OPINION: Continued investment in carers services is in everyone’s best interest: our learnings from Devon
Summary
Unpaid carers are the ‘third leg’ of the health and social care system, but they need timely and appropriate support to continue providing vital care to the person they care for.
We recently produced a report for a remarkable unpaid carers charity, Devon Carers, to evaluate their life-changing work supporting Devon’s third leg. This evaluation came at a critical moment in time: just as Devon County Council faced tough financial decisions concerning the carer budget and proposed cuts to their investment in Devon Carers.
Our independent report, whilst objective, makes it quite clear that proposed cuts to Devon Carers just do not make sense. Outlined below are five considerations that present barriers to any combination of cuts to Devon Carers’ budget. If you’re from another locality facing similar challenges, we encourage you to read on!
Context
Unpaid carers make it possible for people with caring needs to be cared-for at home, by someone related to or connected to them. In this way, unpaid carers are the ‘third leg’ of the health and social care system. Supporting unpaid carers falls under the remit of top tier local authorities. In practice, the carer support function is often best fulfilled by charitable and civil society organisations that are often agile, deeply motivated, trusted by carers and extremely knowledgeable of their needs too, often helped by the fact that such organisations are typically led by people with lived experience that are passionate about unpaid carers. We recently produced a report for a remarkable unpaid carers organisation, Devon Carers, to provide a full picture of their life-changing work for Devon County Council, which like all local authorities nationwide, encounters tough financial decisions in relation to the carer budget.
Devon County Council (DCC) invests £3 million per year to commission Devon Carers, providing a mix of statutory services and preventative support; they are Devon Carers main funder. This partnership has led to a cost-effective and high-quality support system for unpaid carers in Devon - a system that supports carers both in crisis and prevents crises from occurring. However, DCC has recently been under pressure to substantially cut the carer budget.
With ‘no fat left to trim’, if the proposed cuts came into force, Devon Carers would be forced to lose key components of their high-functioning system, which they have built in partnership with DCC.
Devon Carers sought an independent evaluator and selected us, Civil Society Consulting CIC, to evaluate the likely impact of proposed funding reductions and service provision, and reflect the implications in a concise report so that DCC is better placed to make an informed decision.
The importance of support for unpaid carers
Being an unpaid carer indefinitely without support is, simply put, not sustainable.
Being a carer, which often involves putting someone else’s needs before one’s own and navigating a health and social care system in crisis, seems to be the perfect storm for chronic stress, social and emotional isolation, and self-neglect. Without preventative measures in place, or timely and appropriate support when problems arise, carers mental and physical health can deteriorate rapidly. Eventually, it may become impossible for the carer to continue providing care.
Devon Carers supports unpaid carers to minimise the negative impact of their caring role on their health, wellbeing and life. Devon Carers provide: practical support and timely information; empathy, recognition and emotional support; and advice and guidance to understand the value of self-care and breaks in achieving health and resilience.
Five key considerations
Our independent report, whilst objective, makes it quite clear that cuts to Devon Carers just do not make sense - whether you come from an economic standpoint or use a human dignity and rights lens, and whether you are looking at it from the short-, medium- or long-term perspective.
We consulted with 25 experts among the Devon Carers staff team and reviewed academic and grey literature about carers and carers services in order to assess the impact of the prospective funding cuts. When examining the various combinations of funding reductions initially proposed in the Council’s Spring consultation, Civil Society Consulting CIC identified five key considerations for implementing any combination of cuts to Devon Carers’ budget.
1. Any significant reduction to Devon Carers’ budget would not generate savings for the council in the short or medium-term:
Unpaid carers support a person in need of care at no cost to the local authority or wider UK Government. However, being an unpaid carer is notoriously challenging, so carers cannot provide care without being supported in a timely and appropriate way (nor can they be expected to).
In Devon and elsewhere, the carer budget fundamentally exists to save the public purse, whilst of course reducing suffering and improving lives for those with care needs and their carers. An unpaid carer’s circumstances can deteriorate very rapidly if timely and appropriate support is not provided, meaning that the additional costs of not supporting them would be felt relatively immediately. Moreover, each of Devon Carers’ services are designed with the explicit purpose of being effective low-cost solutions that reduce expenditure for the local authority. For this reason, a cessation or reduction of Devon Carers’ services/functions is like “releasing the floodgates” on costs that were previously prevented or kept at bay, rather than a genuine solution for reducing overall spending.
Whether bringing statutory services in-house, cutting core aspects of preventative support, or losing aspects of the wider carer offer…
“It’s like getting rid of your washing machine to save money on water, only to realise that you’ll now have to take your clothes to an expensive laundrette that it is a hassle for you to get to anyway… or that you’ll use up just as much water trying to wash your clothes poorly in the bathtub.”
2. Any significant reduction to Devon Carers’ budget would generate considerable additional costs in the long-term:
DCC’s financial predicament is not going away anytime soon. Therefore, they need to be making decisions on how to make savings in the following years. Devon Carers addresses carers’ issues upstream to prevent significant issues and costs arising further down the line. When considering the longer-term, the notion of cutting Devon Carers’ budget is all the more counter-intuitive and ineffectual because:
Late intervention costs more;
If carers aren’t being supported before they reach ‘crisis point’, they are likely to reach a point where they are unable to care; and, because
Poorer health outcomes for caregivers, which are likely to manifest in the present, will ultimately lead to increased costs down the road.
The long-term savings generated by Devon Carers will be experienced by multiple stakeholders besides the local authority, e.g. the health system, which could be taken into account when investigating new funding mechanisms.
3. Increasing Devon Carers’ portion of the Carers Budget is a means for saving money for the council:
Like many other agile, lived experience-led charities across the UK, Devon Carers has the most efficient way of delivering the support that carers need now and for reducing their need for support in the future. Therefore, our report recommends an “invest to save” approach (NHSI, 2021): increasing Devon Carers’ portion of the carers budget (i.e. outsourcing more rather than less work to the organisation) represents an opportunity to generate meaningful savings for Devon County Council and the public purse.
The report specifically finds that:
DCC has not yet reaped the rewards of the cost-saving measures Devon Carers has already implemented earlier this year;
Investing in Devon Carers’ ‘ultra preventative’ activities and services ensures early intervention at scale that would produce net-savings in the longer-term; and,
While there is “no fat left to trim” in terms of how Devon Carers delivers vital support to carers, there are still some future innovations that have the potential to create savings for DCC. By working with Devon Carers co-productively, DCC is more likely to identify opportunities to generate the net savings it needs.
4. The timing of the reductions would amplify their impact:
There has been a sharp rise in complex cases since the Covid-19 pandemic and the current Cost-of-Living Crisis, which have come on the back of over a decade of reduced public spending. Consequently, carer resilience is at an all-time low - and the health and social care system is weakened. The timing of these potential budget cuts would amplify their impact. In particular:
In one way or another, significant cuts to Devon Carers budget would reduce the quality of care or the number of carers receiving it. Withdrawal of support to carers could trigger a sharp downward spiral for many carers with complex cases, since there is no source of comparable support out there. It will also be distressing for Devon Carers staff. With the Cost of Living Crisis adding a further layer of pressure, it could become more difficult to retain the passionate and first-rate staff that are the backbone of Devon Carers, adding further to the downward spiral effect. Moreover, the whole health and social care system is in an urgent and fragile state. Failing to support its ‘third leg’ (unpaid carers) at this critical moment could trigger the system to collapse.
Besides the negative outcomes for carers, staff and the system, funding reduction is likely to lead to various “horror stories” where complex cases have not been managed in an appropriate and/or timely way. Importantly, carers from underserved communities are likely to be worst affected by the impact of reduced spending.
5. Devon’s model for supporting carers is a leading light nationally:
The UK is moving to a more integrated health system, taking a more preventative approach to health and social care. Voluntary and Community Sector (VCS) organisations, like Devon Carers, are regarded as having an integral role in this new system. And this is reflected in law: “integrated care systems (ICSs) must look and feel different from the past by embracing the VCS like never before. VCS bodies should be able to build on the work they are undertaking and be treated as key partners in the delivery of health and care” (NHS Federation, 2022). Now is the time to be strengthening existing statutory-VCS relationships and investing in VCS partners.
Across the UK, statutory partners are grappling with this transition. However, Devon is ahead of the curve - thanks to the excellent partnership between DCC and Devon Carers. This report depicts an exceptionally effective and integrated carers support service that has been successfully developed and scaled. Continued investment at the current level will mean Devon Carers continues to be a leading source of pride for Devon County Council at national level, whereas reducing Devon Carers funding would go against the direction of travel nationally.
The decision to withdraw support from Devon Carers not only poses a risk of undoing all the progress that Devon County Council has achieved in establishing the current system, but it’s likely to only be a matter of time until the county is under pressure to rebuild the current system.
Conclusion
It is difficult to find justification for reducing Devon Carers’ budget - that’s clear. What’s more, these five considerations are part of broader trends. The financial challenges facing Devon County Council are similar to those in many other local authority areas across the UK. And the qualities that make Devon Carers best for the job - motivation, trust, knowledge and agility - are not unique to this one charity. We have found through our other work with other grassroots charities that these qualities enable VCS organisations to complement gaps in public services, as well as meet the needs of people and communities often described as seldom-served or ‘hard to reach’. Now is not the time to divest from VCS services that have been tried, tested and continuously modified to prevent, reduce and delay the need for statutory support, particularly on the back of the socio-economic crisis we all find ourselves in.
If you’re from another locality facing similar challenges, we encourage you to share this article and report as a way of advocating for other local authorities to have DCC’s courage to invest in VCS organisations so they can do what they do best.
