Spending Review 2021 departmental supplement: Department for Health & Social Care

Councils have always wanted their residents to live in safe, affordable, good quality homes locally in their communities. COVID-19 has further shown the centrality of housing as a key component of health and care and the foundation upon which people can achieve a positive quality of life. The impact of poor housing on health is like that of smoking or alcohol and costs the NHS at least £1.4 billion a year, as well as increasing demand for social care.

Affordable, suitably designed and accessible homes in the right places, with supporting infrastructure, can extend independent and safe living for older people and working age disabled people and/or other long-term health needs.

It can also help to reduce demand on social care and health services by supporting greater levels of independence in the community, preventing admissions to residential care and hospital and aiding discharges. For people in vulnerable circumstances, a safe home with personalised support to address practical and care needs, can help people to regain their independence.

Supported housing 

Given the increasing number of older people and working age adults with disabilities, demand for supported housing will continue to increase. The number of working-age adults and older people with a learning disability is estimated to reach 1.1 million by 2025, an increase of nearly 30,000 people since 2020. Furthermore, an estimated 60,000 more adults are predicted to have a common mental disorder by 2025.

To give potential investors the certainty to invest in much-needed supply sufficient and sustainable revenue funding is needed alongside access to capital funding.

We are calling on the Government to support continued access to capital funding, including through the Care and Support Specialised Housing (CASSH) fund and to ensure local government is able to fully fund the ongoing revenue costs of care and support for people living in supported housing.

Extra care housing

There is a shortage of extra care housing. In the UK, there are around 74,000 housing with care units, which represents around 16 per cent of the total housing stock for older people. We build around 8,000 housing with care units a year. Over the next decade a fivefold increase in the delivery rate of housing with care is needed to keep pace with the ageing population.

In addition to delivering much better outcomes for people who want to live in this type of housing, the financial business case for investment in building more older people’s extra care housing is also compelling for councils, the NHS and the wider public purse. For example, every additional extra care apartment on average saves social care £2,400 per year as well as saving money for the NHS and improving lives.

We would like to work with the Government to unlock the potential of a significant expansion in extra care housing across all tenures, including capital funding through a new 3-year Homes England strategic partnership. Combined with social care reform and more focus on older people’s housing in NHS prevention and integration, an integrated strategy could deliver significant health, wellbeing and economic benefits for older people who wish to live in extra care housing.

Adapting the existing housing stock

Timely home adaptations support older people and disabled people, their families and carers to manage wellbeing in the home, extending safe and independent living. Improving the accessibility of existing housing is a priority because over 80 per cent of the homes we will be living in by 2050 are already built. 72 per cent of existing homes could be adapted to meet the four features of ‘visitable’ accessibility for people with a disability or accessibility needs.  Public Health England estimate a social return on investment in adaptations of £7.23 for every £1 spent.

The Disabled Facilities Grant (DFG) funds adapting existing stock in the private and rental sectors. It is allocated via the Better Care Fund Policy Framework and requires close working between housing authorities and social care authorities in two-tier areas. Government funding for the DFG has more than doubled, from £220 million in 2013/14 to over £500 million in 2020/21. In December 2018, a government commissioned independent review recommended simplifying the DFG process.

Given earlier points about the increasing number of older people and working age adults with disabilities, demand for DFG will continue to increase.

Councils are ambitious about upgrading existing housing and give people timely advice and access to funding where needed to adapt and repair their homes but the Government needs to continue to provide Disabled Facilities Grant funding, linked to demand increases from working age adults with disabilities to enable councils to expand this work. We also would like to work together with Government and other stakeholders, like landlords and housebuilders, on ways to make it easier for the increasing number of people living in the private sector to access adaptation grants.

Since its introduction in 2015, the Better Care Fund has been a major driver of health and social care integration to join up health and care services, so that people can manage their own health and wellbeing and live independently in their communities for as long as possible.

While BCF has undoubtedly escalated the scale and pace of integration in many areas, it has not been without problems. The lack of a long-term policy framework and financial settlement has meant investing in joined up new services to support independence and community-based services has not been possible. In addition, reducing delayed discharges from hospital and length of hospital stay have been the dominant focus, taking attention away from preventative support to support people to remain in their communities and reduce avoidable hospital admissions.

We are calling on the Government to set out a medium-term funding aligned to the NHS Long Term Plan and adult social care so that the NHS and local government can work together to invest in place-based, community-based prevention, reablement and longer-term support, under the oversight of Health and Wellbeing Boards, including funding to help councils play a full part in new Integrated Care Systems. This will enable people to maintain or recover their health, wellbeing and independence, and reduce the demand for unplanned or unnecessarily prolonged interventions.

Supporting people’s mental health and wellbeing underpins all aspects of the COVID-19 recovery. From reopening schools, to getting the country safely back to work, dealing with the economic and housing consequences of the pandemic, and supporting people who may have become lonely or socially isolated. The Centre for Mental Health estimates that 10 million people, including 1.5 million children and young people, will need support for their mental health as a direct result of the pandemic over the next three to five years with some population groups at higher risk than others.

Before the pandemic, statutory mental health services and wider wellbeing services were already stretched because of the gradual increase in mental health difficulties for all age groups. Despite this, councils worked with partners to quickly offer mental health support in different ways and respond to new needs that arose from the pandemic.

Continued investment for NHS mental health services is welcome. The Spending Review offers an opportunity to give greater recognition to the role of local government supporting the Long Term Plan’s mental health goals for people with severe and enduring mental health needs, including the Community Mental Health Framework. The Government’s Mental Health Recovery Plan included some welcome additional short-term funding for councils and the local voluntary and community sector, such as Public Health England’s £15m Prevention and Promotion Fund for Better Mental Health targeted at the most deprived communities in England.

The Spending Review is an opportunity to build on recent short-term funding, to ensure that local government also has sufficient and sustainable public health and social care funding to enable councils and their partners to harness all of their services and assets to help the whole population to be mentally healthy, prevent the escalation to more costly clinical services and work with health colleagues to support people of all ages while they are mentally unwell and to support their recovery.

The annual cost of mental health problems in England is estimated to be £119 billion, measured in terms of spending on health and the impacts on an individual’s work or education. Three-quarters of mental health problems first emerge before the age of 25, so it makes sense economically to invest in mental health support for young people, as well as making a huge difference to people’s lives.

While there is a growing body of research on preventing mental illness, some areas are more advanced than others in evidencing impact. For example:

• Improving children and young people’s mental health – evidence-based parenting programmes, for example, are estimated to generate savings in public expenditure of nearly £3 for every pound spent over seven years, with the value of savings increasing significantly longer term.
• Improving mental wellbeing and preventing mental illness in the workplace – mental health problems cost UK employers £35 billion a year in sickness absence, reduced productivity and staff turnover. A number of interventions to help employees stay at work and fulfil their productive potential have been shown to have potentially significant savings for businesses and the economy.
• Suicide prevention – one initiative increasing the use of psychosocial assessment for people who have self-harmed was modelled to deliver a return of investment of £2.93 for every pound spent in health, local authority and police costs over a ten-year period. This rose to £39.11 when increased productivity and other wider, long-term costs are considered.

Councils are also working with the NHS and other partners to reform the Mental Health Act. The LGA strongly supports the aims of the reforms to address inequalities, reduce detentions and improve care in the community. We urge Government to introduce the Act to Parliament in 2022 and look forward to continuing to work with Government and others to get ready for implementation.

The Liberty Protection Safeguards (LPS) are due to be introduced in April 2022 as part of mental health reform. We are working with government both on the further development of an initial impact assessment that will determine funding for councils, expected to be announced as part of the Spending Review , and on supporting councils prepare for implementation.

We would like to work with the Government on the following proposals:

• Providing sustainable funding for local government statutory and non-statutory mental health services to put them on an equal footing with NHS clinical mental health services, and to meet current, unmet and new demand in the community as a result of COVID-19. This is necessary to ensure appropriate support for people who have vulnerabilities, to invest in preventative mental wellbeing work at scale (including suicide prevention) and to respond to any further local outbreaks.
• Making school based counselling (SBC) mandatory in all secondary schools and alternative education provision would complement the whole school approach that is being developed. The government should invest at least £100m per annum into rolling out school based counselling to all state funded secondary schools and academies. This would ensure access to a school counselling for at least 2 days a week for over 90% of schools. There is a clear and positive evidence base that SBC can really make a difference to young people and add value to existing arrangements
• Councils should receive funding to enable the roll-out of Early Support Hubs in partnership with health and other partners across the country, ensuring access for all children and young people. This is because not all children can access provision or feel comfortable accessing it through schools. Early Support Hubs bring together a range of provision focused on young people, to support their mental health and emotional wellbeing. This could include youth services, sexual health, drug and alcohol, health and wellbeing practitioners, mental health practitioners. The intention is for the hubs to be accessed without referrals, offer support up to age 25, bring together a range of services and build on existing expertise and support. They do already exist in some areas.
• Councils need full funding to meet the New Burdens costs from implementing the Mental Health Act and Liberty Protection Safeguards, including the significant workforce implications.

Many councils are engaged in innovative work to promote the participation and engagement of autistic people in their communities. Councils and partners deliver services and support covering areas such as, care and support, education, housing, employment and training. Councils can use their unique local leadership role to raise awareness of autism, drive continued improvement in the delivery of services and support for autistic people.

The Government published the strategy to improve the lives of autistic people in July 2021 which runs to 2026. This is the first cross government strategy which covers children and young people as well as adults. Councils fully support the aims of the strategy.

We are ready to work with the Government to jointly develop the implementation plan for year 2 and beyond, with a new burdens process undertaken covering new areas, such as implementing social worker capabilities.

For people with a learning disability, the last year saw a traumatic loss of routine, activities and contact with family and carers that was hard to understand and to cope with. In addition, the increased risk of dying from COVID-19 is significantly higher for people with a learning disability, compared to the general population. Sustainable local longer-term funding is needed with an emphasis on investment in community services to deliver the aspiration to support all people with learning disabilities to live in the community.

As the ADASS Spring Budget survey highlights, 40 per cent of Directors of Adult Social Care report that they are most concerned about funding the increasingly complex care and support for working age disabled people, compared to 3 per cent for financial pressures relating to older people. Care and support for people aged 18-64 also now accounts for 63 per cent of demographic pressures, the amount of additional funding required to meet the same level of need as the previous year. A significant proportion of this budget is spent on people with learning disabilities and that need is rising in this group due to covid impacts and increasing complexity of need.

Too many people with learning disabilities and autistic people are still being admitted to hospital, staying for too long, and tragically there have been more examples of unacceptable care in hospital settings. Sustainable local longer-term funding is needed with an emphasis on investment in community services to deliver the aspiration to support all people with learning disabilities to live in the community.

Councils are strongly committed to working with people and families, NHS partners, the voluntary and community sector and support providers, through the Building the Right Support programme (Transforming Care). They aim to find solutions and improve care and support for people with a learning disability, so they can leave hospital or avoid admission in the first place and access the right services close to home, friends and family.

We are calling for:

• Funding for the further development of small support providers and adult social care models of community provision for the learning disabled population and the Building the Right Support cohort to facilitate life in the local community.
• The three-year Community Discharge Grant to continue to help councils and their local partners speed up the discharge process safely with levels of funding reflecting demographic and other pressures.
• Full funding for councils to meet any new duties/responsibilities for the learning disabled population arising from the new cross government all ages Autism Strategy for the autistic people who also have learning disability (around half); the Mental Health Act Review; the implementation of Baroness Hollins’ review of people in long-term segregation; and the Ministerial Building the Right Support Board’s forthcoming recommendations.

Local authority public health teams have been able to respond rapidly and effectively to the pandemic based on a detailed understanding of their community. ‘Local by default’ is now the approach to addressing public health in the COVID-era. A sector-led transformation programme that can address specific local challenges, share best practice nationally and drive improvements in outcomes is the best and most cost-effective way to sustain this change.

Building on the DHSC sponsored ‘Quality in Public Health: a shared responsibility’, a sector-improvement programme would address the issues that the pandemic has further exposed and exacerbated. The current Public Health reform presents an opportunity to tackle many of these issues head on at a local level. Local authorities are strongly connected to their place and understand their local populations. By working in partnership with communities as well as a wide range of system partners, including the NHS, social care, police, fire service, housing services, planning teams and schools, Councils can deliver real and sustainable change, as well as value for money

It is an opportunity to strengthen the public health role within the Integrated Care Systems and Partnerships.  Working with communities and system partners, including NHS, social care, police, fire service, housing services, planning teams and schools, councils can deliver sustainable change and value for money. It also delivers recommendations from Dame Carol Black’s ‘Review of Drugs, Part 2: Prevention, Treatment and recovery’

Adult social care

For adult social care we are calling for a three-year settlement to deliver the Care and Health Improvement Programme.

£30 million over three years would enable a longer-term approach, alongside the recently announced social care reforms, to:

• Transform the commissioning of social care.
• Strengthen the social care workforce.
• Improve market management alongside the use of care technology to enable people to stay at a place they call home for longer without the need for care and to ensure adult safeguarding.
• Provide more support to councils so they can play their full part, alongside the NHS, in the Integrated Care Systems being introduced in the Health and Care Bill.

Public health

For public health sector-led improvement, we are calling for £10 million over three years to establish a full-scale Public Health sector improvement offer.

This will help to:

• Enable local delivery of national public health targets supported by a shared responsibilities approach between local government, Office of Health Improvement and Disparities and DHSC.
• Allow for effective implementation and evolution of key government reforms, including changes to brought in by the Health and Care Bill and the Levelling Up White Paper.
• improve outcomes for people and communities, particularly in government priority areas.
• Increase greater accountability locally that can be aggregated upwards.
• Improve transparency of service delivery across local authorities.