The polarisation of adult social care

Our recent survey of around 100 Council chief executives and senior directors showed that the financial sustainability of adult social care remains a key worry. We also found that the outlook for adult social care is becoming increasingly polarised. There are two aspects to this:

The social care precept

From our survey it is clear many see charging the precept as straightforward (“[politics isn’t relevant,] the government has almost told local authorities to do this”). However, 23% of those who expressed an opinion said the precept will definitely be hard to sell politically: “2% tax plus 2% levy is hard to sell . . . [the message is] pay more, get less”.

It is not just how easily you can charge the precept that causes the polarisation. Our most popular blog of last year drew attention to the winners and losers of the precept which showed how the best off were benefiting by more than double from the worst.

Health and care integration

Secondly, the polarisation is perhaps even more evident with integration, still almost universally accepted as essential in some form for sustainable social care.

We know from experience that it isn’t just an inequality of funding that local government suffers with, it is also an inequality of relationships. In our survey nearly 20% of respondents said there is “limited contact” with other parts of their local system. For some authorities the lack of effective relationships will be a significant threat to their ability to make adult social care sustainable.

Also, Clinical Commissioning Groups (CCGs) have a big job of their own to be getting on with. This represents both an opportunity and a threat. For some CCGs the council can be a helpful partner and ally, but for many CCGs collaboration could look like a costly and inefficient use of time. This would be damaging to those local authorities who have staked much on the integration agenda.

What’s the lesson from this? Make sure you don’t happen to live in an area with less to gain or little chance of gaining from the precept, mediocre local relationships, challenging finances on both sides of the fence and disengagement from health partners. In spite of this the overall future for adult social care looks brighter than it did, but only just.

(The full version of this article is available in the MJ)

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