Opinion: The Care Act cost conundrum

4 September 2014

Trevor Hampton, Director for Local Government, Northgate Public Services

The fundamental aim of the Care Act is as simple as it is powerful – to keep people independent and healthy for as long as possible.

It prioritises outcomes rather than services, involves people in defining the outcomes that matter to them, provides integrated support and introduces duties to promote wellbeing and prevent or reduce need.

This integrated approach to prevention enjoys strong support from the social care sector and is a financial necessity. Hospital admissions and long term dependent care are expensive. Factor in an aging population and limited public finances and the status quo is just not an option.

Logic suggests that prevention is not only preferable but also infinitely cheaper, both for individuals and for government. It is the cost of advice on how to stay mobile versus a fall-related A&E admission.

Yet it’s the cost of moving to this ‘cheaper’ model that is threatening to fracture the consensus around the Care Act reforms. It will not become cheaper overnight, not least because councils still need to cover the dependent care costs of those already in the system. The Local Government Association has said nine out of ten councils think implementation is under threat from a lack of funding; the Government’s response has been to restate its commitment to making the changes sustainable.

The conundrum at the heart of this legislation is in understanding the relationship between what a preventative approach costs, the outcomes it delivers and how much money it saves.

Take social isolation as an example, where there is a correlation between feeling isolated and entering the care system. Helping communities to build their own local support networks will be vital for early intervention and is a model that already works well; increasing numbers of older people are using social networking sites to find information, access practical support and build connections with others.

If we can encourage more people to connect with each other locally and involve families and carers in this process we can enable simple things like lift sharing to a lunch club or a jointly planned theatre trip. In this way, social media can help reduce isolation and also build community capacity to meet other needs in the future.

This is a low-cost example with obvious wellbeing benefits but can councils ever know how many people it helped to keep out of the care system? And if that’s not known, how can we know how much money it saves?

The answer to how much the Care Act costs will come a lot faster than the answer on how much it saves, but councils and health bodies are already considering what information they will need in order to judge the success of different approaches. They are also looking at how to capture insight from care providers, the third sector and from citizens themselves, who may be aware of someone in need but are unsure what to do.

Making it easy for communities to build their own forms of early intervention could play a key role in making prevention cost-effective, but the wider debate on funding is likely to run for some time. One thing is certain; neither central nor local government can afford to get it wrong.