A ‘transformational’ bridge too far

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The sources of Haringey’s plans for the ‘redesign’ of adult social care services are, piece by piece, emerging. We have already discovered the influence of Gerald Pilkington, accountant and management consultant, and his inappropriately extended ‘reablement’ programmes. (Fitzpatrick 2014, 2015a) We are still waiting for the details of the ‘desktop review’ which encouraged Council leaders to believe that there was ‘substantial reablement potential’ among current recipients of social care services. (Fitzpatrick 2015b) Most recently, we have learned that the Local Government Association’s Adult Social Care Efficiency Programme has helped to guide Haringey’s drive to impose drastic cuts in spending on adult social care.

A glance at the Final Report of the LGA’s efficiency programme, published in July 2014, is sufficient to confirm that this is the origin of much of both the substance of Haringey’s proposals and its aspirational rhetoric. (LGA 2014) This document reports on 44 projects carried out over the preceding three years in which the LGA ‘supported councils to make transformational approaches to making efficiency savings’. These included ‘a range of technical and structural transformations’, ‘bold and innovative approaches to public service reform’, offering ‘workforce optimisation, culture change and creative new delivery models’. Words like ‘radical’, ‘innovative’, ‘new‘, ‘creative’, sometimes yoked together for extra impact – ‘radically new’, ‘bold and brave’, ‘bold and clear’, ‘bold and innovative’, even ‘innovative and creative’ – are sprinkled throughout the text.

The challenge facing the programme was that councils were required to make ‘8-10% savings over three years’ to balance their books; they needed to make ‘3% savings per year’ to meet competing demands (recognising growing demand as well as shrinking resources). One contrast with Haringey is immediately apparent: after making drastic cuts over the past four years, the Council is now planning to make even deeper cuts over the next three. Its budget projections for adult social care envisage a cut in spending from £88.1m in 2014/15 to £69.8m in 2017/18 – a reduction of £31.2m or 20.7%. This amounts to an annual cut of 7% over this period, more than twice that envisaged in the LGA’s bold and transformational programme. Before looking more closely at the LGA’s proposals, it is worth noting its sombre concluding caveat:

‘Indeed some councils are beginning to believe that they cannot make the level of savings required without putting their basic services for vulnerable people at risk,’

What are the ‘big lessons’ that emerge from the LGA programme?

 ‘Managing demand’

The object is to achieve a ‘fundamental shift in expectations’ through a ‘dialogue to transform attitudes, culture and behaviour’. Citizens must accept ‘a duty to contribute as well as a right to support’. The cynical denial of the imperatives of austerity is presented in the familiar rhetoric of empowerment and independence: ‘it is not about cutting services in response to financial pressures, but about proactively helping and encouraging people’ to adopt healthier lifestyles, etc. ‘Reablement’ makes another appearance here, quoting the now

familiar ‘Pilkington 60%’ savings claim, together with the claim that ‘diversion’ can redirect 75% of applicants for Council care into the voluntary sector or ‘the community’.

 ‘Transforming services’

Blending the old radical critique of ‘traditional models of social care’ and ‘paternalism’ with conservative prejudices against the ‘culture of dependency’, the LGA insists that ‘the individual must take more responsibility for their own care’. There is ‘no one magic solution’, but social enterprises, ‘robust performance management’, ‘workforce optimisation’ and a ‘relentless focus on efficiency’ are all recurring themes. The trick is to ensure that ‘the savings delivered are not seen as “cuts” but have come about through an approach to delivering better outcomes for customers at lower cost’.

 Learning Disability services

The Final Report includes two case studies of councils which have introduced programmes aimed at reducing costs in learning disability services: in Tameside and Croydon. LD services are identified as a particular problem, because spending continues to rise, a trend that is attributed to increasing life expectancy and declining mortality. Recognising that LD services present ‘an ongoing challenge’ to local authorities, the LGA has embarked on a new project involving five councils (Barking and Dagenham, Darlington, Cumbria, Kent, Wiltshire) to explore this area (due to report in 2016). The ‘single biggest challenge’ in LD services is that of ‘younger adults’ and the transition to adult services is identified as a key point at which to effect a ‘culture shift’, to promote independence – ‘progression not maintenance’.

The specific proposals are familiar – reviewing all placements, discouraging expensive out-of-borough placements, using technology to replace night staff, cutting day services, transport, employment, etc. But two points stand out.

First, the scale of the cuts achieved by these model projects was evidently small: Tameside managed a 5% reduction over three years (Croydon’s figures are not given). This is on a much smaller scale than the 20% cuts proposed by Haringey over the next three years.

Second, the Croydon model focuses on ‘identifying those receiving more services than required to meet their needs’. But it has nothing to say about identifying those receiving fewer services than they require to meet their needs, which, as is well known in the sphere of autism and learning disabilities, is a substantial population.

In conclusion, the LGA report emphasises that it ‘will not be easy’ to achieve the proposed ‘transformation’ of adult social care, and that it will require ‘political leadership and vision’ together with ‘strong management’, qualities conspicuous by their absence in Haringey.

Michael Fitzpatrick, 12 February 2015

References

Fitzpatrick, M (2014), Realities of reablement, 31 December. http://saveautismservicesharingey.co.uk/wp-content/uploads/2015/01/Realities-of-Reablement.pdf

Fitzpatrick,M (2015a), Evidence-based policy or policy-based evidence?, 8 January. http://saveautismservicesharingey.co.uk/wp-content/uploads/2015/01/Evidence-based-policy.pdf

Fitzpatrick, M (2015b), Desk-top Review, 25 January. http://saveautismservicesharingey.co.uk/wp-content/uploads/2015/02/Desk-top-review.pdf

Local Government Association (2014) The Final Report: LGA Adult Social Care Efficiency Programme, July. http://www.local.gov.uk/documents/10180/11779/LGA+Adult+Social+Care+Efficiency+Programme+-+the+final+report/8e042c7f-7de4-4e42-8824-f7dc88ade15d

 

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