If I close my eyes, I visualise an entire new introductory paragraph...
Over recent weeks I’ve been asking system leaders their opinions on which government initiatives are going to have the most impact on adult social care over the medium term. Views were interestingly varied, and I have compiled the results from my informal polling (at the party conferences, the HSJ Integration Summit, and a cross-departmental workshop on adult social care) into a Top 7 chart. Time for a countdown!
7. Green Paper. Rock bottom on this list. As soon as I mentioned it, most of the people I spoke to said “of course, it is only a GREEN paper”. As I’ve written about in the past, my fear is that it is likely to focussed on the wrong questions. However, as expectations are so low, is there the potential for us all to be surprised?
6. Budget. Not a lot of hope here. The feeling was that the sector has had its £240 million pocket money early.
5. Brexit planning. There is plenty of rhetorical worry about this, but the level of actual action planning going on in most local areas means Brexit only scrapes into a mid-table position on this list.
4. Comprehensive Spending Review. This is a recent climber in the charts, now that there is the possibility that ‘austerity is over’. There is less hope about transformational or structural reform. The regular short-term cash injections over the last couple of years show that the 2015 settlement was wrong. Can we make a much stronger case this time around?
3. NHS long-term plan. This one split the room (or more precisely, the rooms). Some think it is going to be transformational for social care, others (notably, some of those most closely involved in the workstreams) see it being treated mainly as an afterthought.
2. Fair Funding review. Shire Counties and outer London councils in particular are putting a lot of hope on a promised review of the funding formula that is expected to favour some types of council.
1. Short-term funding fixes….yet again at No. 1! An additional £1 billion for the improved better care fund kept the health and social care systems afloat last year, and the aforementioned £240 million for winter pressures might help them survive this winter. Whether we like it or not, social care now seems to be in a regular pattern of arguing for long term fixes, but receiving last minute short-term ‘bungs’.
This drives a certain type of change – like the 39% reduction (since February 2017) in Delayed Transfers of Care attributable to local authority departments of adult social care, which Matt Hancock highlighted in his letter of 17th October confirming the additional winter funding. It means that those in the sector are forced to narrow-frame challenges, in search of quick impact on specific metrics, and doesn’t allow them to widen the lens and plan for sustainable impact. An example of this is the deterioration in expectations of joint working. Previous strategies had to be jointly agreed with health colleagues, but this time the letter merely (and rather pleadingly) suggests “. . . you will want to continue local discussions with health partners”, but only goes on to only mention acute hospitals, with the target achievement being “satisfactory engagement”.
Looking through this chart, it doesn’t seem likely that government initiatives are likely to be the saviour of adult social care. Is it time for the sector to take more control of its own destiny?