As government continues to shift the burden for services (and the blame for their shortcomings) onto councils, whilst cutting their budgets, Julian Andrews explains the impact on Devon’s budget and inhabitants.
“The age of irresponsibility is giving way to the age of austerity”, said David Cameron in 2009. Shortly afterwards, then-Chancellor George Osborne announced cuts of £40bn to public spending: the age of austerity had well and truly begun. Twelve years of Conservative government later, we are still suffering the effects.
In 2015, the Joseph Rowntree Foundation concluded,
“Despite local authorities’ best efforts, the cuts have hit the poorest people and places the hardest, with those least able to cope with service withdrawal bearing the brunt.”
Those cuts to local government funding have continued unabated. Successive administrations have reduced funding to our local authorities by 37 per cent in real terms between 2009/10 and 2019/20.
In January 2022, with the start of a new financial year (FY) just two months away, it’s budget-setting time for our local authorities. The amount of money which county councils will receive from central government for the FY ahead has been announced – but for one year only, instead of the usual three.
Devon County Council has five specific areas of responsibility within its overall budget:
- adult care and health;
- children’s services;
- communities, public health, environment and planning;
- highways, infrastructure development and waste; and
- corporate services.
Overall, Devon County Council is proposing an overall target budget of £629m for the 2022-23 FY – an increase of 8.4 per cent on the current year. Of that total, adult care and health services have been allocated 49.7 per cent (£313m), including a 10.5 per cent increase worth close to £30m on the previous year’s allocation. You would probably assume that the increase would guarantee continuing – if not improving – the level of care offered to the county’s elderly folk, to people with disabilities and to those suffering with mental health issues.
You’d be wrong. In order to balance its budget, from April the county council will have to make some very serious cuts, totalling almost £18m, to its adult care and health services.
The details of these cuts are contained in the Joint Report from the county council’s director of finance, the chief officer for adult care and health services, and the director of public health. The report was presented to the council’s Health and Adult Care Scrutiny Committee on 20 January and if you, a friend, a relative or someone you know has need of health or social care services from Devon County Council, then you may want to take more than a passing interest in the numbers – and what they mean in practice.
The Scrutiny Committee is a cross-party group of councillors tasked with examining how the proposed budget would be spent, commenting upon it and making recommendations which then go to the council’s nine-member cabinet, whilst the overall council budget for the new FY must balance and must be approved at a full meeting of the county council. That’s how it works.
I watched the webcast of the Scrutiny Committee meeting, at which members questioned the three council officers responsible for managing adult care and health services, led by the department’s chief officer, Jennie Stevens. Listening to the councillors’ questions and the concerns they expressed, and hearing about the financial and practical pressures the officers face, you couldn’t fail to feel sympathy for them. Unreasonably high public expectations – sadly, often born of ignorance – must make their jobs even harder.
The report explains:
“The overall financial approach in Adult Care and Health is to protect the most vulnerable whilst seeking to manage costs at a fair and affordable level and balance of risks. This involves continuous improvements in efficiency and effectiveness and being innovative in how to meet the care needs of eligible individuals. This has to be achieved against the ongoing challenge of an ageing population, rising complexity of care needs (including younger adults), and an ongoing Covid-19 pandemic.”
That all sounds like council jargon and a bit predictable, but they can’t put it as boldly as they’d probably wish: ‘We haven’t got enough money coming to us from central government, we can’t put up council tax as much as we need to, we haven’t got enough care staff and yet you lot want us to keep doing more and more. With less’.
The report details where the £18m ‘savings’ (cuts, to you and me) can be made. In large part, these are:
- reduction in support for independent living for disabled people;
- reduction in care and support for elderly people;
- reduction in care and support for people with physical and learning disabilities;
- reduction in care and support for mental health services;
- savings on ‘prevention’ contracts (measures to protect health, to avoid later intervention) and associated fees; and
- the introduction of an ‘arrangement fee’ for those arranging their own self-funded care, and improvements to non-residential care charging processes.
That last one is interesting because although 11,000 people in Devon have their residential care funded by the county council, the same number make their own financial and practical arrangements for suitable, specialised accommodation. From April 2022 it looks as if these people – despite funding their care themselves – will have to pay a fee to the council for their needs to be assessed.
At the Scrutiny Committee meeting, the officers were asked why the cuts were necessary when there was to be a 10.5 per cent increase in funding: an obvious and entirely reasonable question, you would think. “Doing more, with less”, came the short reply. That sounds glib but is actually true, and when you look at the figures baldly tabulated in Jennie Stevens’s report, you listen to the three council officers justifying their decisions and calculations, and then you reflect on the national ‘social care picture’, you can see the council’s predicament all too clearly.
Life expectancy is generally increasing – it was 66 for men and 70 for women in 1948 but is now 79 and 83 respectively. Ever more care home and nursing home places are needed: not easy to source when there are so many hard-to-fill care sector vacancies in Devon. There are estimated to be 105,000 across the country, and the staff turnover rate is almost 30 per cent.
The Chief Officer said Devon has proportionately more elderly people living here than in other counties and she laid it out very clearly: demand for adult care and health services is increasing constantly because there are simply greater numbers of needy people now, many of whom have complex physical and mental difficulties, and some who may need more specialised and costly help for longer.
She also outlined new regulatory and financial challenges: the cessation of covid-related grants from the NHS and from central government; increasing numbers of people becoming eligible for their needs to be assessed; changes to the law on equality and ‘liberty protection’ (the safe accommodation, in order to facilitate their care or treatment, of people without the mental capacity to consent to these arrangements); increasing numbers of vulnerable young people transitioning from care via children’s services, to those for adults; increases in the cost of care provision owing to the introduction of the National Living Wage and proposed National Insurance Levy; and, of course, the effects of inflation. Inevitably, the impact of covid has also exacerbated the situation in many ways – none of them good. It is a long, ‘money-hungry’ list which Jennie Stevens outlines in her report and remarks to the Scrutiny Committee.
Paradoxically, the proposed adult care and health budget, though cut, makes provision for almost £1m to be spent (as shown on page 12 of the report), on “new staff required to support savings plans”. A million quid to employ staff to tell applicants, ‘Sorry, no money for you, so you’ll have to manage without our help’? It’s not as simple as that, however, because those applicants’ needs must be assessed, which involves employing more social workers, more occupational therapists, and other health and social care professionals.
Watching the video of the meeting, I couldn’t help but feel a measure of despair. The officers admitted that the cuts in the next financial year’s funding will inevitably mean that fewer people will get help from the county council in supporting their physical and mental needs, that any help given will be for shorter duration, and that any ‘care packages’ offered may be smaller in both scope and substance.
One ray of hope was mentioned, in the form of £10m for which the council is in negotiation with the NHS – the source of the money. But it’s far from confirmed as yet, and – if it comes to Devon – it’s a ‘one-off’, for one year only, and must be used to fund projects and processes which will be of direct benefit to the NHS, such as shortening patients’ hospital stays. Like so much else, everything is short-term, leaving county council staff, and the independent care providers on whom the council depends to such a large extent, unable to plan for the future with any degree of certainty.
Balancing the books is ever more challenging for our county councils. With some MPs suggesting that the Chancellor should cancel the more than 10 per cent rise (planned for April) in National Insurance payments – a ‘levy’ intended specifically to increase funding for the NHS and social care – it’s anyone’s guess where the money and resources will be found in order to meet the needs of disabled, elderly and vulnerable people in Devon and elsewhere in the UK.
One of the council officers suggested that there could be a much greater role for charities, communities, family members and friends in providing support.
Perhaps, but that sounds like a rather desperate solution to a problem which will certainly not be fixed anytime soon. We are a long way from seeing the light at the end of the austerity tunnel.
The author thanks Cllr Martin Wrigley (LibDem, Dawlish) of Devon County Council for his assistance with this article.