Wholesale reorganisation of Birmingham social services to save £75m
A dramatic reorganisation of the way Birmingham City Council provides care for vulnerable adults will put paid to “well-meaning paternalism” and also cut costs by £75 million.
Driven by the unprecedented scale of Government grant cuts, the council says it can simply no longer afford to place so many people in residential care and must shift to a system where many more of those in need of help are looked after in their own homes.
A consultative paper launched by council leader Sir Albert Bore proposes a stronger working relationship with the NHS aimed at preventing children with learning disabilities and mental health problems from progressing to adults requiring a lifetime of costly residential care.
Greater emphasis will be placed on preventative action to promote healthier lifestyles, making it less likely that older adults will end up spending their final years in nursing and residential homes.
The council will also seek to embrace the Government’s Big Society model by looking to community groups, family and friends to provide care for older people rather than relying on the state.
The shift towards personal budgets, where those in need of help are allocated a sum of money and encouraged to make their own decisions about buying in services from the council and private and voluntary sectors, will take on a greater pace.
Essentially, the council’s strategy is to control demand and move away from trying to do something for everyone regardless of the severity of needs. Sir Albert said the alternative would be to carry on spending more and more on social services, resulting in the wholesale closure of almost every other service offered by the council.
He pointed out that Birmingham spends far more on adult residential care than other comparable authorities, with the financial burden per person ranging from about £400 a week to £3,500 a week for people with the greatest needs.
Just over half of the entire budget for adults with learning difficulties is spent on residential care. The aim is to bring the proportion down from £1 in every £2 to £1 in every £5.
The push for better joined up services between the council, the NHS and the voluntary sector is a crucial test for the new Birmingham Health and Wellbeing Board, which brings council leaders together with the city’s three clinical commissioning boards.
Health and Wellbeing Board chairman, Birmingham cabinet member Steve Bedser, said change on an “unprecedented scale” was required if the council was to reduce spending while continuing to look after adults whose needs are critical and substantial.
Cllr Bedser added: “The board is not yet three months old but it is already grappling with how we best organise services for elderly frail people.”
He added that people who had “dipped their toe in the water of independent living” by using personal budgets to stay out of residential care invariably reported a happier lifestyle.
A briefing paper released by the council says Birmingham is over-reliant on residential care, even if it is not always in the best interests of clients.
It states: “Not everyone who is in the care system needs to be there. Birmingham is placing too many people with all types of needs in residential and nursing care. This is a reflection on the current quality of housing, community and employment options.
“The outcomes for people from a high cost and high end system are poor. Regardless of the financial context, there is a case for urgent change based upon ambition to do better for people.
“We want a preventative model of care that focuses on those most in need of intervention. The experience with many older people has already shown that a little bit of help delivered at the right time stops the need for on-going long term care.”
However, the small print makes it clear that what’s being proposed is nothing less than a radical shift away from the notion that the council will always be there to provide assistance for everyone. Social workers will become “people’s champions” and spend more time “strengthening the circles of support offered by family and friends”.
The document warns: “We need to change well-meaning paternalism into championing rights, and those rights for many people are not their rights to care, but their rights to be citizens.
“The long and short of it is that at present we promote the need for care. We need to promote the rights of all our people, regardless of ability or disability, to jobs, housing and high quality universal public services like health care.”
