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Survey of confidence in adult social care reform

The results of the LGA's survey with council lead members for adult social care, assessing their levels of confidence in the upcoming adult social care reforms.

Summary

Background

In June 2022 the Local Government Association (LGA) conducted a survey of the lead members for adult social care of all councils in England. The purpose of the survey was to assess levels of confidence in the upcoming adult social care reforms among senior council members. A total of 80 responded – a response rate of 53 per cent.

Key findings

  • Seventy-eight per cent of respondents were very or fairly confident in their council’s ability to meet existing statutory duties in adult social care, disregarding future reforms, compared to 21 per cent who were not very or not at all confident.
  • The aspects of the reforms which respondents expressed the greatest confidence in being able to deliver was adult social care assurance, which 55 per cent said they were very or fairly confident in their council’s ability to deliver within the government’s timetable.
  • The aspect of the reforms which respondents were least confident in implementing to the government’s timetable was Section 18(3) of the Care Act, whereby self-funders can ask their council to arrange their care at the rate the council pays, with 66 per cent saying they were not very or not at all confident in delivering this aspect of the reforms.
  • Thinking about all elements of the reforms, 62 per cent of respondents were not very or not at all confident in their council’s ability to deliver the programme to the government’s timetable.
  • The vast majority (98 per cent) of respondents were not very or not at all confident that the government funding earmarked for the adult social care reforms is sufficient to deliver them.
  • A large majority of respondents (81 per cent) were very or fairly confident in having the required staff capacity in terms of senior leaders to implement the reforms. Just over half (53 per cent) of respondents were very or fairly confident in having the required capacity in terms of service managers or supervisors, whilst 75 per cent of respondents were not very or not at all confident in having the required capacity in terms of social workers and financial assessment officers.
  • Taking into account the wider health and care reforms, 59 per cent of respondents were not very or not at all confident in their council’s ability to deliver everything the government is asking of them in the coming year.
  • A large majority (86 per cent) of respondents thought that some or all of the adult social care reforms should be delayed, including 20 per cent who thought that all of the reforms should be delayed and 65 per cent who thought that some of the reforms should be delayed.
  • The reform which the most respondents thought should be delayed, at 64 per cent of respondents, was Section 18(3) of the Care Act, whereby self-funders can ask their council to arrange their care at the rate the council pays.
  • The reform which the least respondents thought should be delayed, at 36 per cent of respondents, was adult social care assurance.
  • Respondents’ comments focused on the difficulty of acquiring the necessary staff capacity for the reforms, the significant additional expenditure which the reforms are likely to require, the potential impact on other council services of delivering the reforms, and the simultaneous difficulties imposed by rising demand from deprivation, the ageing population, the rising cost of living and the ongoing impact of the COVID-19 pandemic.

Introduction

In June 2022 the Local Government Association (LGA) conducted an online survey of councillors with overall responsibility for adult social care across all councils in England. The purpose of the survey was to assess levels of confidence in the upcoming adult social care reforms among senior council members.

Methodology

From 6 to 23 June, the LGA’s Research and Information Team sent an online survey to councillors with a lead role in adult social care across single tier and county councils in England (that is, all councils excluding district councils). Of the 152 councils with responsibility for adult social care in England, a total of 80 replied – a response rate of 53 per cent.

Whilst these results should strictly be taken as a snapshot of the views of this particular group of respondents, rather than representative lead members for adult social care in local authorities, this level of response means that the results are likely to provide a good indication of the position of senior councillors in the sector more widely.

Table 1 shows the response rate by type of council. This demonstrates that the authority type with the highest response rate was county councils, at 58 per cent, whilst London boroughs had the lowest response rate, at 45 per cent.

Table 1: Response rate by type of council

Type of authority

Total number

Number of responses

Response rate

%

County

24

14

58

London borough

33

15

45

Metropolitan district

36

19

53

Unitary

59

32

54

 

Table 2 shows the response rate by region. This shows that the region with the highest response rate was the South West, at 80 per cent, whilst the one with the lowest response rate was the North East, at 33 per cent.

Table 2: Response rate by region

 Region

Total number

Number of responses

Response rate

%

East of England

11

5

45

East Midlands

10

7

70

London

33

15

45

North East

12

4

33

North West

23

13

57

South East

19

8

42

South West

15

12

80

West Midlands

14

8

57

Yorkshire and Humber

15

8

53

 

The above tables demonstrate that the responses are reasonably evenly spread across authority types and regions. The results have been weighted by authority type and region to correct for variations in responsiveness between these categories of local authority.

In addition, the following points should be noted about the research methodology:

  • The bases from which percentages were calculated are unweighted, whilst the percentages themselves which feature in this report are weighted.
  • Throughout the report percentages in figures and tables may add to more than 100 per cent due to rounding. Percentages are rounded to the nearest whole per cent.

Survey of confidence in adult social care reform

This section contains analysis of the full results from the survey.

Confidence in meeting existing statutory duties

Table 3 and Figure 1 show respondents’ levels of confidence in meeting existing statutory duties in adult social care, disregarding future reforms. These show that 78 per cent of respondents were either very or fairly confident in their ability to meet existing statutory duties, whilst 21 per cent were not very or not at all confident, and one per cent did not know their level of confidence.

Table 3: How confident are you or not in your council's ability to meet existing statutory duties in adult social care in the coming year and within existing resources, disregarding future reforms?

Response

Per cent of respondents %

Very or fairly confident

78

Not very or not at all confident

21

Very confident

12

Fairly confident

66

Not very confident

20

Not at all confident

2

Don't know

1

Base: all respondents (80 respondents).

 

Figure 1. How confident are you or not in your council's ability to meet existing statutory duties in adult social care in the coming year and within existing resources, disregarding future reforms?

Bar chart showing that 78 per cent of respondents were very or fairly confident in their council's ability to meet existing statutory duties in adult social care, disregarding future reforms. This includes 12 per cent who were very confident, and 66 per cent who were fairly confident. Twenty one per cent were not very or not at all confident, whilst one per cent did not know.

Levels of confidence in delivering different aspects of the reforms within the government’s timetable 

Table 4 and Figure 2 show the levels of confidence respondents had about their councils’ ability to deliver specific aspects of the adult social care reforms to the government’s timetable.

These show that the aspect of the reforms with the greatest respondent confidence was adult social care assurance, with 55 per cent saying that they were very or fairly confident in their ability to deliver the reform; whilst the aspect with the least respondent confidence was Section 18(3) of the Care Act, where self-funders can ask their council to arrange their care at the rate the council pays, with 66 per cent of respondents saying they were not very or not at all confident in implementing this reform within the Government’s timetable.

Table 4: How confident are you or not in your council's ability to deliver the following aspects of the adult social care reform programme to the government's timetable?

Area of reform

% Very or fairly confident

% Not very or not at all confident

Adult social care assurance

55

35

Fair rate of care

50

48

Changes to the financial means test thresholds

44

51

The cap on care costs

42

56

Section 18(3) of the Care Act whereby self-funders can ask their council to arrange their care at the rate the council pays

33

66

Base: all respondents (80 respondents).

 

Figure 2. How confident are you or not in your council's ability to deliver the following aspects of the adult social care reform programme to the government's timetable?

Stacked bar chart showing respondents' levels of confidence in specific aspects of the reforms, showing that 56 per cent were not very or not at all confident with regard to the cap on care costs, compared to 51 per cent for changes to the financial means test thresholds, 48 per cent for fair rate of care reforms, 66 per cent for the Section 18(3) of the Care Act reforms whereby self-funders can ask their council to arrange their care at the council rate, and 35 per cent for the adult social care assurance

Overall level of confidence in ability to deliver the reforms within the government’s timetable

Table 5 and Figure 3 show respondents’ overall levels of confidence in their council’s ability to deliver the reform programme to the government’s timetable. These show that 62 per cent of respondents said they were not very or not at all confident in their council’s ability to deliver the programme within the government’s timetable, compared to 38 per cent who were very or fairly confident, and one per cent who did not know their level of confidence.

Table 5: Overall, thinking about all elements of the reforms, how confident are you or not in your council's ability to deliver the programme to the government's timetable?

Response

Per cent of respondents %

Very or fairly confident

38

Not very or not at all confident

62

Very confident

1

Fairly confident

36

Not very confident

53

Not at all confident

9

Don't know

1

Base: all respondents (80 respondents).

 

Figure 3. Overall, thinking about all elements of the reforms, how confident are you or not in your council's ability to deliver the programme to the government's timetable?

Bar chart showing that 62 per cent of respondents were not very or not at all confident in their overall ability to deliver the reforms. This includes nine per cent who were not at all confident, and 53 per cent who were not very confident. Thirty eight per cent were very or fairly confident, and one per cent did not know.

Confidence in the sufficiency of funding earmarked for the reforms

Table 6 and Figure 4 show respondents’ levels of confidence that the government funding earmarked for the adult social care reforms is sufficient to deliver them. This shows that 98 per cent of respondents said they were not very confident or not at all confident in the sufficiency of the earmarked funding, consisting of 30 per cent who were not very confident and 68 per cent who were not at all confident, whilst one per cent were very or fairly confident, and a further one per cent did not know their level of confidence.

Table 6: How confident are you or not that the government funding earmarked for the adult social care reforms is sufficient to deliver them?

Response

Per cent of respondents %

Very or fairly confident

1

Not very or not at all confident

98

Very confident

0

Fairly confident

1

Not very confident

30

Not at all confident

68

Don't know

1

Base: all respondents (80 respondents).



Figure 4. How confident are you or not that the government funding earmarked for the adult social care reforms is sufficient to deliver them?

Bar chart showing that 98 per cent of respondents were not very or not at all confident in their overall ability to deliver the reforms. This includes 68 per cent who were not at all confident, and 30 per cent who were not very confident. One per cent were very or fairly confident, and one per cent did not know.

Confidence in having the required staff capacity to deliver the reforms

Table 7 and Figure 5 show respondents’ levels of confidence that their council will have the required capacity to deliver the reforms, either through existing staff or additional recruitment. These show that 81 per cent of respondents were very or fairly confident in having the required capacity in terms of senior leaders, whilst this figure was 53 per cent for service managers or supervisors. In terms of frontline staff, including social workers and financial assessment officers, 75 per cent of respondents were not very confident or not at all confident in having the required capacity.

Level of seniority

% Very or fairly confident

% Not very or not at all confident

Senior leaders

81

18

Service managers or supervisors

53

46

Frontline staff (including social workers and financial assessment officers)

21

75

Base: all respondents (80 respondents).



Figure 5. How confident are you or not that your council will have the required capacity, either through existing staff or additional recruitment, to deliver the adult social care reforms?

Stacked bar chart showing respondents' levels of confidence that their council will have the required capacity to deliver the reforms at different levels. This shows that 18 per cent of respondents were not very confident or not at all confident in having the required capacity in terms of senior leaders, compared to 46 per cent for service managers or supervisors, and 65 per cent for frontline staff, including social workers and financial assessment officers.

Confidence levels accounting for the wider health and care reforms

Table 8 and Figure 6 show respondents’ levels of confidence in their councils’ ability to deliver everything the government is asking of them, taking into account the wider health and care reforms. These show that 59 per cent of respondents were either not very confident or not at all confident in their ability to do everything asked of them in the coming year, taking into account the wider context.

Table 8: Taking into account the wider health and care reforms, how confident are you or not in your council's ability to deliver everything the government is asking of you (existing statutory duties, social care reforms, and wider reforms and initiatives) in the coming year?

Response

Per cent of respondents %

Very or fairly confident

40

Not very or not at all confident

59

Very confident

3

Fairly confident

38

Not very confident

38

Not at all confident

20

Don't know

1

Base: all respondents (80 respondents).

 

Figure 6. Taking into account the wider health and care reforms, how confident are you or not in your council's ability to deliver everything the government is asking of you in the coming year?

 

Bar chart showing that 59 per cent of respondents were not very or not at all confident in their overall ability to deliver the reforms. This includes 20 per cent who were not at all confident, and 38 per cent who were not very confident. Forty per cent were very or fairly confident, and one per cent did not know.

Opinions on whether some or all of the adult social care reforms should be delayed

Table 9 and Figure 7 show respondents’ opinions on whether some or all of the adult social care reforms should be delayed. These show that 86 per cent of respondents thought some or all of the reforms should be delayed, including 20 per cent who thought all of the reforms should be delayed, and 65 per cent who thought some of the reforms should be delayed. Ten per cent of respondents did not think any of the reforms should be delayed.

Table 9: Finally, bearing in mind what you know about current demand duties, the timescale, funding and capacity available for the adult social care reforms, and the wider health reform agenda, do you think some or all of the adult social care reforms should be delayed?

Response

Per cent of respondents %

Yes, some or all of them

86

Yes, all of them

20

Yes, some of them

65

No

10

Don't know

4

Base: all respondents (80 respondents).

 

Figure 7. Finally, do you think some or all of the adult social care reforms should be delayed?

Bar chart showing that 86 per cent of respondents thought that some or all of the adult social care reforms should be delayed, including 20 per cent who thought that all of the reforms should be delayed, and 65 per cent who thought that some of them should be delayed. Ten per cent thought that none of the reforms should be delayed, whilst four per cent did not know.

Opinions on which of the reforms should be delayed

Table 10 and Figure 8 show respondents’ opinions on which aspects of the reform should be delayed. This question was only asked to those who replied that some of the reforms should be delayed. Those who responded that all of the reforms should be delayed were assumed to think that each of the individual reforms should be delayed, whilst those who did not think any of the reforms should be delayed were assumed to think that none of the individual reforms should be delayed.

These show that 64 per cent of respondents thought that the Section 18(3) of the Care Act reforms should be delayed, compared to 54 per cent for the cap on care costs, 50 per cent for changes to the financial means test thresholds, 41 per cent for the fair rate of care reforms, and 36 per cent for the adult social care assurance reforms.

Table 10: Which of the following reforms do you think should be delayed?

Care Act reform

%

Section 18(3) of the Care Act whereby self-funders can ask their council to arrange their care at the rate the council pays

64

The cap on care costs

54

Changes to the financial means test thresholds

50

Fair rate of care

41

Adult social care assurance

36

Base: all respondents (80 respondents). Note that whilst only those who thought that some of the reforms should be delayed were asked this question, the results in this table also include those who said all reforms should be delayed.





Figure 8. Which of the following reforms do you think should be delayed?

Bar chart showing which of the reforms respondents thought should be delayed, showing that 64 per cent thought that the Section 18(3) of the Care Act reforms, whereby self-funders can ask their council to arrange their care at the rate the council pays, should be delayed, compared to 54 per cent for the cap on care costs, 50 per cent for changes to the financial means test thresholds, 41 per cent for the fair rate of care reforms, and 36 per cent for the adult social care assurance reforms.

Further comments on adult social care reform

Respondents were asked to provide any further comments on the topics covered by the survey which they would like to share. A total of 49 respondents – 61 per cent of all who responded to the survey – provided textual comments to elaborate on their response to the survey. Their comments can be classified into the following broad themes, with illustrative quotes:

  • A concern about low levels of staffing and lack of capacity to implement the reforms. This includes the need to upskill the working population to be able to meet the demands for additional employees: ‘Nationally, it is recognised that trained people to work in the care sector are not there and we recognise the need for many more people to be trained for this sector.’
  • The significant financial burdens to be imposed by the reforms, and the likelihood that, in the absence of additional funding from central government, other essential local authority services will suffer: ‘The cost of care will have to be found by my authority but at a cost of something else as budgets have to be balanced.’
  • The increasing demand for services imposed by various factors including deprivation, the rising cost of living and an ageing population, making the baseline for needs to be met rise even without the additional requirements of the reforms: ‘We have a disproportionately aging population, many in very rural locations, and more low-paid jobs and significant deprivation across the county, all of which increases demands for our services.’
  • The observation that current circumstances, including the pandemic, the rising cost of living, and labour and skills shortages in the social care market, make the present time particularly difficult for the implementation of the reforms. This was coupled with an emphasis on the need to reduce the pace of the reforms, whenever they are implemented: ‘Local government adult social care is being asked to do a lot, in a short timescale, with little knowledge of funding for the year ahead, missing/incomplete adult Social Care Funding Reform guidelines; and a crisis in the social care work force, including hiring additional financial assessors.”
  • The recognition of the complexity and level of detail involved in the reforms, their potential to create confusion, and the need for local authorities to engage in increased communications activity to provide clarity about the reforms to their residents: “We are already planning for implementing the reforms, but this is an extremely complex area, involving many council departments. The complexity of this work and of communicating the details of the reforms to our residents is very challenging.”

A further four individual comments could not readily be grouped into the four themes above, and concerned the following:

  • A concern that health (as opposed to social care) will dominate the reforms, and key actors will lack essential knowledge of the local government system and election cycle;
  • An expressed lack of confidence in the effectiveness of working relations between NHS bodies and local authorities to implement the reforms;
  • An observation that the reforms around adult social care assurance extend in their implications well beyond social care and that other council departments are also likely to see increased burdens and require support;
  • One respondent who stated “Although I have low confidence that all the reforms can be delivered, I don't believe we should delay those reforms as otherwise we will make no progress at all.”

Annex A: Questionnaire

If you are responding on behalf of more than one authority please note this in the 'authority' box below, but please check with us first whether a separate return is needed for each authority. 

  1. Name  (1) ________________________________________________
  2. Authority  (2) ________________________________________________
  3. Job title  (3) ________________________________________________
  4. Email address  (4) ________________________________________________

1. How confident are you or not in your council's ability to meet existing statutory duties in adult social care in the coming year and within existing resources, disregarding future reforms?

  1. Very confident  (1)
  2. Fairly confident  (2)
  3. Not very confident  (3)
  4. Not at all confident  (4)
  5. Don't know  (5)

2. How confident are you or not in your council's ability to deliver the following aspects of the adult social care reform programme to the Government's timetable?

 

Very confident (1)

Fairly confident (2)

Not very confident (3)

Not at all confident (4)

Don't know (5)

The cap on care costs (1)

 

 

 

 

 

Changes to the financial means test thresholds (2)

 

 

 

 

 

Fair rate of care (3)

 

 

 

 

 

Section 18(3) of the Care Act whereby self-funders can ask their council to arrange their care at the rate the council pays (4)

 

 

 

 

 

Adult social care assurance (5)

 

 

 

 

 

3. Overall, thinking about all elements of the reforms, how confident are you or not in your council's ability to deliver the programme to the government's timetable?

  1. Very confident  (1)
  2. Fairly confident  (2)
  3. Not very confident  (3)
  4. Not at all confident  (4)
  5. Don't know  (5)

4. How confident are you or not that the government funding earmarked for the adult social care reforms is sufficient to deliver them?

  1. Very confident  (1)
  2. Fairly confident  (2)
  3. Not very confident  (3)
  4. Not at all confident  (4)
  5. Don't know  (5)

5. How confident are you or not that your council will have the required capacity, either through existing staff or additional recruitment, to deliver the adult social care reforms?



Please provide an answer broken down by the following categories of staff.

 

 

Very confident (1)

Fairly confident (2)

Not very confident (3)

Not at all confident (4)

Don't know (5)

Senior leaders (1)

 

 

 

 

 

Service managers or supervisors (2)

 

 

 

 

 

Frontline staff (including social workers and financial assessment officers) (3)

 

 

 

 

 

 

6. Taking into account the wider health and care reforms, how confident are you or not in your council's ability to deliver everything the government is asking of you (existing statutory duties, social care reforms, and wider reforms and initiatives) in the coming year?



These reforms include, for example, those mandated by the Health and Social Care Act, Liberty Protection Safeguards (LPS) and increased collaboration with Integrated Care Systems (ICSs).

 

  1. Very confident  (1)
  2. Fairly confident  (2)
  3. Not very confident  (3)
  4. Not at all confident  (4)
  5. Don't know  (5)

7. Finally, bearing in mind what you know about current demand duties, the timescale, funding and capacity available for the adult social care reforms, and the wider health reform agenda, do you think some or all of the adult social care reforms should be delayed?

 

  1. Yes, all of them  (1)
  2. Yes, some of them  (2)
  3. No  (3)
  4. Don't know  (4)

 

Which of the following reforms do you think should be delayed?



Please select all that apply.

 

  1. The cap on care costs  (1)
  2. Changes to the financial means test thresholds  (2)
  3. Fair rate of care  (3)
  4. Section 18(3) of the Care Act whereby self-funders can ask their council to arrange their care at the rate the council pays  (4)
  5. Adult social care assurance  (5)

 

8. Please write in below any further comments on the topics covered by this survey which you would like to share with us.

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________



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