By Kit Sandeman, Local Democracy Reporter
Two of the leading figures in social care in Nottinghamshire have spoken about the immense pressure the sector is under, and why it’s become one of the most difficult and long-standing problems facing society.
In recent years, strain caused by increasing demand for care has led to it becoming the single biggest expenditure for most councils.
There are several factors causing the pinch: There are more older people needing care; those people are living longer and often with more complex needs; the cost of providing the care has increased; and the money councils receive from the Government has decreased sharply.
Unlike the NHS which is funded directly from the Government, social care is funded by local councils.
It is also means tested, meaning many people who are judged to be able to afford it are asked to pay towards the care they receive.
An already delayed ‘green paper’ on the future of social care and how it is funded was due to be published this month, but has again been delayed by the Government until the new year.
Now, the heads of social care in Nottingham and Nottinghamshire have spoken openly about the strain it is under, and what needs to be done to improve it.
David Pearson started his career at Nottinghamshire County Council as a front-line social worker 36 years ago, before rising to be the head of the service, responsible for a budget of £335 million.
In June 2016 his contribution to adult social care was recognised in the Queen’s Birthday Honours list, when he was awarded a CBE, and last month he was named as one of the 100 most influential people in healthcare.
Now approaching retirement, he has worked with the Government on drawing up the green paper.
He said significant efficiencies in social care had already been found, but the level of funding shortages since austerity started in 2010 were ‘unique’ among the public sector.
He said: “Local government has taken a 49 percent reduction in its revenue support grant (the main block of funding from the Government). That’s a level of reduction which is unique in public services.
“So the current proportion of the council’s budget is 42 percent. If you count the council’s contribution to children’s social care it’s 70 percent.
“If you’ve got those levels of reduction from the Government you can’t manage the budget without reducing expenditure on social care. That lies at the heart of this.
“A number of councils are really struggling. The evidence is pretty strong that there is a funding problem for local Government and for its constituent parts.
“The argument is that there is a problem here, but no-one has really found a solution.”
Councillor Sam Webster is the portfolio holder for adult social care at Nottingham City Council, and represents the Wollaton East and Lenton Abbey ward for Labour.
He said funding for social care at the city was also taking up an increasing proportion of the council’s spending.
He also said it had not been treated as a priority by consecutive Governments.
“I think there’s a lot of misunderstanding about what adult social care is, how it’s funded and who pays and who doesn’t.
“The whole thing is a bit of a mystery to a lot of people,and maybe national and local Government have probably not been the best at explaining to people how it works and how it’s funded.
“I think there needs to be a more grown up, sensible, cross-party debate about how to fund it.
“It often gets kicked into the long grass, because you think it’s never going to happen, and it’s not really a concern for lots of people today.
“It doesn’t actually become a concern until you need one of those services yourself, or for someone you love.”
In recent years, there has been a focus on improving links between social care and the NHS.
When there is limited capacity in social care, hospitals struggle to discharge some patients who are medically fit to leave – known as bed blocking.
Mr Pearson said increased ‘harmonisation’ was key: “We need to make sure we are blending the best of the NHS with the best of social care.
“The NHS is very good at diagnosing medical diseases and problems and fixing them, but what social care is very good at is looking at people’s needs in the round and thinking about how they can help live their best lives with whatever they are living with.”
Mr Pearson went on to say that improvements can be made.
He said: “But when you look at the total amount we spend on it, this isn’t huge amounts of public spending.
“The public expenditure on social care is 1.2 percent of GDP, and it’s going down, as needs are going up. So we are running up an escalator the wrong way.
“But it is fixable, with the right will.”
On the delayed green paper, the Government has said that the proposals will “ensure that the care and support system is sustainable in the long term”.
Topics the Government has said will be included are integration with health and other services, carers, workforce, and technological developments, among others.
The Government has also said it will consider domestic and international comparisons as part of the preparation for the green paper.