Debate on the future of adult social care, House of Lords, 30 March 2023

• The LGA has long highlighted that 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. We owe an enormous debt of gratitude to our frontline care workforce, including unpaid carers, who give so much in supporting people of all ages who depend on care.
• As well as helping people live the lives they want to lead, adult social care contributes at least £50.3 billion to the economy in England and provides significant societal benefits. A report from Skills for Care on the value of adult social care in England found that the sector has a minimum total economic value in 2020/21 of £50.3 billion, made up of £25.6 billion of Gross Value Added (GVA) and a further £12.6 billion of indirect and £12.1 billion induced effects.
• Despite the clear economic and social benefits of investing in social care, the sector has been significantly underfunded. Adult social care has had to manage a funding gap of £6.5 billion since 2010. The sector is now also facing a set of soaring inflationary pressures alongside the ongoing impacts of the pandemic, which threaten its ability to function at even the most rudimentary level. ADASS report that nearly 300,000 people are waiting for an assessment of their needs. More than 37,000 people are also currently waiting for a package of care to commence and just over 210,000 people are waiting for a review of their care.
• We are pleased that the Government has gone some way to addressing the financial challenges on social care and health in the Autumn Statement by providing more resources over the next two years to meet inflationary pressures. But this funding will not address the underlying gaps, unmet and under-met need, market fragility and workforce pressures across health and social care. Neither does it provide sufficient long-term certainty for social care to invest in different models of care which prevent ill health and promote wellbeing, resilience and independence.
• While the additional funding to adult social care is welcome, it falls significantly short of the £13 billion we have called for to address the severity of the pressure facing the service, including rising demand, and ensure councils can meet all of their statutory duties under the Care Act. We are also disappointed that a proportion of the additional funding announced is expected to be raised through council tax, which is not a sustainable or effective solution for funding high-demand national services such as social care. All of the evidence points to a stark truth: our health and social care services are struggling to meet their statutory requirements to provide people with timely, safe, high quality and effective care and support. Without immediate and long-term action from national Government, they will fail to improve, leading to worse health, wellbeing and economic outcomes for all of us.
• The Government is expected to imminently publish a new ‘plan for reform’ which sets out their plan for implementing longer-term transformation of the social care system following the 2021 People at the Heart of Care: Adult social care reform white paper.  We are aware of speculation that the plan will see a reduction in funding from the £1.7 billion the Government committed to provide in the in the White Paper to £1.1 billion. This includes the removal of £300 million for housing transformation and a reduction in funding for measures to support the care workforce from £500 million to £250 million. This would be a hugely disappointing reversal of commitments made in the White Paper, which make clear that this funding will be central to making the system fit for the future.
• There are huge pressures on social care capacity and workforce, and a real need to invest in new models of care including expanding specialist housing. Failing to address these issues will have real consequences for people who access social care, as well people’s confidence in the Government’s commitment to meaningful reform in this vital public service.
• We need a major reset of our social care and health services, to prioritise prevention and promote independence. It is only by doing so that we will turn the growing tide of ill-health and dependence on acute and hospital services. Alongside NHS Confederation and the Association of Directors of Adult Social Services (ADASS), we have published a joint vision for a high quality and sustainable health and care system. To achieve this, Government must invest in prevention of early intervention to prevent and delay people from developing health and social care needs, create the ability within services to plan for the long-term, and deliver a long-term, fully funded workforce plan that covers health and social care – including the public health workforce. This will be essential to ensure that everyone has access to the right care, at the right time, to restore their health and live independent and meaningful lives.

Funding  

In the Autumn Statement, the Government announced that they are making available up to £2.8 billion in 2023/24 and £4.7 billion in 2024/25 in England to help support adult social care and discharge. Having heard the concerns of local government, Government have also delayed the rollout of adult social care charging reform from October 2023 to October 2025.

The additional £2.8 billion of funding in 2023/24 and £4.7 billion in 2024/25 is partly made up of funding that has been freed up by the delay to charging reforms, amounting to £1.3 billion in 2023/24 and £1.9 billion in 2024/25. Government has also provided £1 billion of new grant funding in 2023/24 and £1.7 billion in 2024/25, which will partly be allocated via the Better Care Fund and partly allocated directly to councils. Councils have the option to raise the social care precept by up to 2 per cent instead of the previous limit of 1 per cent, to make up the rest of the funding. Each 1 per cent raises around £300 million nationally. Our joint briefing with NHS Confederation provides further detail on the funding announced in the Autumn Budget and the expected impact on addressing delayed discharge.

We are pleased that the Government has accepted our ask for funding allocated towards reforms to still be available to address inflationary pressures for both councils and social care providers. Councils have always supported the principle of adult social care charging reforms and want to deliver them effectively. However, underfunded reforms would have exacerbated significant ongoing financial and workforce pressures. The Government needs to use the delay to reforms to learn from the trailblazers to ensure that the appropriate funding and support is in place for councils and providers to ensure they can be implemented successfully. Councils, along with the rest of the social care sector, have already undertaken valuable work to prepare for the reforms going live and it is important that this learning is not lost simply because the reforms are delayed.

Although the additional funding for adult social care is welcome, it falls significantly short of the £13 billion we have called for to address the severity of the pressure facing the service, including rising demand, and ensure councils can meet all of their statutory duties under the Care Act.  The £13 billion we called for includes £3 billion to increase care worker pay, which is needed to address the significant recruitment and retention problems in the workforce. An investment of this scale is needed to support our national infrastructure, our economy and our prosperity. We have also called for certainty of funding over the next three to five years so that local care and health leaders can invest in new models of care and support which focus on maximising wellbeing, resilience and independence. Short-term funding arrangements may fend off immediate crises, but they do not allow for longer term remodelling of care and support.

It is disappointing that the Government has continued to rely on council tax and the social care precept as part of its package to increase funding for adult social care. As we have previously stated, Council Tax is not the solution for meeting long-term pressures facing high-demand national services such as adult social care. Council tax raises revenue not necessarily aligned to need, leaving many councils struggling to raise the funds that they need locally.

The Government is about to publish a new ‘plan for reform’ which sets out the Government’s plan for implementing longer-term transformation of the social care system following the 2021 People at the Heart of Care: Adult social care reform white paper.  We are aware of speculation that the plan will see a reduction in funding from the £1.7 billion the Government committed to provide in the in the White Paper to £1.1 billion. This includes the removal of £300 million for housing transformation and a reduction in funding for measures to support the care workforce from £500 million to £250 million. This would be a hugely disappointing reversal of commitments made in the Government’s 2021 adult social care white paper, which set out that this funding for workforce, housing and innovation will be central to making the system fit for the future.

This would be a big blow which will concern people who draw on care and support. There are huge pressures on social care capacity and workforce and a real need to invest in new models of care including expanding specialist housing. Failing to address these issues will have real consequences for people who access social care, as well people’s confidence in the Government’s commitment to meaningful reform in this vital public service.

Our vision for a high quality and sustainable health and care system

The growing demographic, cost of living, workforce and inflationary pressures facing all parts of health and care are too big to be addressed through better coordination or finding yet more efficiency savings. We need a major reset of social care and health services to prioritise prevention and investment in at home support and in recovery focused services.

We support the Government’s focus on getting people out of hospital when they are well enough to go home with the right support. However, we also need to help people live well and prevent them from being admitted to hospital in the first place. This will require much greater emphasis on, and investment in, the kind of support people need to be safe and independent at home, with rapid treatment or crisis support if needed.  

We are calling on Government to trust and resource local leaders, the NHS and voluntary and community sector to shift the model of care and to invest more in prevention and community-based support. Investing in home and community support is better for people, but it is also a far better use of taxpayers’ money than in-patient care.

Across social care, health and the  voluntary and community sector we are developing models of health and care that best deliver for people, but we need long-term resources to invest in these new models that are proven to deliver better outcomes. Government needs to provide implementation funding which goes beyond test and pilot initiatives to ensure new models are mainstreamed and sustainable, and deliver marked improvements in care. The Government’s agenda for reform across health and care already points to many such new models of delivery, but without corresponding funding they will forever remain an aspiration.

We call on the Government to invest in prevention and early intervention by:

• reinstating real terms increases to the public health grant at the level seen before the pandemic
• incentivising Integrated Care Systems (ICSs) to allocate resources according to deprivation in order to address health inequalities
• investing to realise the benefits of social care as a service in its own right, rather than as an adjunct to the NHS. Every day, adult social care enables millions of us to live independent lives in our communities, avoiding the need for hospital care
• investing in care and support at home and community to avoid the need for institutional care, including promoting a full range of housing options to enable people to live in safe and appropriate accommodation.

Workforce

We are facing an unprecedented and severe recruitment and retention crisis across the health, social care and the community and voluntary sector. There are more people working in adult social care than in the NHS – 1.54 million in 2020/21 compared to 1.3 million in the NHS – and is predicted to grow by almost half a million jobs by 2035. Yet, the adult social care sector faced a turnover rate of 28.5 per cent across 2020/21 and every day there are on average 105,000 social care vacancies advertised in England.

People are leaving the sector because they can earn more working in retail or the leisure sectors. And the lack of staff means that many people are waiting longer for hospital treatment, NHS community services and social care, whilst others are admitted to hospital because there are no community services to support them. As identified by the Department of Health and Social Care’s adult social care workforce survey last year, social care employers’ ability to attract and retain staff with the right skills, values and abilities is hampered by low pay, poor terms and conditions, lack of parity of esteem compared to NHS workers in comparable roles, and the absence of a career development framework which might incentivise people to remain in care work.

The workforce is experiencing high levels of burnout. Many of the care workforce are working alone and can feel isolated and under pressure. Smaller providers can also struggle to access support and don’t have the infrastructure to support wellbeing as larger organisations do.

While we welcome the development of a comprehensive workforce plan as announced at the 2022 Autumn Statement. This must extend to the non-NHS health workforce commissioned or directly employed by local councils, the adult social care workforce and those in the community and voluntary sector, without whose support the NHS would not be able to operate.

We call on the Government to deliver a long-term, fully funded workforce plan that covers health and social care – including the public health workforce. We also need to enhance the contribution of the community and voluntary sector and of unpaid carers, without whom the care and support system would collapse. Historically, there has been a Health Education England (HEE) People Plan for the NHS. However, there attempts to establish a similar one for adult social care have been unsuccessful.

The LGA, in collaboration with a number of national partners from across the care sector including ADASS, the Care Provider Alliance, Skills for Care and Think Local Act Personal last year published a sector vision for a future workforce strategy, to achieve the following aims:

• Staff to be recognised, value and rewarded
• Tackle the crucial issue of care worker pay by setting up an independent review of pay, the recommendations of which should be factored into future calculations on fair cost of care.
• Invest in training, qualification and support
• Create clear career pathways and development opportunities
• Build and enhance social justice, equality, diversity and inclusion in the workforce
• Improve workforce planning
• Expand workforce roles which enable prevention and support the growth of innovative models of support.

Unpaid carers

We need to ensure that unpaid carers are supported to continue providing vital support.  Without unpaid carers social care and health services would collapse. Carers UK estimate there are 4.5 million people who have become unpaid carers since the start of the pandemic, 2.8 million of whom are juggling work and care. This is on top of the 9.1 million unpaid carers already caring before COVID-19.

Carers, who are mostly women (57 per cent), are more likely to suffer depression, anxiety and stress and nearly two-thirds of carers have a long-standing health condition. Unpaid carers have been more adversely affected by the pandemic compared to the general public, on aspects of life including work, loneliness, household finances and access to groceries, medication and essentials. Young carers have significantly lower levels of attainment at GCSE level and are more likely to not be in education, employment or training.

Section 10 of the Care Act 2014 gives anyone over the age of 18, who is looking after another adult who is disabled, ill or elderly the right to a carer’s assessment. Young carers and parents of disabled children also have the right to an assessment by their local council under the Children and Families Act 2014. These assessments should cover topics such as carers’ mental and physical health, their ability and willingness to care, and their relationships with others.

Every part of the care and support sector is under intense pressure and councils are doing all they can to support unpaid carers and those they care for. However, a recent report 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. Providing councils with additional funding to support the increasing numbers of unpaid carers should be a crucial part of a long-term and sustainable funding solution for social care.