Debate on support for public sector workers in the NHS and the social care sectors, House of Lords, 18 December 2022

• 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 have given 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 over the years. Adult social care has had to manage a funding gap of £6.5 billion since 2010, and just as the service started to emerge from the long shadow of Covid, 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.
• The Chancellor’s Autumn Statement provided some good news for adult social care. We were pleased to see that the Government will provide extra funding for social care and accepted the LGA’s ask for funding allocated towards the now delayed charging reforms to be made available to address inflationary pressures. Councils have always supported the principle of these adult social care reforms, but have warned that underfunded reforms would have exacerbated significant ongoing financial and workforce pressures. The Government needs to use the delay to the reforms to learn from the trailblazers to ensure that funding and support is in place for councils and providers to ensure they can be implemented successfully in the future.
• 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. This includes £3 billion towards tackling significant recruitment and retention problems by increasing care worker pay. An investment of this scale is needed to support our national infrastructure, our economy, our prosperity and our care workforce.
• In addition, we were disappointed that the Chancellor did not announce a workforce plan for the adult social care workforce. The NHS workforce plan announced must extend to, and align with, the adult social care workforce and those in the community and voluntary sector without whose support the NHS would not be able to operate. The Government has previously announced £500 million for measures to support the adult social care workforce. Further detail on this is needed to ensure the Government is joining up on its various workforce commitments.
• We welcome the £25 million earmarked in the Adult Social Care White Paper for Government to work with the adult social care sector, including councils, to identify and test a range of new and existing interventions for carers, which could include respite and breaks, peer group and wellbeing support, and new ways to combine these to maximise support. On respite, the White Paper commits to working with the sector to explore different models of respite, how they are accessed and what the barriers to access are. The White Paper also sets out proposals for improving data collection and the sharing of data to help better identify unpaid carers and a commitment to ensure that the voice of unpaid carers is properly embedded in Integrated Care Systems.
• While the LGA welcomes the money to pilot new approaches and build on existing good practice, we question whether the scale of the investment matches the scale of the ambition. Any positive outcomes emanating from the pilots must be given sustainable long-term funding. It is important that local authorities, as the key local commissioners and providers of carer services, are involved in the work to kick start new approaches. Similarly, issues pertaining to unpaid carers need to be addressed through place-level arrangements; ICSs will have a role in supporting this work but will not be the vehicle for delivery.
• Anecdotally, we have heard that some unpaid carers misunderstand the term “carers assessment”, and this may put carers off from seeking help and support. The impression that some people have is that they are being assessed based on their ability to provide care, which could be anxiety provoking and stop people from accessing support they may be entitled to. A change the language used around carers assessments could be one way to make support more accessible.

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. However, 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.

As highlighted in DHSC’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 also experiencing high levels of burnout. Although many online and telephone resources emerged during the pandemic, take up from social care was low due to lack of awareness, capacity or concerns about the perceptions of other colleagues. Many of the care workforce are working alone and can feel isolated and under pressure. Feedback suggests that peer networks and face to face support is valued. Smaller providers can also struggle to access support and don’t have the infrastructure to support wellbeing as larger organisations do.

Whilst we support the positive workforce developments in the Government’s recent White Paper, they do not amount to a proper long-term workforce strategy. This is desperately needed to allow for better workforce planning, including consideration of the types of roles and provision that will be needed in the future, as well as establishing the links that need to be made between the care and health workforces. This is why we urge the Government to include the adult social care workforce in its planned comprehensive NHS workforce plan next year.

The LGA, in collaboration with a number of national partners from across the care sector including Association of Directors of Adult Social Services (ADASS), the Care Provider Alliance, Skills for Care and Think Local Act Personal last year published a sector vision for a future workforce strategy. The vision acknowledged that reform of the workforce, valuing people who draw on social care, and shifting towards the vision all go hand in hand. The vision called for:

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

The report explores each priority in turn and sets out the kind of actions needed to deliver on those priorities.

There should be an integrated Health and Care People plan. This would help address the lack of parity of esteem between NHS and social care. Historically, there has been a Health Education England (HEE) People Plan for the NHS and there have been unsuccessful attempts to establish a similar one for adult social care. A joint/integrated plan with the NHS would demonstrate Government willingness to achieve parity of esteem-the NHS.

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. It must also extend to the adult social care workforce and those in the community and voluntary sector without whose support the NHS would not be able to operate. The Government has previously announced £500 million for measures to support the adult social care workforce; further detail on this is needed to ensure the Government is joining up on its various workforce commitments.

The efforts of unpaid carers must also be recognised. Carers UK estimate there are 4.5 million people new to caring 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 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.

A recent report (Supporting carers following the implementation of the Care Act 2014: eligibility, support and prevention The Carers in Adult Social Care (CASC) study) 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 unpaid carers and those they care for.

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.

The LGA supports the Carer’s Leave Bill (Wendy Chamberlain MP, Liberal Democrats), which had its Second Reading on 21 October 2022 and is due for its Report Stage on 3 February 2023. The Bill would support carers to juggle work and care, and for employers, to maximise retention and wellbeing. As we learn to live with Covid, and during the ongoing cost of living crisis, there has never been a more important time to ensure that carers are able to balance their work and caring responsibilities. Successfully passing this Bill would be an important step in the right direction in helping carers remain, or return to, work.

Despite the clear economic and social benefits of investing in social care, the sector has been significantly underfunded over the years. Adult social care has had to manage a funding gap of £6.5 billion since 2010, and just as the service started to emerge from the long shadow of Covid, 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. 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. In addition, more than 37,000 people are currently waiting for a package of care to commence and just over 210,000 people are waiting for a review of their care.

In the Autumn Statement, the Chancellor announced that:

• The NHS performance also relies on the adult social care system, so the Government will make available up to £2.8 billion in 2023/24 in England and £4.7 billion in 2024/25 to help support adult social care and discharge. This includes £1 billion of new grant funding in 2023/24 and £1.7 billion in 2024/25, further flexibility for local authorities on Council Tax and, having heard the concerns of local government, delaying the rollout of adult social care charging reform from October 2023 to October 2025. (Page 26, paragraph 2.38)
• Local authorities with social care responsibilities will be able to increase the adult social care precept by up to 2 per cent per year. (Page 51, paragraph 5.25)

LGA view on funding for adult social care

• In summary, this announcement means that the funding freed up by the delay to charging reforms will be available to support adult and children's services. This amounts to £1.3 billion in 2023/24 and £1.9 billion in 2024/25. In addition, there is new grant funding of £1 billion in 2023/24 and £1.7 billion in 2024/25, which will be partly allocated via the Better Care Fund and partly direct to councils. Councils will have the option to raise the social care precept by up to 2 per cent instead of the previous limit of 1 per cent. Each 1 per cent raises around £300 million nationally.
• We are pleased that the Government will provide extra funding for adult social care and 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 reforms and want to deliver them effectively but have warned that underfunded reforms would have exacerbated significant ongoing financial and workforce pressures. The Government needs to use the delay to reforms 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.
• Although 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. This includes £3 billion towards tackling significant recruitment and retention problems by increasing care worker pay. An investment of this scale is needed to support our national infrastructure, our economy and our prosperity. People who draw on social care and support will remain concerned about the services they access to live the lives they want to lead.
• 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.
• Part of the additional funding for adult social care will be routed through the Better Care Fund (BCF) and we welcome the Government’s commitment to continuing this support. This will give social care and health partners much-needed medium-term certainty on funding. However, the purpose of the BCF is not limited to freeing up hospital beds; it supports people through adult social care to remain independent and in their own homes, helping to prevent admission to hospital in the first place. It is important that the Government works with the LGA and NHS England to agree the BCF policy framework well in advance of March 2023 to ensure that local care and health leaders are able to agree their local BCF plans in good time.
• We look forward to further details on the purpose of the Social Care Grant. We urge the Government to give local leaders the freedom and flexibility to allocate the funding according to local priorities and challenges.
• We note the Government’s decision to delay charging reform for two years and welcome the move to reinvest earmarked reform funding back into social care services, which we had previously called for. The LGA had proposed a short deferral to charging reform to ensure the learning from the Trailblazer sites was fully incorporated into the Government’s thinking and future funding plans. The Government will need to bring forward sufficient funding to implement the reforms in time for the deferred implementation.
• Councils, along with the rest of the social care sector, have undertaken valuable work in recent months to prepare for the reforms going live and this learning should not be lost simply because the reforms are delayed. The Government needs to continue to fund and support councils on this wider learning as it has the potential to improve efficiency, productivity and innovation. We are keen to avoid a delay to charging reform meaning a cessation of the important work councils have begun in using technology to help bring about productivity and efficiency benefits.

Laura Johnson, Public Affairs and Campaigns Adviser

[email protected]