How to cut cost of caring

The Government must consider abandoning free personal care for the elderly, and other universal benefits. By Stephen Naysmith

Councils and the NHS could merge to end squabbling over who pays for social care. And people who need care at home could pay neighbours to pop in and look after them.

These are some of the radical changes being urged by Scotland’s leading social worker as council social services departments face a funding crisis of unprecedented severity.

Today the Association of Directors of Social Work (ADSW) launches a new manifesto – Challenging Systems, Changing Lives.

It is in part a wish list for the coming Scottish elections. But, talking to Michelle Miller, president of ADSW, it is clear that what is being presented is also a warning for whoever ends up leading Scotland in May, that wholesale reform is unavoidable.

The manifesto says ADSW will lobby for the reshaping of universal services and calls for a “fundamental change from the traditional way of matching individuals with existing social care services”.

Ms Miller acknowledged that many councils have already brought in revised criteria – making it harder for people to qualify for support if they are disabled or elderly, for instance.However she said this was short- term and unsustainable. Services will have to become more personalised and rules will have to be relaxed, she argues.

“We have created huge bureaucracies that don’t deliver personalised services. I can provide you with a great quality of care, but you may have to be in bed by 7pm – which is no good if you want to have friends round. It doesn’t make sense, but as a provider, I can’t do anything else.”

Instead, she says, relatives or neighbours could be provided with the funds, and could meet people’s needs better for less. The hurdle is that rules currently bar payments to relatives and there are often restrictions on what money can be used for.

“Associated with that has to be some relaxing of some of the rules,” Ms Miller says.

“If you are caring for a relative and need some respite, I might give you some money. You have a friend who will look after your relative for free and you both spend the money on a holiday in Mallorca, why not?

“If it has cost me less, we’ve assessed your needs, you’ve had those needs met, why would I worry about the detail?”

The dismantling of huge infrastructures will inevitably be costly and painful. One problem, according to ADSW, is that while councils have increasingly taken on care in the community details, they have never found it easy to access the funds which should come with that.

“The NHS and councils have been battling it out over resources – people have been sitting for year and years arguing over money. We are being paid to run these services, we should sit down and say: ‘That is the pot. How are we, as intelligent human beings going to manage it?’”

Potentially dramatic administrative changes should not be off the table, she suggests. Councils and the NHS may be concerned about where care is funded from and who provides it, but the public don’t. “We all need to be accountable to the same place. We can’t merge the NHS with councils? Why not? Politicians would have to legislate for that. So?”

She cites the way the Getting it Right for Every Child programme has united different services around common goals in the Highlands as a possible precedent.

Vested interests may oppose some of these ideas, she acknowledges – naming staff, relatives and unions as among those.

While ADSW will lobby for better resourcing for social work, reality demands a new approach, she says. “If people say, ‘Make the Government give you more money’, I would have to say, ‘What planet are you on?’”

Realism also demands that politicians take a look at some of their sacred cows, she suggests. ADSW is calling for an urgent review of universal services including the planned removal of prescription charges, free bus passes for pensioners and free care for the elderly.

“At the moment we provide a free bus pass for a perfectly fit 60-year-old who is driving around in a 4×4. Why would you?

“Why make prescription charges free? I don’t need it? It is the same for free care for the elderly. We need to ask the question – should we be providing universal services to all, regardless of ability to pay? Everyone will still get the care. The question is whether they get it free or not?”

Resources make the other key areas of social work challenging too, Ms Miller points out. In justice, greater use of community sentences seems inevitable. But making them effective costs money, and any money saved from the prison estate may not reach social work departments.

“If I can reduce reoffending significantly – which is what the figures show – it is hard to sustain an argument against it. But we need to be well enough resourced to make the difference, otherwise people will say, ‘Giving them to social work didn’t work, let’s build more prisons’.”

Early intervention is the key, both here and in the other key area of child protection, Ms Miller insists. Preventive work must not suffer due to cuts, she explains.

“If we are struggling for resources, and only provide help at crisis point it is much more expensive. People have bigger problems and are less likely to recover from it in a meaningful way.

“That very much applies to children. But we can’t say we will let that child suffer a bit more, unless it’s desperate. That’s monstrous.”

The ADSW report Challenging Systems, Changing Lives sets out an agenda for social work, and for a future Scottish Government. But the sense of alarm which runs through it also suggests those at the sharp end of public sector cuts still fear the public are far from grasping the scale of the changes to come.