Our vision for investing £13 billion into adult social care.
Adult social care exists to enable adults of all ages and with a range of conditions to live their best life and an equal life. When done well it can be transformative. But following a decade of underfunding in which adult social care had to manage a funding gap of £6.5 billion, and just as the service started to emerge from the long shadow of COVID-19, the sector is facing a set of soaring inflationary pressures, and others associated with the rising cost of living, that threaten its ability to function at even the most rudimentary level.
People – working age adults, older people and unpaid family carers – will suffer, and suffer seriously, if this situation is not addressed as a top and urgent priority.
In her leadership campaign, the Prime Minister stressed her view that there should be additional investment in social care. Through its actions in the coming weeks, the new Government has a powerful opportunity to act on this view to ensure people have access to the support they need which itself will help reduce pressure on the NHS as well as meeting Care Act commitments.
It is an opportunity to demonstrate that an investment in adult social care is about investing in the lives and futures of our loved ones, rather than simply ‘fixing a problem’. This requires action on the following three key priorities:
- An immediate injection of £6 billion to tackle current pressures and limit their immediate and short-term impact
- Further immediate investment of £7 billion to enable adult social care to deliver its range of statutory duties under the Care Act, particularly in terms of helping prevent the onset or escalation of people’s needs, avoid admission to hospital, and – if that is required – to recover quickly and well from that experience
- Reconsidering the timetable for wider reform.
We recognise this is a substantial investment requirement and we are encouraged by the Prime Minister’s remarks in August 2022 which indicated that adult social care should be the beneficiary of the £13 billion allocated to address backlogs in the NHS. Of course, the fortunes of health and social care are inextricably linked, but an investment in the latter as significant as indicated, would benefit both sides of the system. This is the type of bold decision-making that is needed to finally tackle the historic under-funding of social care and put it on a path to a better future so that people can live the lives they want to lead.
Tackling current pressures and limiting their impacts (immediate £6 billion investment)
The perilous state of adult social care funding, and its serious consequences for people who draw on social care (or may need to do so in the near future), is unquestionable.
Recent survey work by the Association of Directors of Adult Social Services (ADASS) shows that just 12 per cent of directors are confident that they have the resources required to deliver all of their statutory duties. The survey also reveals directors’ concerns about growing demand, the position and experience of unpaid carers, the fragility of the provider market, and reductions in quality and choice within local care markets. The difficulty of recruiting and retaining care workers is a further concern shared by many across the sector.
Further survey work by ADASS shows the very real and serious consequences of the aforementioned pressures. In August 2022, ADASS reported that nearly 300,000 people are now waiting for an assessment of their needs, with 600 people a day joining the waiting list. Additionally, more than 37,000 people are currently waiting for their package of care to commence and just over 210,000 people are waiting for a review of their care. These are staggering numbers and each represents a person whose needs are not being met and who is not living an equal life. Each also represents a risk that deterioration will lead to a need for NHS services.
Known pressures will swell costs further in 2023, particularly the potential 8.6 per cent increase in the National Living Wage (NLW) and a possible 6.1 per cent increase in 2024. Combined inflationary and demographic pressures will also require additional funding. These, of course, are not the only pressures facing adult social care and the sharp increases in the costs of energy, food and fuel we are likely to see over the coming months will hit the sector hard.
In this context, we agree completely with the conclusion of the cross-party Levelling Up, Housing and Communities Select Committee in their recent report on long-term funding of adult social care:
“The Government is focussed on long-term reform of adult social care, but in order to get to the future it needs to save the sector from the brink of collapse…
We strongly disagree…that adult social care has adequate funding currently, having received compelling evidence that there is an immediate need for additional funding.
With every day that passes, pressures are growing on adult social care with consequences for people who use social care, its workforce and the NHS. An injection of £6 billion, as outlined below, is needed urgently to help bolster adult social care ahead of what is widely expected to be an extremely challenging winter (and in so doing help mitigate demand pressures facing the NHS). It would help to stave off the worst of the pressures in 2023/24, and provide a platform for moving towards a more stable and secure position in future years. Without such investment, pressures will increase with a compounding effect.
Inflation and demography
Prevent councils from having to make further cuts in their spending
Increasing care worker pay
Tackle significant recruitment and retention problems
Increasing fees for providers
Stabilise the market and reduce the number of providers going out of business or handing back contracts
Delivering on the promises in the Care Act (immediate £7 billion investment)
Immediate investment to shore up adult social care in the here and now needs to be made alongside immediate investment to ensure the service is able to deliver on the full range of its statutory duties under the Care Act. This remains a well-supported piece of legislation, but its full intent has never been realised owing to the funding pressures that have beset the service since the Act’s implementation in 2015. This is particularly true in respect of social care’s wider preventative duties and the role it plays in supporting discharge and helping people recover from time spent in hospital. An injection of £7 billion is needed to tackle historic under-investment in the issues and services set out below.
- Tackling unmet and under-met need through investment to expand provision for both those already receiving support and those who would benefit from doing so but currently do not. This would include the specific areas of priority identified below, which would also help maximise the impact of the investment so that acute needs and pressures on the NHS are minimised.
- Investment in housing provision, such as extending Shared Lives models and more supported living facilities.
- Investment in the voluntary and community sector, which itself has suffered as a result of the pandemic and is under its own set of pressures. Drop-in services, befriending schemes, post-discharge support to prevent readmission and meals on wheels are just some of the types of services that the sector could help deliver, working closely with primary care as part of wider recovery support for people who have spent time in hospital.
- Investment in community-based crisis services for people with a learning disability, autism or mental health issues, which would help prevent admissions to assessment and treatment units and more acute and costly levels of care and support.
- Investment in handyperson services, aids, adaptations and falls prevention services to limit the number of people having to be admitted to hospital.
- Investment in recovery services such as enablement and intermediate care. These services need to be supported by therapies and other community health services such as district nurses to aid the process of recovery after time spent in hospital. These could be jointly designed and commissioned with the NHS with a clear focus on what works, rather than bureaucratic concerns about who does what and who pays. Decisions on how such services should be funded should be made locally, but with a shared objective of avoiding hospital admission or reducing length of stay in hospitals.
Many of these types of activity are reflected in the Government’s adult social care white paper from December 2021, so there is immediate alignment on the kind of models of provision being proposed. But as helpful as the white paper was in paving the way for this kind of activity, it was a ten-year vision with only minimal funding when the models and more significant levels of investment are needed now.
Without immediate action and funding, the white paper’s vision will simply remain an ambition, pressure will continue to grow on the NHS as social care needs go unmet, and people will be unable to live the life they deserve.
We have previously estimated the cost of addressing unmet and under-met need at around £6 billion for older people and people of working age. As indicated above, this is broadly equivalent to the funding gap that social care has had to close since 2010, which has been achieved by councils making savings and cuts to the service itself as well to other council services that support people’s wellbeing in a broader sense (such as leisure, transport and green spaces).
A £7 billion investment in this area would therefore supercharge the Government’s ambitions and bring them to fruition far more quickly. It is not an optional investment to the £6 billion outlined above. Both are needed now: to perform urgently needed stabilisation to a service that is not functioning as it should; and to ensure that all legal requirements of the Care Act are being met effectively. In this way, the two sums of money are mutually reinforcing.
The £13 billion investment we are seeking is also not too dissimilar to the £14.4 billion put forward by the Health Foundation for funding an improved scenario comprising: expected growth in demand; a 10 per cent increase in council budgets to increase the amount of care people already receive or to expand provision for more people (or both); and enabling higher fees to be paid for care packages. We have been deliberately cautious in setting a more modest proposal given the constraints on the public purse.
The timetable for wider reform
In August 2022, the LGA wrote to the then Secretary of State for Health and Social Care urging the Government not to exacerbate the strains and pressures councils are already under in the realm of adult social care. The letter shared findings of a survey of adult social care lead members conducted by the LGA, including that:
- 98 per cent of respondents lacked confidence in the adequacy of earmarked funding for the Government’s charging reforms.
- 75 per cent of respondents lacked confidence in the required frontline capacity to deliver the reforms successfully.
- 62 per cent of respondents lacked confidence in delivering the reforms to the Government’s timetable.
- 86 per cent of respondents indicated a preference to delay all (20 per cent) or some (66 per cent) of the reforms.
In light of these stark findings, the LGA proposed a short 6-month deferral to implementing the care cost cap, changes to the financial means test thresholds, and Section 18(3) of the Care Act. We argued such a deferral would:
- Significantly ease the pressure on councils’ adult social care teams as they tackle immediate pressures, prepare for what is widely expected to be an extremely challenging winter, and continue their important work on ‘cost of care’.
- Allow for a longer period of reflection and deliberation on the crucial learning from the work being conducted by the social care reform trailblazer sites; this learning should continue, though thought should be given as to whether their ‘go live’ date is realistic.
- Provide more time to ensure necessary software systems are up and running effectively and to recruit staff ahead of increased numbers of assessments and the start of metering as part of implementing the new means test, care account and care cap.
- Provide space for the Chancellor to use the Autumn Budget to address any specific funding issues surfaced through discussions between national and local government on learning from the trailblazers and the outcome of cost of care exercises and market sustainability plans.
At the same time, the LGA also called for a delay of at least 12 months to the rollout of the new adult social care assurance regime, due to commence in April 2023. This would allow more time to: ensure the proposed regime is fit for purpose; better consider how to align sector-led support and improvement with the proposed national improvement offer from the Department; ensure that councils can collect and submit the data that CQC will require; and better identify and understand the sorts of issues that assurance is likely to surface and how they would need to be addressed.
In the context of the perilous state of adult social care funding and its consequences for people who draw on care and support, these firmly remain the LGA’s positions.
Waiting lists and backlogs for social care are growing month on month. This worsens people’s health and wellbeing, including their mental health, and builds further pressure on the NHS. What we are calling for would help immediately to halt this worsening trend and, crucially, reverse it. For this reason, the two categories of investment we are seeking are not ‘either/or’: they are both essential and needed immediately.
We acknowledge that the proposed actions outlined above are significant and represent a major funding commitment. But after so many years of underfunding, coupled with the experience and consequences of the pandemic – and now the many issues associated with increases in the cost of living – it is time to demonstrate that people of all ages and with different conditions will be able to access the support promised by the Care Act, so they are best enabled to live an equal life.
This is an investment in the whole of our population. If the Government works with councils to support urgent action, recognising existing capacity constraints and the inevitable challenges in increasing support quickly, local government can deliver for people across our country.