The future of adult social care

Over the last year, social care has demonstrated that it is not simply a set of services some people need because of age or disability, but is a key means by which people are supported to live a full life, whatever their circumstances.

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Everyone should be able to live the life they want to lead; to connect to what makes us feel alive and valued. To feel human.

This is common to us all.

Social care is about supporting people to achieve this when age or disability might otherwise be a barrier. It is used in every community when needed to enable adults of all ages to do whatever helps grow and sustain their wellbeing.

In this way, social care is common to us all, too.

Where we’ve come from

Over the past decade, adult social care costs have risen by £8.5 billion, while total funding has grown by only £2.4 billion. This has left councils with a gap of £6.1 billion to fill. Of this, £4.1 billion has been met by making savings to adult social care services, whilst a further £2 billion has been diverted from other services; cutting them faster than otherwise would have been the case.

Securing and sustaining the short to medium-term

Our analysis before the 2020 Spending Review showed that adult social care faced a funding gap of £2.2 billion in 2021/22, rising to £2.7 billion in 2023/24. This is just for ‘core pressures’ (demography, inflation and National Living Wage increases) and the provider market gap (the difference between what providers say is the cost of delivering care and what councils pay). This does not take into account the cost of tackling many of the challenges facing social care, such as unmet and under-met need; a lack of funding for prevention; an over-stretched and undervalued workforce; and growing strain on unpaid carers.

This year’s Spending Review must address the social care funding gap as well as tackle these additional challenges. It must inject new Government funding into social care to stabilise it for the short- to medium-term. Increasing or extending the council tax precept is not the answer.

But we must also think bigger.

Learning from the pandemic

Over the last year, social care has demonstrated that it is not simply a set of services some people need because of age or disability, but is  a key means by which people are supported to live a full life, whatever their circumstances.

That support, spanning different organisations and different people, has shown itself to be inherently local, with councils playing an important role in local leadership and coordination.

But the experience has also shown the consequences of the often hidden nature of social care, historically being ‘done behind closed doors’. The tragic situation in care homes, the disproportionate number of deaths by people with learning disabilities, and the similarly disproportionate mortality of the black, Asian and minority ethnic (BAME) care workforce, are just some of the ways that a historic lack of national attention has played out in our communities.

A better future for adult social care must be one of the legacies of COVID-19. This means action that reflects the following principles:

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1. People first and the value of social care

Whatever emerges for social care post-pandemic should be rooted in, and guided by, what works best for people. It must support the realisation of Think Local Act Personal’s ‘Making It Real’ framework for quality, personalised and community-based support. It must also properly reflect the value of social care in its own right; as a way in which we help improve social justice and inclusion, and support people’s freedoms and human rights.

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2. The importance of ‘local’

Social care plays a key role in making connections in our local communities between a wide range of public, private, voluntary and community organisations that all work together in supporting people to be well, safe and independent. Links with housing are particularly important so as to support people to remain independent at home and in their community. Councils’ democratic accountability and leadership supports effective partnership working at the local level and the Government should follow this lead by working with local government and its many partners as equals in helping to build resilient communities that are geared towards prevention, wellbeing and public health.

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3. Funding

Any additional funding that is made available to social care, whether in the short- or medium-term, should not simply be used for ‘more of the same’ and the pre-COVID-19 status quo. Rather, it should be used to help us move to a more person-centred and preventative model of social care that is rooted in supporting people’s wellbeing in line with the Care Act, supporting the aspirations set out in the NHS Long Term Plan and building resilience in our local public services.

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4. Workforce

The future requirements of and for the social care workforce should be a far more prominent consideration for Government, both as a standalone priority and in respect of its links with NHS workforce planning. We need action on pay, training and development, career progression and professionalisation and recognition.

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5. Provision and commissioning

Traditional services (such as residential care, domiciliary care and day centres) will continue to have a role to play in the future. But they need to be part of a much broader local offer including smaller, more bespoke providers, micro-enterprises, a vibrant voluntary sector and wider community assets, such as community-owned care, mutual aid and shared lives, that have all played a part in responding to the current pandemic. These help bolster community resilience and their potential to help secure a more preventative approach to wellbeing that supports people to live safely and well at home must be harnessed.

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6. Health and integration

NHS services and social care are equally important and decisions and prioritisations about the future of each should reflect that. The needs of one should not be addressed to the detriment of the other and both should unite around embedding a far more preventative approach to wellbeing that works closely with public health and housing.

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7. The scope of ‘reform’

Protecting a person from having to sell their home to pay for care is certainly one element of the ‘fairness debate’ at the heart of the question about long-term reform. But it is not the only one. The scope of and ambition for social care reform must be far greater, support adults of all ages including unpaid carers, and have at its heart a commitment to the Care Act wellbeing principle and improving people’s choice and control of the care and support they use to live their best life. Progress must be made quickly.

Moving forward

As we gear up to this year’s Spending Review and the publication, we hope, of the Government’s proposals for the future of care, we believe the following questions need to keep being asked:

  • What do we want social care to be and what kind of care do we want for ourselves and each other?
  • How best can we influence politicians, the media and the public so that social care is seen as part of the solution for building flourishing and connected local communities in the wake of the pandemic?

It is clear we need a ‘1948 moment’ for social care; a moment where we collectively aspire to something bigger and better for social care, because we aspire to something bigger and better for us all. Delivering such a moment cannot happen instantly. We therefore support calls for a long-term plan for social care, equivalent to that for the NHS. The immediate priorities must be:

  • investment to help meet the continuing costs of COVID-19 on social care, particularly on the care workforce and unpaid carers
  • investment to tackle the social care funding gap.

This funding should help begin the process of moving to a new system of social care, in which the priorities must be:

  • addressing unmet and under-met need by revisiting the existing model of eligibility
  • tackling workforce challenges by developing a new deal for the workforce
  • improving provision, choice and control by thinking about how the system can best be driven by people’s needs and experiences
  • improving quality by being clear on the outcomes we are collectively seeking to achieve and how performance against them is coordinated and supported, including the role of sector-led support
  • securing a more rational, sustainable and transparent funding model that is based on universal risk pooling
  • protecting people from facing catastrophic costs.

Each priority is important and collectively constitute a major change to our care and support system. This is what will deliver the truly person-centred and preventative care that is needed to underpin people’s wellbeing.

Our ask: We're calling on the Government to publish its proposals for the future of adult social care, which address these priorities, as soon as possible and before the summer parliamentary recess.