Impact of the Spending Review on health and social care Contents
Annex 2: Note of meeting with voluntary sector organisations, Salford Royal NHS Foundation Trust, 21 March 2016
At the meeting between members of the Health Committee and representatives of voluntary organisations at Salford Royal NHS Foundation Trust on 21 March 2016, these were among the main points made by the voluntary and other bodies attending:
- Reliable housing was important for those with mental health problems, but recent changes had meant that there was less certainty. The risk was that these vulnerable people would end up requiring drastic and expensive interventions.
- The Spending Review had failed to provide the not-for-profit sector with any long-term assurance on public funding. Local authorities were in fact making more and more decisions on funding for contracted services at a late stage, sometimes just a few days before the start of the relevant financial year. Although many non-profit organisations could raise funds through donations from the general public, income from local authority and other contracts was vital to maintaining services.
- In many areas established providers are dropping out of the provision of services because they simply can’t afford to provide the service for the amount of money now being offered. A number of examples were also given of services which were now simply not being commissioned by the local authority: the “stop smoking” service in Manchester was one; another was a sexual health/HIV centre in Oxfordshire. In another case mentioned, the local authority was now tendering for only 48 weeks’ care in a year, where previously it had funded a full 52 weeks.
- A number of participants suggested that the disinvestment in public health and other services, especially social care, was having knock-on effects and resulting in higher costs to other public services, particularly the NHS, but also other services such as criminal justice.
- The ability to secure Lottery funding is compromised because preference is for innovative projects not for established practice proven to work. Nor is Lottery funding provided as a substitute for government funding.
- There were concerns that, if voluntary organisations were to base contacts on the newly published Grant agreement, then they would be subject to VAT. Had NHS England asked HMRC to assess the model agreement before it was published? https://www.england.nhs.uk/nhs-standard-contract/grant-agreement/
- Far from having multi-period budgets, local authorities now regularly renegotiated contracts with service providers, including non-profit bodies, a few months after they had started. One body said that this instability meant that 25 percent of its services for the public sector were now provided without any relevant contract being in force. The Committee was told that the security of core contracts for third sector providers enabled additional services to be provided as well from charitable funds: the loss of those core contracts put the charitably-funded services at risk as well.
- The late timing of the Spending Review statement, with its radical changes to local authority funding, had meant that decision-making in councils had been pushed back by two months. In these circumstances, local authority commissioners deserved some sympathy when they found it hard to provide suppliers of services with a settled contract. But without clarity about income streams, voluntary organisations are unable to invest in new services.
- There were likely to be regional differences in the impact of the introduction of the National Living Wage (NLW). In addition, local authorities were not adjusting their funding for contracted services in light of the NLW; they tended to tell service providers that the NLW was ‘their problem’. The operation of the ‘Transfer of Undertakings (Protection of Employment)’ (TUPE) regulations could cause particular problems for smaller non-profit organisations; in some cases they were now walking away from invitations to tender for local authority contracts.
- The pressure on social care budgets was likely to continue to increase. The eligibility bar for access to social care had been raised, meaning that many people with less severe needs no longer received social care. However, those who remained eligible for social care were likely to have more complex needs and these would be more expensive.
- There was a general recognition of the potential benefits of integration of health and social care, but in order to make it work there needed to be serious investment in social care services, which had become run down. There were many examples of the benefits of early intervention and the provision of services, including palliative care, in the community; these examples contrasted with the more expensive (but not necessarily more effective) provision of care in acute hospitals.
- The aspirations of social services for older people, as expressed for instance in personal budget documents, were often very unambitious compared with services’ aspirations for younger people. This suggested that there was ageism at work. On the other hand, it was suggested by others that discussion about social services often focussed too narrowly on services for the elderly, to the detriment of thinking about those of working age.
- There were difficulties about the funding of palliative care services. For example, there was no clear agreement on when “the end of life” started and it was suggested that around 25% of people don’t receive the palliative care they need. Related to this was uncertainty about the level of funding currently devoted to “end of life” services. This lack of an agreed baseline would make it difficult to identify future progress on spending.
- It was said that the benefit of the 2 percent precept for social care would be more than wiped out by the impact of the National Living Wage and increased pension and NI contributions on budgets.
- Some participants said that the Greater Manchester Combined Authority needed to involve the not-for-profit sector more closely with the process of health and social care devolution. The sector could offer a new and positive perspective, but did not always feel that it was integrated enough with the development of devolution. There was wide variation in the extent of involvement of the sector in the ten localities into which Greater Manchester was divided.
- A suggestion that each local authority and clinical commissioning group should have a “link person” for the voluntary sector was agreed as a good idea in principle, but only if that person was sufficiently senior to be influential.