A care manager says cuts can drive useful change – but uncertainty prevents it
“I work for a large local authority with both urban and rural, rich and poor communities; my job involves commissioning support services for adults with learning disabilities or mental health problems, and for older people. I develop strategy for social care, make key decisions and improve service quality. I’ve been working in social care for decades, and I’m passionate about serving the public.
I try to split my time evenly between my client groups, but whether I can do so depends on what’s going on – both locally, and in government policy. Last year, for example, I was doing a lot of work to develop and improve services for people with learning disabilities.
At the moment, the two biggest sets of issues I’m handling concern funding and the NHS reforms. On the latter, the problem for me is not so much the nature of the reforms, but the very fact that the NHS has been undergoing continual reforms for years. I’ve worked here for less than 10 years, and during that time the primary care trust has been reconfigured three times. Just as we’ve learned how to work really effectively with a particular organisation, it’s suddenly changed into a different kind of body, with different people and priorities.
If politicians want better social care, they should build a stable NHS – whatever it looks like – and then let it get established. Otherwise, the NHS and all of its partners will never be clear about where the future lies.
In terms of funding, the challenge is to maintain good services in the face of budget cuts and diminishing capacity. Last year we had to find millions in savings, which has been really difficult. The fact that some experienced social care managers took voluntary redundancy meant that the council lost huge amounts of experience; it also reduces flexibility in the system, and the reduction in manpower creates capacity problems when someone is ill or on leave.
To be fair, the cuts also presented opportunities: it can be possible to get things done more quickly with fewer people involved, and when teams are smaller people must learn to work in a flexible and more dynamic way, crossing old boundaries.
In trying to make savings, we were determined we would not compromise on our belief in user-led services; this has shaped our services for years now, and it supports good quality care. So while we did make some cuts and close some services, we also invested in more personalised services and developed them to meet people’s needs and aspirations. Overall I think they’re much better now; and without the cuts, I’m not sure there would have been the appetite for that level of change.
As budgets fall, though, I do worry about the personalisation agenda. It’s been a big policy driver for some years now, but when you’re making big changes you ideally need a long lead-in time – and perhaps to run new services alongside the old ones, giving people time to get used to the new agenda. This is difficult in an era of tightening budgets.
What’s more, personalisation requires a culture change among the staff; and when money’s tight, they can fall back into old habits.
One particular danger is that, if we have to close traditional services due to the cuts, personalisation gets the blame; that wouldn’t be fair, but it could tarnish the agenda. We’ve done what we can to minimise that risk by ensuring that our staff are dedicated to supporting users’ choice, and setting up peer-led support services.
Progress on social care hasn’t been helped by the fact that the Department of Health’s 2007 social care white paper, Putting People First, was followed nine months later by the collapse of Lehman Brothers and the subsequent recession. This was awful timing: as we know, social care is underfunded, and I think the then-government was talking about putting in extra money into social care.
That money hasn’t materialised, and this has made it difficult to be innovative; something that people assumed would underpin personalisation. We’ve tried our best by increasing the uptake of direct payments, but it is challenging.
It has helped that this government said clearly that it was committed to personalisation and personal budgets as soon as it came in, because people at least knew where they stood and were encouraged to continue with their work on personalising services. However, the government is not being very helpful by delaying the implementation of Andrew Dilnot’s July 2011 recommendations on social care. We need to see a white paper soon, and to understand how much of Dilnot’s plans the government intends to implement. I know that money is tight, but social care is so important to people – and they tend to only realise that when they need it. Integrating councils’ social care funding and services with those of health providers – something signalled in the NHS reforms – will be a step in the right direction, though local authorities will never have the kind of budgets that NHS bodies do. Ultimately, while I have managed to find savings and to keep services running at a good quality, as a country we need to think carefully about where extra money for social care will come from. In the end, this is an issue that will affect us all.” ?