taken an increasingly bigger share of it. This has not been the case in other authorities where ASC has been expected to shrink at the same rate as the rest of those councils.
To a great extent ASC in Leeds has been consciously protected. Although we have had to manage increases in demands for our services from within a resource base that has changed very little in three years, we have not been required to ‘cut’ services by raising the line of eligibility. Again, to use a now well-worn phrase, we are doing ‘more for the same’. This has been a terrific effort for everyone concerned, many painful choices have had to be made to ensure that we are able to continue to offer social care services to as wide a group of people as we are able. These painful choices are not only felt by those of us working within the council. Much of the care we provide is commissioned from outside the council and in the past few years we haven’t been able to review the prices we pay for that care. In many instances we have had to negotiate price reductions to make sure we live within our means.
Like many others, I don’t think this position is sustainable beyond the next couple of years. By that time the pressure to increase spending on ASC will be very great indeed, borne out of increasing demographic pressures, upward wage pressure in the care sector, real term reductions in NHS spending, uncertainties over the true cost of implementing the Care Act and, in all likelihood, we will have exhausted most of the creativity and innovation that us got us to here!!!
A flurry of recent reports has diagnosed the same set of problems and each in turn suggested potential ways forward – I’ve posted links to some of these at the end of the blog for anyone who’s interested. What all these reports have in common is the same broadly pessimistic view that the funding base of health and social care needs radically overhauling if there is to be a robust health and social care offer in the future.
We have a good understanding of the broad scale of the problem locally. We also have a broad understanding of what part of the solution might look like – at least from an adult social care perspective. We know that if we can put measures in place to maximise even further the use of public money on health and social care services (the Leeds £ as we like to call it), then we have gone some way to ensure the sustainability of remaining council services. It’s that stark.
In an ideal world, to make all the changes that are necessary for this to happen, you’d like five or so years starting from now. It’s clear we are unlikely to get that sort of breathing space – I think the most we can hope for is two.
It’s often been said about waiting for buses, you wait for ages and then three come at once (or in this case four…) – that’s pretty much what it feels like right now, changing legislation, changing demand, changing funding arrangements, changing organisational arrangements – all at the same time. How will it all turn out? As well as we can make it, I guess.
Until next time…
Those links in full…