"While there is general agreement that the current system of health and care is unsustainable, there is still debate as to how the system might be improved".
This warning neatly summarises the current situation faced by care and health. Yet these words are taken from an introduction to a report published by the Local Government Association a year ago, and the fact they are still accurate reflects the stalemate that social care finds itself in today, at least in terms of funding.
Although the government has acknowledged the crisis by announcing an increase in the social care precept (the amount of council tax that funds social care), this response is a short-term drop in the ocean as leaders in the sector have warned.
Looking back at 2016 it is easy for the enormous financial strain that the social care sector has experienced to overshadow our positive progress. As the year ends, a review of the key issues - and our responses to them at VODG (Voluntary Organisations Disability Group) - offers a glimpse of where the sector's focus must be in 2017.
Although in 2016 social care loudly and collectively banged the drum for a decent funding settlement, our unified voices went unheard. We had, for example, built on our earlier, unprecedented, moves joining forces between providers, commissioners, and the NHS for a sustainable solution. And 2016 also saw Simon Stevens, chief executive of NHS England making a strong case for extra funding for social care.
As Ray James, former president of the ADASS (Association of Directors of Adult Social Services), asked "How can an Autumn Statement in the midst of an unprecedented financial crisis in social care ignore every respected voice across the sector"? Even the regulator CQC, which continued to shine a light on quality in 2016, issued the bravest message in its lifetime focusing on the sustainability of the sector and warning of the impending "tipping point" in adult social care.
More evidence of our sector's financial dire straits came in the 2016 budget survey of directors of adult social care, which reported £941m being taken out of services during 2016/17. One finding was that over 90% of directors of adult social services reported assistive technology being a key means of overcoming the challenging financial environment. The subject related to a VODG report published not long after the ADASS survey. The publication, Technology is changing the way we live, found providers willing to invest in technology to generate long term savings if commissioners focused on outcomes rather than fixed hourly rates. But, as 2017 nears, it is clear our sector has yet to shift towards outcome-based approaches at any significant scale or pace.
Commissioning, collaboration and social value
As for progress on stronger commissioning, this year voluntary sector organisations continued to convince commissioners to maximise investment from public spend through the Public Services (Social Value) Act (legislation that places a duty on prioritising social value over simple efficiency or lowest price). This is a key area for VODG, which in 2016 published a practical resource to support the delivery of social value in commissioning, arguing for commissioning driven by outcomes for people.
Social care providers also welcomed the recognition for greater alignment between statutory agencies and the voluntary sector, reinforced with the publication of the VCSE (voluntary, community and social enterprise sector) review (the largest ever review of the voluntary sector's involvement in statutory health and social care). With the ongoing challenge for voluntary organisations to land social value squarely within the social care 'market', in 2016 VODG brought leaders together to investigate opportunities for partnership between health services and voluntary organisations.
Anticipating an increasingly competitive "market" for social care provision, the opportunity is for all organisations, however large or small, to be more clear about how surplus from trading activities delivers wider social good. One way, as outlined in a volunteer management toolkit produced with colleagues at the National Care Forum, is by raising the status of volunteers to help build community capacity.
Volunteers are vital but, as our members told VODG this year, our sector also needs to transform itself into a career of choice and secure the supply of an affordable workforce. VODG work in 2016 included a summit on workforce challenges. The event and related report, How do disability organisations recruit, retain and develop the right workforce, reflected a strong commitment to partnerships. There is clearly an appetite amongst organisations to actively collaborate to share workforce intelligence and ways of sharing costs, such as through improved procurement and combined back office functions.
Disability and employment
The launch of the government's green paper on work, health and disability towards the end of the year acknowledges the need for social care services to increase the numbers of disabled people working within our sector. We need more providers, employers and policy makers to grasp and roll out innovative ways to support disabled people into work, as underlined in VODG's report in response to the green paper, Closing the disability and employment gap.
National Transforming Care policy
And 2016 marked four years since the abuse at Winterbourne View assessment and treatment unit (ATU), the scandal that sparked a renewed effort to move people from such institutions and back into communities. However, commissioners are still using such units, despite policy to the contrary set out in the national Transforming Care plan from NHS England and partners. Ongoing use of ATUs continues to compromise the lives of thousands of people with complex needs each year, despite calls for changes to commissioning practice. The 2016 VODG report, Together we can, called greater system leadership to address this - but progress has been exceptionally poor.
Much of the year was dominated by the fallout of the decision to leave the EU. VODG's subsequent analysis of the impact of this on social care, identified concerns amongst voluntary organisations about rising inequalities. VODG documented the impact on providers of the vote to leave the EU in the report, Post-Brexit: what next for voluntary sector disability organisations? Subsequently, specific concerns include the rising tide of hate crime. The continuing unease led to a further exploration of social care priorities after Brexit, in our report, Post-Brexit: the impact for social care provider organisations. It is clear that in 2017, it will be increasingly important to monitor and respond to the known - as well unknown - emerging issues following the referendum.
Yet despite the uncertainties that permeate the sector, the late Harold Bodmer used his inaugural address as ADASS president to call on the sector to come together. He said: "We need a social movement about social care - a campaign that starts now and reaches out over the next few years." And this is a fitting way to approach the next year too. Throughout 2016 there have been separate pockets of discussions. Like the #EveryBritCounts event which sought to take forward the learning from Australia which is achieving a new settlement for disabled people via a citizen led social movement.
So 2016 - a year of progress against the unprecedented odds? What the challenges of this year show us is that no single organisation can address the plethora of risks to the social care system. The issues in 2016 provoke social care in 2017 to act as a unified body and strengthen our existing partnerships, not least after the government's underwhelming response to raise the social care precept, a move that is more sticking plaster than rescue package. And, more than this, we must go further and collectively invest in the success of enabling our sector to develop, flourish and crucially support people to live the life they choose.