Debate on challenges facing social care in England following the pandemic, and effect of the Health and Social Care Levy on government social care plans House of Lords, 14 October 2021

COVID-19 has brought into sharp relief the challenges facing adult social care, and in many cases exacerbated them, but it has also powerfully underlined the essential value of social care in supporting people to live the life they want to lead.


Key messages

  • Years of significant underfunding, coupled with rising demand and costs for care and support, have combined to push adult social care services to breaking point. Over the past decade, adult social care costs increased by £8.5 billion while total funding (including the Better Care Fund) only increased by £2.4 billion. This left councils with a funding gap of £6.1 billion. Of this, £4.1 billion was managed through savings to the service, and £2 billion was managed through funding diverted from other services by cutting them faster than otherwise would have been the case. 
  • COVID-19 has brought into sharp relief the challenges facing adult social care, and in many cases exacerbated them, but it has also powerfully underlined the essential value of social care in supporting people to live the life they want to lead. 
  • The LGA has long called for fundamental reforms to adult social care and therefore the Government’s Build back better: our plan for health and social care (pdf) publication is a potentially important first step in changing the way people contribute to their care costs. It is helpful that the Government has looked beyond just this issue, outlining action on, for example, the workforce and supported housing. The Government has also committed to publishing a new adult social care white paper by the end of the year. 
  • However, we have serious concerns and question whether the proposals make the kind of progress needed to help adult social care deliver for people. For instance, we question the adequacy of the new health and social care Levy to fund all of the Plan’s adult social care commitments and need to know the profile of the £5.4 billion allocated to social care over the next three years, and what proportion of the Levy will reach adult social care beyond the three-year period covered in the Plan. 
  • We are also alarmed that the Plan does nothing to address ‘here and now’ pressures. On this, the Government’s solution for tackling social care’s core pressures appears to be the continued use of council tax, the social care precept, and long-term efficiencies. The reliance on the council tax social care precept has been a poor tax base to fund national entitlements under the 2014 Care Act. It is highly visible locally, but it has no relationship to need and the money raised has been insufficient to cover increasing costs. 
  • We estimate that an annually recurring cost pressure of £1.5 billion needs to be funded to stabilise the care provider market (the difference between what providers say is the benchmark cost of delivery care and what councils pay). We also estimate that core pressures (inflation, demography and National Living Wage) total £1.1 billion per year to keep services running at 2019/20 levels of quality and access. We need the Spending Review to deliver genuinely new funding to stabilise the system in the short-term and as part of securing the foundations for longer-term change. We call on the Government to commit a greater share of the new Levy to go to frontline social care from the outset. Addressing the NHS backlog and freeing up hospital beds cannot be done without action to tackle the immediate pressures facing adult social care. 
  • It was disappointing to see the absence of any action on a number of other crucial issues that all need addressing if we are to deliver a social care system that best enables people of all ages to live the lives they want to lead. This includes, for instance, a greater focus on and investment in prevention, funding to tackle unmet and under-met need, and investment for innovation and transformation. We hope the forthcoming white paper will tackle these issues and reflect and be informed by the range of work the LGA and partners have done on the future of care and support. Reforms emanating from the white paper must be fully-funded by Government.
  • It is also important the Government delivers a new deal for the care workforce, comprising action on pay, training and development, career progression and recognition. The plan must be developed in a manner equivalent to the NHS as part of a stable, sustainable solution to long-term funding problems and that this must involve “parity of esteem” for social care staff with their NHS colleagues. 
  • Any changes to pay and reward must be fully funded by central Government as there is no resource in the sector to meet the demands of this challenge. It will be important to assess the best form of comparison with the NHS on basic pay and resulting costs as overall costs could be in the region of £1 billion. 
  • This is a hugely complex area and there is much that needs clarifying in the Government’s plan. Over the coming weeks and months, the Government needs to work with councils, their partners and those with lived experience, in order to build on the proposals and develop a care and support system which is fit for the future.  
     

LGA response to "Build Back Better: Our plan for health and social care"

Following the Government’s publication of their plan for social care, the LGA produced a briefing which sets out our response to different parts of the Government's plan for health and social care. While there have been potentially positive developments, we have serious concerns and question whether they make the kind of progress needed to help adult social care deliver for people. Our main concerns are:  

  • We question the adequacy of the Levy to fund all the Plan’s adult social care commitments and need to know what proportion of the Levy will reach adult social care beyond the three-year period covered in the Plan.
  • We are alarmed that the Government’s solution for tackling social care’s core pressures appears to be the use of council tax, the social care precept, and long-term efficiencies. The reliance on the council tax social care precept has been a poor tax base to fund national entitlements under the 2014 Care Act. It is highly visible locally, but it has no relationship to need and the money raised has been insufficient to cover increasing costs. We estimate that an annually recurring cost pressure of £1.5 billion needs to be funded to stabilise the care provider market. We also estimate that core pressures (inflation, demography and National Living Wage) total £1.1 billion per year to keep services running at 2019/20 levels of quality and access. We need the Spending Review to deliver genuinely new funding to stabilise the system in the short-term and as part of securing the foundations for longer-term change. We call on the Government to commit a greater share of the new Levy to go to frontline social care from the outset. 
  • We are disappointed by the absence of any action on a number of other crucial issues that all need addressing if we are to deliver a social care system that best enables people of all ages to live the lives they want to lead. This includes, for instance, a greater focus on and investment in prevention, funding to tackle unmet and under-met need, and investment for innovation and transformation. We hope the forthcoming white paper will tackle these issues and reflect and be informed by the range of work the LGA and partners have done on the future of care and support. 
  • There is currently a real lack of detail on the Plan’s initiatives, and we are seeking to gather this information as a matter of urgency.
     

The Spending Review

If the Government’s plan for social care is to be realised, the Spending Review must deliver new national funding to stabilise the service. As laid out in our submission, the 2021 Spending Review is an opportunity for the Government to lay down a clear statement of intent for moving towards a future model of care and support where people of all ages who need to draw on social care are treated equally, valued for their contribution, respected for their knowledge of what works best for them and supported to live the life they want to lead in the communities they know and love. If the Spending Review does not set out in detail the level of funding given to social care overall, the reforms set out in the Government’s Plan run the risk of making the pressures facing adult social care considerably worse.

To ensure we can help people live the lives they want to lead, we are asking for a £1.5 billion injection of funding to stabilise the adult social care provider market, together with annual funding needed to meet the cost pressures. We also used our submission to call on the Government to develop the social care workforce in a manner equivalent to the NHS. Any consequent changes to pay and reward must be fully funded by the Government. We estimate overall costs of making pay comparable to equivalent NHS roles could be in the region of £1 billion.
 

Unpaid carers

The adult social care system could not survive without the contribution of unpaid carers who provide vital support for thousands of people every day.

Councils offer a wide range of support to unpaid carers as noted in our publication Supporting carers: guidance and case studies. As well as respite at home or short break services, they provide or commission services such as information and advice, carers hubs, discount cards, and direct payments. Additionally, councils commission specific support to young carers.

COVID-19 has further highlighted the incredibly valuable role played by unpaid carers and the difficult circumstances they face. An estimated 4.5 million additional people have become unpaid carers because of the pandemic. This is on top of the 9.1 million unpaid carers already caring before COVID-19 with many juggling their own health and wellbeing issues and employment.

Enabling councils to support the increasing numbers of unpaid carers should be a crucial part of a long-term and sustainable funding solution for social care. Additional funding will allow councils to support the increasing number of carers with a range of services including to help address specific needs, such as supporting carers of people with dementia, carers from BAME communities and young carers.

Caring can place a real strain on individuals – emotionally, physically and financially. Carers are more likely to suffer depression, anxiety and stress and nearly two-thirds of carers have a long-standing health condition. The impact is often exacerbated by carers being unable to find the time for medical check-ups or treatment. Personal relationships can also suffer and carers are more likely to be socially excluded. Recent ONS data has highlighted how unpaid carers have been more affected by the pandemic compared to the general public on aspects of lives including healthcare work, household finances and access to groceries, medication and essentials.

Young carers face particular disadvantages as caring often takes its toll on their education, physical health and wellbeing. They may have also struggled to access remote learning during the pandemic and this will have impacted on their education. Young carers are already more likely to fall behind in education and have lower educational attainment. Their needs should be fully considered in the government’s education recovery package as part of a long-term child centred recovery.

A recent report, Supporting carers following the implementation of the Care Act 2014: eligibility, support and prevention, found that the 2014 Care Act’s strengthening of carers’ rights appears to have been limited by the requirement for local authorities to keep within budget, and as a result these rights have not led to greater access to support for carers. Every part of the care and support sector is under intense pressure due to the pandemic and councils are doing all they can to support carers and those they care for.

Contact

Carlotta Rauch, Public Affairs Support Officer

carlotta.rauch@local.gov.uk