What value does low-level preventative support have for society and what does it cost?
The Scottish Finance Committee is currently conducting an inquiry into exactly this. Its aim:
"To consider and report on how public spending can best be focused over the longer term on trying to prevent, rather than deal with, negative social outcomes."
This is exactly the sort of approach we need for the longer term. Whatever public money there is, let’s make sure it is used wisely. Let’s talk about how to save public money without false economies, and without diminishing social justice or quality of life.
(Read JRF's full response to the inquiry.)
For older people, most services are focused on the highest needs of the frailest people, mainly funded from health and social care budgets. Yet these services are not what many older people want – they value supportive interventions, often at an earlier stage, and ‘that bit of help’.
When JRF’s Older People’s Inquiry explored this further, it found many examples already in existence of the kind of help older people want. Importantly, many were provided by volunteer services, often with support from local authority grants.
In the current climate of budget cuts, any investment must be justified by its social return on investment, if not clear evidence of cost savings. Seemingly unproven prevention schemes may be viewed as a luxury.
But some preventative work is hard to quantify. For example, we may know that unsafe and unsuitable housing can be a trigger for admissions into hospital or residential care (falls are a major cause). But it is notoriously difficult for schemes like this to quantify any direct impact on future costs to housing, health or social care budgets.
The effectiveness of preventative spending in later life has been most clearly demonstrated by the national evaluation of POPPs (Partnership of Older People Pilots) – a point highlighted in a Policy Exchange report, Careless.
Policy Exchange advocates continued investment in low-level preventative support to older people, in part to help keep down the costs (to individuals, state and society) of funding long-term care, and to increase the quality of later life.
POPPs offered a range of services to promote health, well-being and independence, to understand how this might prevent or delay the need for higher intensity (and more expensive) care. The evaluation found that overnight hospital stays were reduced by 47% and use of A&E departments by 29%. The result: for every extra £1 spent on the POPP services, there was approximately a £1.20 additional benefit.
When you scale that up to a rapidly growing population of older people, we are talking about significant savings to public spending.
More recently, JRF funded an evaluation of three pilots which trained care staff in residential care homes with basic clinical and nursing skills. This produced clear evidence of benefits and cost savings, preventing between 81 and 197 potential hospital admissions over the first two years, as well as facilitating 20 early discharges. There was an overall saving of £36.90 per resident per week, from avoiding hospital admissions and transfers to nursing homes.
But the depressing reality is that pressure on public spending on health and care is likely to incentivise fire-fighting approaches as well as salami-slicing. The onus will be on dealing with the most critical cases, not prevention. Many preventative services rely heavily on user charges and increasing these will undoubtedly restrict access. They also need volunteers, who are often older people themselves. Stimulating and sustaining volunteer-based support will be essential.
It is vital we exploit what we know to face the challenges that the comprehensive spending review will bring. That is why JRF and Centre for Policy on Ageing are working together to gather evidence for empowering and effective solutions that lend themselves to these cash-strapped times.
So this is where I want to shout 'hurrah' for the Scottish Financial Committee for looking at the potential of preventative spending. Justifying something that may initially raise costs is going to be increasingly difficult...and incredibly important.
PDF version Scotland's Draft Budget 2011-12 sets out the Scottish Government's spending plans.
Key commitments in the Budget for 2011-12 include:
* an agreement with COSLA to deliver a further council tax freeze, maintain police numbers and key education and social care commitments.
* funding for major infrastructure projects such as the new Forth Crossing, the South Glasgow Hospitals and Scotland's Schools for the Future building programme - and a £2.5 billion pipeline of health, education and transport projects to be delivered through the Non-Profit Distributing model.
* protecting spending on running health services in Scotland and abolishing remaining prescription charges, finally removing the tax on ill-health.
* introducing a pay freeze for public sector workers, with staff earning less than £21,000 receiving a minimum annual pay increase of £250, and bear down on the cost of the pay bill for the highest paid. This will also suspend all access to bonuses next year.
* sufficient teaching posts for all post-probationer teachers in 2011 and a further real reduction in longer term teacher unemployment as agreed with the COSLA leadership.
* maintaining existing eligibility criteria for free personal care and concessionary travel, saving money for older people.
The Scottish and Welsh governments have sought to protect social care from swingeing cuts in draft budgets that would see councils in the two countries face smaller reductions than counterparts in England.
Council leaders across the two countries hailed the proposed settlements as the best that could have been negotiated at a time when both countries are receiving real terms cuts in their block grants from Westminster of about 11% from 2011-15.
In a proposed one-year settlement, Scottish government revenue funding for councils will fall by 4.4% in real terms. The Welsh government's proposed three-year settlement would reduce revenue funding by 3.6% in real terms next year and by 7.1% overall from 2011-14.
English councils will face a real terms reduction of 28% from 2011-15, with more than 10% coming in the first year.
Both the Scottish and Welsh governments said they wanted to protect social care more than other areas. In Scotland, departments other than local government are expected to see real terms falls of about 8.3% in funding next year, with the exception of health, which will have a roughly stable budget in real terms.
As part of their settlement, Scottish councils will be expected to maintain free personal care for older people and uprate benefit payments next year. Social care should also be boosted by a £70m change fund allocated to NHS boards in 2011-12 to help shift health and social care services from acute settings into the community.
The settlement was hailed as "the best financial package with the maximum flexibility" under the circumstances by local authority body Cosla.
"Nobody is saying it is brilliant, the money coming to Scotland is down but there is a significant level of 'protection' for local government compared to other parts of the public sector," said president Pat Watters.
In Wales, the 7.1% real terms reduction from 2011-14 is in line with the average for all departments. However, the Welsh government said the settlement was sufficient to ensure that the most vulnerable social care users were protected from service reductions.
The Welsh Local Government Association said the Welsh government had "responded positively to the arguments made by local government particularly in relation to social care".
"I'm sure that council leaders will agree that in the current climate this outcome is as good as it gets although we will await the distributional impacts on individual councils next week and we must not forget the rising cost of services arising from inflation," said WLGA leader John Davies.
As widely trailed, the Scottish government also announced a one-year pay freeze for public servants for 2011-12, apart from those earning less than £21,000, who will receive a £250 rise. Though this does not apply to council social workers, Cosla has already proposed a two-year pay freeze for local authority staff, which unions are challenging.
http://www.communitycare.co.uk/Articles/2010/11/18/115843/scots-and-wels...
Edinburgh struggles to maintain social care in face of funding settlement
Edinburgh Council will struggle to maintain its social care provision after being one of the worst hit by the Scottish government's local authorities settlement, the lead member for social care has warned.
Edinburgh is one of six authorities set to see their central government revenue funding drop by 4.5% in 2011-12, the highest percentage cut.
Paul Edie, convenor for health, social care and housing, said: "We will be struggling to stand still on social care provision." He said in the past the council had always looked to free-up resources to meet more people's needs but that this would be impossible given the scale of cuts imposed by the Scottish government.
"We were expecting a little bit more than we got [in the local government settlement]," he added. "I'm disappointed that we seem to have gotten squeezed out again but my job is to do what I can to protect services for the vulnerable people."
Edie was optimistic that Edinburgh would get substantial support from a £70m Scottish government change fund, earmarked to fund greater integration of health and social care. The fund was announced alongside the details of the local government settlement last week. Edinburgh is expected to receive £6.9m, which must be spent on joint projects with health.
The Scottish government has said this funding is only available to councils who freeze their 2011-12 council tax at 2010-11 levels.
http://www.communitycare.co.uk/Articles/2010/12/13/116004/council-will-s...
A further council tax freeze next year and the delivery of key commitments, including the maintenance of 1,000 more police officers, has been secured after Scottish councils formally accepted the terms of a deal agreed between Ministers and the Convention of Scottish Local Authorities.
Councils had until yesterday to confirm whether they backed the agreement, which will restrict local government's revenue funding reduction next year to 2.5 per cent in the face of swingeing Westminster cuts - a greater degree of protection than other parts of the Scottish Budget and superior to that for local government in England.
All 32 councils had earlier provisionally supported the agreement before setting their budgets. Today it was confirmed that all 32 councils had now formally agreed to sign up.
Finance Secretary John Swinney said:
"This is excellent news for Scottish communities and householders who, in what remains a challenging financial climate, will see the benefits of a fourth successive council tax freeze fully-funded by the Scottish Government.
"The agreement will also maintain 1,000 more police officers than were in post before this Government came to office and secure the delivery of outcomes for Curriculum for Excellence. It will maintain pupil teacher ratios to improve education for our children and young people, protect the number of teacher posts as far as possible and provide resources for a social care fund.
"In the face of the biggest reduction in public spending imposed by Westminster on any Scottish Government, the local government funding package for next year is the best possible outcome. It restricts councils' average funding reduction to 2.5 per cent - a greater degree of protection than other parts of the Scottish Budget, and superior to that for local government in England. The alternative would have been not to maintain delivery of key commitments to improve vital public services, from which the people of Scotland would undoubtedly have suffered."
The Scottish Government will shortly table an amendment to the recently-agreed Local Government Finance Order, which will seek parliament's agreement for the remaining distribution of funding to local government, following the confirmation that all councils have formally accepted the agreement with COSLA leadership.
Scots have come out strongly against spending cuts in the National Health Service, according to an exclusive poll for BBC
Scotland.
The finding is at odds with that of the independent Beveridge Report on Scottish spending plans, which said the NHS should not be exempt from cuts.
Ipsos MORI asked 1,000 Scots about 10 areas where savings could be made ahead of the UK government's spending review.
The Scottish government is due to publish its budget in November.
BBC Scotland public spending poll
PDF download Read the full poll here[6.90 KB ]
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Respondents were asked to comment on the 10 options for saving money featured in the Beveridge Report, commissioned by the Scottish government.
Those polled by Ipsos Mori came out vigorously against the notion of cutting health spending in line with cuts due to be made elsewhere.
That applied to men and women, across social groups and the age range.
This finding helps explain why the UK government has promised a real terms increase for the NHS - and why the Scottish government has pledged to match that promise for Scotland.
This was a "forcing" poll: That is, it obliged respondents to make a choice without giving them the option "none of the above".
To read more http://www.bbc.co.uk/news/uk-scotland-11522955