CROYDON COMMENTARY: After spending his career working in senior positions in the voluntary sector, RICHARD PACITTI (pictured left) says that if we funded adult social care differently, it would solve a lot of problems
Most people are aware of the dire financial circumstances now facing Croydon Council, but perhaps it’s worth giving some thought to what brought this situation about.
A lot has been written about the “collective corporate blindness” that led to the council’s bankruptcy. The council website has a consultation asking residents to comment on their ideas for saving money.
Suggestions include closing five of the borough’s public libraries, shutting leisure centres and selling-off one or more of its recycling centres. Local people feel they are being penalised and will be losing highly valued local services they have paid for via their Council Tax because of poor governance by the council.
But there is an issue which faces all local authorities, most of which have not bankrupted themselves, but many have had to cut their other local services to meet the ever-rising costs of adult social care.
In my 30 years of working in health and social care, how the provision of adult social care was to be paid for was constantly re-examined. But it was never resolved.
It never seemed logical and consistent to me that health care should be paid for via national taxation and be (largely) free at the point of access without the need for means-testing, while social care is funded via local authorities and local taxation, is not free at the point of use and it is subject to means-testing.
In my opinion, health and social care are two sides of the same coin. Having them funded so differently makes no sense and leads to “cost shunting” and poor joint working.
One of the reasons why this issue has become a “political football”, constantly (to strangle the metaphor) “kicked into the long grass”, is because it has not been possible to come up with a solution that seems fair to everyone.
One argument is that it isn’t fair that people who have “done the right thing”, worked all their lives, saved and bought their own home, should then have to use their savings (including having to sell their family homes) to pay for the social care they need, whereas people who have not prepared for their old age have the cost of their social care met by the state.
In fact, “self-funders” generally subsidise those funded from the taxpayers’ purse by paying higher fees for very similar care. This, so the argument goes, rewards the feckless, whilst penalising the prudent. What chance will the state have in encouraging people to save and prepare for the costs of their old age if they are penalised for so doing?
Others argue that people who can afford to pay for their care should do so, while those whose circumstances are more modest shouldn’t go without the care they need.
Both positions seem reasonable, but again, the fact that health care isn’t means-tested and social care is, seems inconsistent.
This, for me, raises a “democratic deficit”, that occurs when less and less of local taxation is spent on general services for local people.
Most people think their Council Tax funds local services such as schools, libraries, parks and leisure services, refuse collection and street sweeping, funding for local community groups and planning.
No one really likes paying taxes, but when you think that you are getting something in return for your Council Tax, it does sweeten the pill a little.
In fact, a paper that went to the council cabinet in Croydon in September 2019 pointed out that, “Increased spending on adult social care – which now accounts for nearly 40 per cent of total council budgets – is threatening the future of other vital council services, such as parks, leisure centres and libraries, which help to keep people well and reducing [sic] the need for care and support and hospital treatment.”
It could be argued that the largest item of expenditure for Croydon Council (and all councils, I would suggest) is not really a local service at all, in the sense that it is not generally available to all the citizenry of the borough. I would guess that Croydon’s adult social care budget is mainly spent on individual packages of care for a relatively small number of people deemed to need such support.
Of course, I am not in any way suggesting that people shouldn’t be getting this support if they need it. In fact, the evidence is that this system doesn’t work very well and lots of people who do need a package of support simply don’t get it. The charity Age UK suggests this figure is 1.4million people nationally.
The way this support is funded needs to be changed urgently.
My suggestion is that the costs of funding social care should no longer be raised via local taxation because these are not, in any real sense, local services. If social care were funded in the same way as health care, the two would work much better together. Of course, these costs would be high (the National Audit Office estimated nearly £11billion a year), but I suspect if this money were raised via general taxation, people would relatively comfortable with this.
Moreover, if local authority costs, such as Croydon’s, as a result were reduced by £110million per year (the amount set aside for adult social care in the 2020-2021 council budget), and all of this money was not clawed back by central government, then it would mean that they could then reinvest in some of the local services – the parks, the public libraries, planning, refuse collection and street cleaning – that have been lost or cut, and the democratic deficit would be repaired.
They might even be able to reduce Council Tax bills.
One of the “silver linings” of the covid cloud that I have noticed is that people are showing far more interest in their local communities – in their parks, open spaces, local businesses and community groups. After covid, my guess is that people will want to work from home more or will want to work closer to home. Councils could use the money freed up from social care to create more local jobs – either within the council itself, or by encouraging local businesses (and local charities) to establish and expand.
Without wishing to seem too Utopian, funding social care differently would mean everyone would be a winner.
People would get the social care they need; people wouldn’t have to spend their life savings on their care; local services could be re-established; the connectedness that people feel to their local community would be improved; there would be more local jobs so people would need to travel less, thereby reducing congestion and pollution; the relationship between local taxation and local services would be restored and, although Income Tax would need to go up, Council Tax might go down.
This idea doesn’t solve Croydon Council’s immediate financial problems and would require significant changes to be introduced by national government.
But it does propose a more sustainable way forward, so long as our council doesn’t use any savings to buy another hotel or shopping centre.
- Richard Pacitti spent all his working life in the voluntary sector, including 30 years at Mind in Croydon, where he was chief executive until he retired in April 2020. During this time, he worked closely with statutory colleagues on strategic issues and was involved with a number of local and national initiatives to improve health and social care
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I very much agree with what Richard says. It can’t be right that someone with, say, a heart condition gets their care free through the NHS, whereas someone with dementia (usually) has to pay the full cost of their care if they have savings of more than £23,250.
Absolutely right, governments have been kicking this can down the road for years. It cannot be right that paying for social care should be left for incompetent councillors to juggle with the cost of libraries, cutting the grass and so on.
When late mother needed care at home in Croydon, an agency was selected. Next door neighbour needed help dressing after an accident, another agency provided her care. When I queried this with Adult Social Care the reply was that they had to award clients “fairly” between agencies. Result: Mum’s carer and that of neighbour spent more time travelling between clients than caring for them. ASC management insists on doing it their way, but it really needs looking at. Surely having neighbours sharing carers makes far more sense?
At last, some ‘out of the box’ thinking AND a feasible solution from someone who understands the social care system. It seems most councillors and politicians lack such knowledge, vision and good sense. Let’s hope some of them read this article and take note!
I find it interesting that this is referred to as Social Care. Many of the people having ”social care” require this for chronic medical conditions and/or age related infirmity. The ”care” needed used to be called nursing. Irrespective of who foots the bill does anyone really feel that the 15 – 30 visits of care staff can compare. Care staff work in Dickensian workhouse employment conditions many not even paid for the travel time and very few get £20 an hour, The average weekly cost of living in a residential care home is £704, while the average weekly cost of a nursing home is £888 across the UK. More severe medical conditions and other needs and this goes up. Charges are made for medical services that are free at point of use to non care home residents (not unrealistically as it costs the company to provide them).But by doing this are we not discriminating between those who can go to Hospital and get medical treatment (freely) and those who cannot. When was the last time the NHS forced a patient to sell their home to fund a hospital stay.
Richard makes many good points and a valid solution. But perhaps we need to not just look at how its funded but what we are paying for – be it Private or Public or Medical / non Medical. And please at least in the next round of cuts lets get rid of costly non functioning quangos unfit for purpose, regulators and non functioning high cost bureaucracy.
A most clear and lucid presentation, thank you Mr Pacitti, of an argument that has been going on for many years. Of course it makes sense on so many levels to integrate health and ”social” care, both in provision and financing. The practice of multi-service case conferences has also been trying for years to do so locally, against all the structural limitations. But to do so would require either a new department or better an expansion of the NHS – which all administrations, labour included, have been trying to privatise and fragment since the late 1980’s. Such an inherently socialist leviathan and hotbed [sorry…] of genuinely altruistic non-profit social provison cannot be tolerated, any more than genuinely social housing can. If it went hand in hand with reform of local taxation, such that those with multi-million pound houses did not have their council tax capped at ludicrously low amounts, then increases in general taxation might be better tolerated. As it is, many of the much vaunted thatcherite home-owning class has seen what they were lead to believe would be an inheritance for their children swallowed up in ”social care”. Such a clever way of shrinking the state, wasn’t it. There is another similar politico/financial con and its consequences looming for the current generation who have had their pension provision removed from the link to their working income and tied instead to market funds which few realise will provide them with tiny incomes in retirement compared to those of us with what used to be the most common form, defined benefit pensions. Unfortunately, historically, such signifcant reforms as that proposed for social care, increasing public provison for the lower and middle classes, are usually associated with major conflicts involving the whole country and large numbers of the populace returning to civilian life who have become used to emergency centralised control and administration, to the use of weapons, and to death and mayhem.