Debate on social care provision in the UK and the role of carers in that provision, House of Lords, 24 June 2021

Over the past decade, adult social care cost pressures have increased by £8.5 billion and total funding has increased by £2.4 billion. This has meant a gap of £6.1 billion needed to be managed. 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 so that councils could fund adult social care.


Key messages

  • COVID-19 has put adult social care firmly in the public, political and media spotlight. This emergency has highlighted the essential value of social care to the wider public and this interest needs to be harnessed in the debate about the future of care and support. Long-term reform is urgently needed and we are calling on the Government to set out its thinking before the summer recess.
  • 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. Many of these pressures have been exacerbated by COVID-19.
  • Over the past decade, adult social care cost pressures have increased by £8.5 billion and total funding has increased by £2.4 billion. This has meant a gap of £6.1 billion needed to be managed. 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 so that councils could fund adult social care.
  • The adult social care workforce is a vital asset. More people work in social care than the NHS - 1.65 million compared to 1.5 million on the NHS. However, the ability to attract and retain staff with the right skills sets is hampered by poor pay and reward and the lack of coherent career structures. This is why we are calling on the Government to deliver a new deal for the care workforce, comprising action on pay, training and development, career progression and professionalisation and recognition.
  • The adult social care system could not survive without the contribution of unpaid carers who provide vital support for thousands of people every day. We know 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.
  • 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, and as a result these rights have not led to greater access to support for carers. Every part of the care sector is under intense pressure and councils are doing all they can to support unpaid carers and those they care for.
  • The LGA, along with other leaders in the adult social care sector, have written an open letter urging the Government to act now on reform of England’s social care system and publish its proposals before the summer recess. We stand ready to work with the Government to ensure that the system is best able to support people to live their best lives.

Social care provision

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 cost pressures have increased by £8.5 billion and total funding has increased by £2.4 billion. This has meant a gap of £6.1 billion needed to be managed. Of this £4.1 billion was managed through savings to the service, and £2.0 billion was managed through funding diverted from other services by cutting them faster than otherwise would have been the case.

Councils are also facing significant extra costs from the demands created by COVID-19 as well as a significant loss of income. In relation to adult social care, councils are supporting care providers who face additional costs in ensuring continuity of care for those who rely on their support, as well as seeking to protect staff and the people they support from infection by COVID-19, and then providing care to those who fall ill with the virus.

The 2020 ADASS Budget Survey shows that the onset of the pandemic, and the additional financial and demand pressures faced by local authorities as a consequence, has led to a significant change in the Directors’ confidence in meeting their statutory duties relating to adult social care. For the current financial year (2020/21) only 4 per cent of Directors are fully confident that their budget will be sufficient to meet their statutory duties; this compares to 35 per cent in 2019/20.

The Health and Social Care Committee last year called for a £7 billion annual increase in adult social care funding by 2023/24 to cover demographic changes and uplift in staff pay in line with the national minimum wage, as well as funding to protect people who face catastrophic social care costs at a cost of £3.1 billion by 2023/24. LGA analysis, completed before the spending review, estimated an adult social care funding gap rising to £2.7 billion in 2023/24. Costs are considered in terms of core pressures (demography and inflation), the provider market gap (the difference between what providers say is the cost of delivering care and what councils pay), and assumptions are also made about the path of future funding (including council tax and core grant rising in line with inflation). The LGA will be publishing new analysis on the funding gap facing local government later this year.

One of the only positives to come out of COVID-19 is that it has put adult social care firmly in the public, political and media spotlight. It has also shone an important light on the tireless work of our invaluable social care workforce who are providing care and support to all who need it in the most challenging of circumstances. This emergency has begun to highlight the essential value of social care in its own right to the wider public and this debate needs to be harnessed as we think about the future of care and support.

The legacy of COVID-19 for social care – and most importantly the people who use social care services – must be a reset, not simply a restart. This impetus should spur our thinking around long-term reform of care and support, which we have always said should be built on cross-party cooperation. We are committed to working with Government and all parts of the social care world – particularly people with lived experience – on a way forward that is informed by the many valuable lessons from the response to COVID-19 on the role and value of social care in all our lives.

The LGA has published seven principles for reform of adult social care, which chart a way forward for ensuring the very best local care and support in the future, so that people can live their very best life. Several prominent organisations have signed up to these principles.

Role of care workers

Adult social care workforce

One of the LGA’s seven principles for adult social care reform is that the Government should commit to a new deal for the care workforce, comprising action on pay, training and development, career progression and professionalisation, and recognition.

There are ongoing recruitment and retention problems highlighted in high vacancy and turnover rates that affect service quality. In addition, many staff have uncertain incomes because of the prevalence of zero-hours contracts. The temporary shifts in these patterns due to COVID-19 have highlighted the need to deal with them permanently. A recent Skills for Care report on ‘the state of the social care market’ found:

  • Pay in adult social care is on average 25 per cent lower than pay in the NHS.
  • The adult social care sector in England still needs to fill around 112,000 job vacancies on any given day.
  • The staff turnover rate of directly employed staff working in the adult social care sector was 30.4 per cent in 2019/20.

The ability to attract and retain staff with the highest skills sets is hampered by poor  pay and reward and the lack of coherent career structures that allow people to think beyond temporary work in social care. Better pay and reward needs to form part of a package of reforms to transform the sector as set out for example in the recent strategic workforce framework by the LGA, ADASS and Skills for Care. Increased investment in training and development, the use of technology and a focus on the wellbeing of staff will all help to drive improved productivity across the sector alongside improved pay and conditions.

The social care workforce 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.

As we set out in our submission to the 2020 Spending Review, we believe the Government should establish an independent process to gather evidence and make recommendations on the level and future determination of social care pay as soon as possible so that planning can begin. The transformation of pay and reward is a complex medium to long-term proposition and will require considerable investment. Moreover, there will be a variety of opinions on the best way to take things forward. An independent process provides the best opportunity to achieve a consensus on outcomes. Other terms and conditions should be looked at as soon as possible.

It is vital that we think and talk about adult social care as an economic opportunity rather an economic cost.  Reforming pay and reward for those working in adult social care pay will attract people to work in the sector, fill existing vacancies and ultimately benefit local economies. The Resolution Foundation calculated that if a living wage for care workers was publicly funded, just under half (47 per cent) of public costs would be returned to the Exchequer through higher personal tax receipts and lower benefit payments. The overall economic contribution of adult social care is considerable, as estimates produced for Skills for care and the LGA show. At the time of the report, adult social care contributed £46.2 billion to the economy on an annual basis and supported 603,000 jobs through indirect spending as well as the 1,200,000 employed directly in the sector. Adult social care can play an important role in supporting the country and the economy as we seek to recover from the effects of the pandemic. 

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. 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 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.