Wednesday, 25 November 2015

Osborne fails on social care

George Osborne has missed the mark on tackling the growing social care crisis.  He has failed to provide a coherent analysis or strategy to deal with the problem. We need a national strategy.

The crisis in social care funding was recognised by the Chancellor of the Exchequer  in his autumn statement today.  He announced that local authorities will be allowed to increase council tax by up to 2% to help meet social care needs.  This appears a good move. It is a step, but much more is needed.

It is anticipated that the new social care "precept" in council tax of up to 2% will allow local councils to raise £2bn for social care. It is good that more money will be available,  but I anticipate a fundamental problem with this approach.

Not only does need varying geographically, but those areas with the greatest needs are not those with the greatest potential for raising revenue. It may exacerbate the north-south divide in resourcing.

Data from the ONS and from the National Audit Office show that local social, economic and demographic factors lead to variation in the level of social care need in each local authority. Thus, there are more self-funded residents in care homes in the South than the North.   In the Northeast, almost 80% of those in care homes are funded by the local authority.  In the South that figure can be less than 50%. There will be large variations across local authorities - the areas where there is the greatest need may not be those where there is the greatest potential to raise income through the new precept. 

Local authority spend on care depends on local need, but also on local policies and priorities. It depends also the local authority’s commissioning and financial management skills. But as the National Audit Office has pointed out,  many factors are outside a local authority’s control or can only be influenced long term or by national economic and social policies.  

Need for care is also linked to an adult’s health, the quality of their housing and the effectiveness of other support and services, in preventing needs developing. This again is why the burden falls disproportionately in some areas and less in others.  The poorest areas of the country are also those with the poorest health and the greatest social care needs. 

Demand for care varies according to need, availability of informal care, quality of formal care services, voluntary provision, health, housing and other services, plus individuals’ wealth, choices and expectations. These factors combine to create different levels of demand in each local authority area.  Meanwhile the distribution of wealth and the ability to pay for services is disproportionately distributed.  It is an old problem - the areas of greatest need are the less able to meet that need.  This is why we need a national approach.  

Allowing local authorities to raise a precept is not in itself bad.  It is a strong move to devolve local decision making and priorities.  That much is right.

But we need more. If there is to be a hypothecated approach then we need this at the national level too.  We need a national strategy not simply throwing the burden onto cash-starved local authorities. Just as we have a national health service, so we need a national approach to care. 

Osborne has failed to address the problems of care nationally. We need a joined up care and health system responsive to need and not a post-code lottery in care dependent on a local authorities ability to pay.

We need resources fairly distributed so that the areas of greatest need do not fall short of meeting those needs.  Much more needs to be done to address the issues.


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