Social care does need more funds, but there are also savings to be made | David Brindle

Ministers last week stepped in with an extra cash boost for social care. On top of a funding increase announced three months ago, they unveiled a further rise to help meet payroll costs and to help professionalise the workforce. Council leaders “warmly welcomed” the move and the emphasis on preventive support for older and disabled people.

You may have guessed this wasn’t in England. It was in Wales, where, as the Welsh Local Government Association (WLGA) observes, the policy position is “very different”. True, the sums involved are not huge. After a £25m grant increase for social care in 2017-18 set out last October, the Welsh government last week found a further £10m and raised the individual cap on homecare costs – a feature of the system not replicated in England – from £60 a week to £70, which should give councils another £4m for the year from April.

Overall, that makes £39m more against what the WLGA says would have been a £92m shortfall in social care funding. Still a problem, then, but if the Westminster government were to make an equivalent contribution towards a previously forecast £1.9bn shortfall in England in 2017-18, that would be worth £805m. As it is, measures hastily put together just before Christmas may amount to a maximum of £281m, according to the Institute for Fiscal Studies, and only £75m of that is grant.

If ministers thought a combination of face-saving package and festive goodwill would get them off the hook, they were mistaken: last week, the chairs of three influential Commons select committees sent a joint letter to the prime minister urging cross-party agreement on the future of social care and health funding, and the Liberal Democrats’ health spokesman, Norman Lamb, is expected to put the idea of a cross-party convention directly to Theresa May in the Commons on Wednesday.

Leading care charities are rallying behind Lamb with support for a cross-party “process” – note the difference – in another letter to May. “Such a process should not aim to ‘take the politics out of health and care’,” says the letter, coordinated by older people’s charity Independent Age, “but rather to make clear the costs and consequences of the political decisions that must be made.”

That is a degree of clarity May is unlikely to be comfortable with. In all her (admittedly limited) utterances on what she concedes is a need to review the social care funding system, she has been careful not to include reviewing NHS resources, too. The prospect of opening another bidding war on NHS cash plainly terrifies her. And the ease with which the hospitals lobby has slipped back into its familiar importunate mode in recent days – muscling social care aside after their brief united front last autumn – shows why.

Would social care be better off going it alone? While logic and principle suggest that the care and health system should be seen as an inseparable whole, and reviewed as such, realpolitik may dictate otherwise.

But social care should also show willingness to look at its own performance. May is convinced there remains money to be found in the system by making better use of existing resources. Although this does not obivate the need for funding reform, it is true that better value is being found in some places than others. Research by the Social Care Institute for Excellence (SCIE) in Birmingham shows that significant savings could be made if the city adopted three models of care reform pioneered elsewhere: the Living Well scheme of support for older people in the community, developed in Cornwall; Kent county council’s hospital discharge programme; and the Shared Lives concept of family-based accommodation for people with disabilities.

Using data supplied by Birmingham council, SCIE estimates that applying the three approaches could save the council £6.6m a year and the NHS £1.4m. To put that into perspective, the council has to make cuts of £78m in its overall budget in 2017-18 and the care and health economy across Birmingham and Solihull faces a £720m shortfall by 2020. But £8m is not to be sniffed at. Equally important, the kind of community support fostered in SCIE’s models plays perfectly to May’s vision of a “shared society”. If that’s the flow, social care needs to go with it.

• David Brindle is the Guardian’s public services editor

Social care does need more funds, but there are also savings to be made | David Brindle

George Osborne to give elderly greater access to pension savings

George Osborne: sweeping liberalisation of principles on pensions and annuities. Photograph: Amer Ghazzal/Barcroft Media

Individuals will be permitted to get lump sums out of their pension pots effectively right after they have retired to pay out for the value of care in old age and other needs under a further sweeping liberalisation of business rules to be unveiled by chancellor George Osborne on Monday.

At existing pensioners have to decide at the time of retirement no matter whether to consider a tax-totally free lump sum of up to 25% of the value of a pension pot. If savers want to take out a lot more they face punitive amounts of tax.

But below modifications to tax rules getting planned in the Treasury, offers will be available in potential making it possible for income sums to be taken out later in daily life to meet sudden wants that could arise, for illustration substantial expenses for lengthy-term care.

Ministers are also anticipated to announce a reform of annuities so that they can proceed to shell out out properly after death, to stay away from all revenue out of the blue becoming misplaced to the family members of a deceased policyholder. At the moment income from annuities is guaranteed for a highest of only 10 years from the time they are taken out – if an individual dies 9 many years following retiring, his or her family members will receive absolutely nothing following a further yr.

Under the Treasury strategy, the ten-12 months cap will be dropped and the annuity provider will be in a position to spend out far longer, even though income charges would depend on the length of the promise. A even more alter will introduce deals that fluctuate the ranges of earnings paid out, possibly providing much more in the early years of retirement and less later on, or vice-versa.

The new tax principles and resulting wider choices follow a public consultation launched this 12 months, after Osborne had outlined ideas for a dramatic shake-up of the market to let a lot more versatility for shoppers.

The chancellor mentioned in his March budget that, from April 2015, savers will be ready to entry and use their pension pots in any way they want after the age of 55. They will be able to take a quarter of their pot tax-cost-free and will then shell out earnings tax at the highest fee they at present pay (the marginal fee) on any a lot more they wish to take out. Osborne shocked the pensions market by saying that no one would be obliged to purchase an annuity, and that people would, instead, be in a position to get all the income as income.

Treasury insiders explained the newest ideas developed on concepts introduced in the spending budget. A Treasury source said: “The reforms to the tax guidelines are about encouraging innovation and making sure buyers have the widest attainable option in how they secure their economic potential.

“The government would like [monetary]companies to tailor goods for folks, and our reforms will empower people to pick those goods that are right for them.”

With the expansion of the elderly population, and a developing amount needing costly care, ministers are established to enable pension funds to be utilised as and when men and women need them. Some experts concern the ideas will backfire and that these who income in all their cost savings at once will be left far more dependent on the state later in lifestyle. But ministers argue that the huge majority will get wise choices according to their own needs, and say that the industry has extended been in require of a shake-up.

The attraction of cashing in all or some of a pension pot is that individuals can then deal with their personal money which can be handed down to their loved ones following their death, rather than going to the pension provider. In his March spending budget, Osborne said: “People who saved their whole lives, saved for a pension, these are accountable individuals … it is their money. They can do what they want.”

George Osborne to give elderly greater access to pension savings

Councils and NHS companies should function collectively to share dangers and savings

Public health, social care and neighborhood government solutions must prioritise reductions in emergency admissions, says Richard Vize. Photograph: Getty Photos

The most significant ever push to integrate wellness and social care is in critical problems. What has gone wrong with the Better Care Fund and can it be fixed?

The issues stems from the reality that half of the basic £3.8bn fund, meant to support integration tasks in 2015-16, has been stripped out of budgets for acute health services. The hospital lobby argued that this risked pushing companies additional into monetary difficulty. The government has responded with a clawback mechanism which will keep £1bn of it largely in the NHS and make it dependent on achieving locally agreed reductions in hospital admissions.

In response, David Sparks, in his very first speech as the new Labour leader of the Neighborhood Government Association (LGA), advised its yearly conference on Tuesday: “We are seeing Whitehall striving to strangle [the fund] at birth.”

The increasingly bitter tone of the dispute displays the substantial fiscal stress facing each the NHS and nearby government. It is akin to drowning sailors fighting in excess of a lifebelt. But it is also a clash of cultures and perspectives.

Neighborhood government resents that, even though it has been coping with a loss in government grant of nearly 30% with the bare minimal of shroud-waving, hospitals have gone bleating to ministers the 1st time they have to deal with something approaching a lower. Councils are baffled by the way growing numbers of trusts are operating deficit budgets instead of obtaining sustainable solutions. They bristle at social providers getting handled as an extension of the hospital discharge technique. They can’t realize why trusts are so inward hunting alternatively of seeing the larger picture.

Trusts are annoyed that the mirage of ring-fenced and even growing funding is obscuring deep cuts in acute services’ revenue. They have tiny faith in schemes that guarantee to throw many years of development in A&ampE admissions into fast reverse in a matter of weeks. Some companies have observed their nearby council turn into a rallying stage for opposition to badly necessary reconfiguration ideas, paralysing change in nearby well being economies that desperately need to have reform. Unlike social care, the NHS cannot control demand by raising eligibility criteria – it largely has to treat what comes through the door.

The true function has not even began. Relationships across the method need to be received back on track before the fund goes dwell next April. The option is to permit the inevitable difficulties and setbacks to trigger recriminations and division.

There requirements to be agreement on what integrated care implies, and it has to be broader than just decreasing emergency admissions and speeding up discharge from hospital. It needs to be developed about empowering the patient and giving them a coordinated service. Excessive claims about cutting admissions require to be replaced with realism. In numerous locations, just stopping growth would be a triumph.

Simplistic assumptions about substituting low-cost social care for expensive medical care must be replaced by an understanding that the two are largely complementary.

Public overall health, social care and the entire variety of nearby government services need to prioritise reductions in emergency admissions, particularly through reducing obesity and alcohol abuse and escalating physical exercise.

Crucially, the two NHS trust regulators, Keep track of and the NHS Believe in Improvement Authority, need to cease judging providers largely in isolation from each other and the wider care method. Driving NHS leaders to think in terms of institutions rather than programs is obstructing integration and encouraging fragmentation.

A lot more demands to be carried out to share risks and cost savings among health and nearby government. Nearby organisations need to have greatest freedom to agree their personal solutions to this. The offer by NHS England chief executive Simon Stevens, speaking at the LGA conference, to create pooled personal budgets for four groups – people with extended-phrase conditions, kids with complex needs, folks with understanding disabilities and these with serious and enduring psychological health issues – is a promising move. It will inspire integration strategies to focus on the support consumer rather than institutions and promotes technique thinking.

Above all, councils and neighborhood NHS companies require to unite close to shared objectives that tackle the most hard issues confronting them. There merely isn’t the money to do anything else.

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Councils and NHS companies should function collectively to share dangers and savings

Integrating wellness and social services is no promise of savings | @guardianletters

‘The extremely elderly come in to hospital generally as a outcome of a fall, or getting to be abruptly confused or significantly less mobile.’ Photograph: Garry Weaser

I am unsurprised that the Cabinet Office overview (Whitehall calls halt on £3.8bn NHS reforms, 7 May possibly) found that strategies to integrate health and social care services showed little prospect of generating financial savings. It is not the separation of these two companies which is the underlying result in of overuse of hospital care by the frail elderly it is the much more basic issue of care being free of charge in the NHS but indicates-tested for social providers. This can lead right to an extended length of stay in hospital while detailed assessments are carried out to make a decision who will be responsible for paying for the care required on discharge.

Shortening the length of stay is the place the main savings for hospitals can be produced. Enhanced local community providers have only a limited role to play in decreasing admissions in the very first location, as practically all admissions are the direct end result of both new or worsened medical circumstances. The quite elderly come in to hospital frequently as a end result of a fall, or getting to be out of the blue confused or much less mobile. Even though the 1st of these sounds amenable to greater social and local community care, in practice this prevents reasonably few falls as most are due to medical issues. These need diagnosis and remedy, and the elderly need to not be discriminated towards by becoming denied this just simply because they are elderly. The underlying diagnoses are many and different, and frequently demand the services of an acute hospital.

Even though the funding techniques for wellness and social companies continue to be so disparate, individuals who wish to find financial savings in the hospital sector would do better to emphasis on speeding sufferers across the boundary amongst the two, rather than integrating them.
Dr David Maisey
Retired consultant geriatrician, Norwich

• Contrary to your reports, far from halting the Far better Care programme, we have produced great progress on a venture that heralds a historic merger between health and social care commissioning.

The schemes in each and every spot start from April 2015, but we asked for early drafts to be ready a yr early so we had time to make sure they provide the genuine advantages for individuals envisaged when the scheme was set up. That is what is occurring, and the consequence is an interesting collaboration which has observed neighborhood government and local NHS commissioners operating collectively in a way that has by no means took place just before.

As your editorial states, the Greater Care Fund is “crucial to the prolonged-term viability of the NHS”. Mixed with the announcement by Simon Stevens last week that clinical commissioning groups will be invited to commission main care jointly with NHS England, we have for the first time the prospect of a single organisation leading the commissioning for all out-of-hospital care, a significant step forward in the integration of care that has often been talked about but in no way in fact delivered. No doubt the road to acquiring there will be bumpy, but it is a vital phase in the revolution in out-of-hospital care we require if the NHS is to carry on to meet the growing aspirations of an ageing population.
Jeremy Hunt MP
Secretary of state for overall health
Eric Pickles MP
Secretary of state for communities and
local government

• Your write-up appeared to suggest that the fund was unravelling. Clearly, trying to draw two extremely various providers collectively – the NHS and regional government – to integrate in a way that ends an institutional obsession with acute provision in hospitals as a implies to offer care, the BCF is not the only way of repairing the program, but it is the best way to guarantee all places benefit from integration amongst the NHS and Nearby Government. 

In Staffordshire, we have previously established a partnership trust with our nearby NHS to bring collectively solutions from each the county council and acute sector into one particular automobile that breaks down silos, avoids duplication and provides a vehicle to deliver a much better services locally. We did this without having a Far better Care Fund.

The actuality is that in Staffordshire, and in several other nearby places we are already integrated, but only as far as current resources permit. The BCF is the next stage, a means of investing in prevention and community care to cease the horrendous unsustainable burden placed on acute solutions inside of the well being service. Integration, the BCF and closer functioning with the NHS are vital basically since of the long shadow cast by the Francis report. Better integration is portion of the lesson we all have to discover from the Francis report in Mid-Staffordshire.
Philip Atkins
Leader, Staffordshire county council

• The push-back on the Greater Care Fund by Numbers 10 and eleven is but one more illustration of short-term political consideration blocking a critical try at rebalancing overall health and social care. Anyone with any grasp of health organizing understands there has to be front-loading to get new local community services functioning prior to any financial savings will be delivered at the hospital finish (the transitional funding stressed by David Nicholson). It did not occur with the closure of the psychological hospitals in the 1970s and 80s or with the Community Care Act in the 1990s. When New Labour had the cash and the neighborhood structures in spot to do it (coterminous and potentially co-operative principal care trusts and regional authorities) political fixation with hospital targets squandered the opportunity.

Lansley’s reforms have been always going to make the collaboration more hard. Pre-election panic in excess of hospital balance sheets yet yet again scuppers wise approach. How differently factors may have gone if Norman Lamb had acquired Lansley’s publish in 2010. Kate Barker’s interim report for the King’s Fund demonstrates extremely obviously that the Greater Care Fund was heading in the right direction but that the politicians are by no means going to provide if they cannot be sincere about the price. Her group is consulting on funding but also on how best to harmonise commissioning at national and nearby level. A single can only hope that the up coming government requires far better note than Gordon Brown did of her recommendations on residence-building.
Colin Godber
Winchester, Hampshire

 • Lambeth (and no doubt other authorities) have place in spot innovative programs for the demolition and promote-off of perfectly excellent and nicely-loved (if ill-maintained) sheltered housing schemes, constructed in the halcyon days of the reknowned Ted Hollamby. This has grow to be a indicates for nearby authorities to shuffle off obligation for their elderly tenants, bringing in “private providers” and medicalising outdated age.

Hundreds of the frail and elderly, whose tenancies are exempt from correct-to-buy, are currently being subjected to anxiousness and uncertainty with the threat that they will be moved to unknown destinations, away from close friends and loved ones members and their minor help networks broken up. An example of the “large society” in action.

Will the Cabinet Workplace suggestions to government that the claims of the Much better Care Fund do not stack up put a stop to this excoriating cruelty currently being visited on the elderly?

Allow us hope so.
Kate Macintosh
Winchester, Hampshire

Integrating wellness and social services is no promise of savings | @guardianletters