26th September 2018
The challenges we face
The reductions in Government Support Grant we have seen have produced significant challenges for Stockport. Whereas we have made great efforts to protect the level of resourcing we allocate to Adult Social Care as much as we can, including increasing the taxation burden on residents via annual increases in council tax, resource reductions have inevitably meant other service areas have faced resource constraints (as well as greater rationing of council funded ASC service provision). The challenge we face is that reductions in these areas inevitably have knock-on effects for ASC in terms of demand. We cannot, for example, pretend reducing the resourcing of Children’s services, Leisure Services, or Public Health may not affect demands upon Adult Social Care down the line. There needs to greater recognition of the false economies produced for Adult Social Care by the overall reductions in resources for Local Authorities face and the lack of a proper funding solution based around need. The only way to do so, in our view is through the delivery of a sustainable funding mechanism for Adult Social Care, funded by Government and calculated by population needs.
Within Adult Social Care itself, we have had to make difficult decisions which have indirectly led to some care home closures due a lack of resources to pay for Adult Social Care placements. This has also led to reductions in some non-statutory services (for example the meals on wheels service) and have seen Care providers struggling to provide the services they would like to within their funding envelope. As an indirect result, resource limitations are resulting in recruitment and retention challenges across the care sector, as careers in care suffer from a lack of recognition and remuneration.
In response, in March 2017 Stockport Council passed a Motion committing Stockport to develop a Stockport Ethical Care Charter, in line with Unison’s Ethical Care Charter principles. This commits the Council to encourage care providers that we currently commission, and those we commission in future to:
- Respect the right of care staff to organise a union in their workplace and do nothing to undermine the reasonable efforts of staff to organise a union.
- Allow access to accredited union representatives and officials for membership recruitment activity. Provider organisations should engage positively with union requests for access to staff and, where necessary, agree arrangements that do not disrupt service delivery.
- Pursue a partnership approach to employment relations. We would expect the provider to engage constructively with the union including a recognition and facilities agreement to underpin collective working.
- Work with the Council and unions to pursue our shared objective of achieving the provisions of the Stockport ethical care charter. This process will necessarily take account of factors including local levels of funding and procurement practices.
Whereas these measures will have positive impacts upon the pay and conditions of care staff locally, this cannot make up for wider national issues of pay, conditions and recognition in a chronically underfunded sector.
The risk of false economies
The aforementioned risks of false economies reductions to services which affect demand upon Adult Social Care are only likely to increase over time, should a sustainable funding mechanism not emerge. These risk producing spiralling demands across service areas leading to greater burdens upon the system and the taxpayer, only to increase pressure for further cuts, particularly in relation to non-statutory services. In Stockport, we have sought to mitigate this through reforming services to protect the frontline, and pooling funding between Adult Social Care and the NHS, helping to mitigate incentives to burden-shift between the two. This approach, while helpful, cannot make up for the lack of a proper funding solution to Adult Social Care need. The lack of this threatens not only the future of Council services, but long-term this is likely to produce negative impacts overall in terms of public wellbeing.
We already seeing increased burdens and pressures upon informal carers. This is worrying in its own terms, however it has further implications in terms of Council services due to increased economic inactivity and worrying mental health conditions for these individuals. In terms of Service users, it is clear that this is disproportionately affecting those of lesser means as those with more resources have the option to spend more on their care. Overall, inadequate funding and delay in finding adequate policy solutions are already proving inimical to the efforts of Local Authorities to improve provision in Social Care.
The role of Local Government and accountability
Local Government has a central role in improving health and wellbeing across their localities. It has a unique role as an agency capable of delivering joined up policy and service delivery relating to a range of areas which impact on people’s health and wellbeing. These span across housing, public health, adult social care, children’s services, place and the built environment, leisure, redevelopment, infrastructure planning and economic development, among others. As such, Local Authorities are uniquely placed to develop locality-based health and social care policies and strategies informed by their knowledge and understanding of the needs of the population they serve. The local accountability provided by Local Authorities is therefore highly important in this context. We believe the scrutiny and democratic accountability afforded by Local Authorities across these functions cannot be matched by other locality-based providers of health and wellbeing services.
As such, local future Health and Social Care commissioning bodies could make greater use of this to improve democratic accountability and decision-making. One way in which this could be achieved is through having local care officers on CCG boards and elected, accountable Councillors on boards as decision makers, making commissioning decisions accountable to the people through Local Council representatives. Central Government could aid this through ensuring health, social care and Local Authority geographies coterminous.
The fostering of strong and resilient communities is also a vital plank in both reducing demand for care and promoting health and wellbeing across society. We believe greater emphasis and support for this from central Government could provide a great return on the investment put in, helping to produce a number of win-wins. The quickest way to do so is through producing a properly funded mechanism for Adult Social Care which is fully integrates with National Health budgeting, as the two cannot be separated in terms of demands upon either system.
This can liberate Local Authorities to get on with funding other areas of its responsibilities which can have positive impacts upon demand, including Local Parks, public health, the environment and leisure and building strong, resilient communities – all of which have bearing upon the health and wellbeing of the population.
How funding should be designed
We have concerns over mixed approaches outlined within the Social Care Premium policy package, which could lead to further social divisions and disjoints in the level of care people receive. This runs the risk of building into the system different standards of care for those who are able to pay more, where this is an opportunity to end this division and build a system which operates in accordance with need. A universal contributions system is our preference in accordance with the principles of progressive taxation and resulting in universal benefits, free at the point of need and provided in accordance with need. This is in contrast to the current system, based upon Council Taxation, which inherently means more resources become available in more wealthy areas, often inversely proportional to demand and population needs. As such, contributions through some combination of National Insurance and Income Taxation is our preference as a source of funding, in terms of the simplicity of the system and in terms of generating the significant funds necessary for a sustainable finding solution to be found. Ultimately this policy suite should work towards an end to charging and provided universal access to services in accordance with need.
Further to this, the policy solutions on offer could be wider in scope; there appears to be no exploration, for example of the role of Corporation Tax and employer contributions (other than NI). These should also be explored as part of the long-term responsibility employers have to the wellbeing of their employees and to society.
There can be no sustainable solution to NHS funding without a sustainable solution to Social Care funding, as the two are not separate issues and directly impact each other in terms of demand. The two issues cannot be separated in terms of policy and should not be separate in terms of funding. We therefore believe a new care funding system is needed and that this should be in addition to and integrated with NHS budgets, not at their expense. Toward this, the principles of contributory fairness and designing universal services which can meet the needs of the population should underpin policymaking.
Today’s Social Care Crisis is significant and deepening. Had such a situation emerged in the 1940’s, we would have developed a National Health and Social Care Service. It is the responsibility of the Department for Health and Social Care to come up with meaningful and progressive solutions today, so that the much needed process of integration across these services – and the status afforded to Social Care – goes beyond the departmental name.
ENDS