Second Report - Long-term funding of adult social care

The Government provided vital additional funding to the adult social care sector during the pandemic, and we appreciate that the additional covid-19 funding cannot continue indefinitely. However, the Government’s own guidance that care workers should self-isolate if they test positive … Read more The Government provided vital additional funding to the adult social care sector during the pandemic, and we appreciate that the additional covid-19 funding cannot continue indefinitely. However, the Government’s own guidance that care workers should self-isolate if they test positive for covid-19 indicates that the risk to the sector is not over. We do not accept that controlling covid-19 infections is analogous to other types of infection control, since Ministers were unable to name any other sector whose employees the Government is still advising to self-isolate. Given the huge financial pressures on the sector and acute challenges with retaining staff, the Government should extend the Infection Control Fund for as long as the public health situation requires it to advise care workers to self-isolate with covid-19. (Paragraph 13) Immediate pressures Show less

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The Government is focused on long-term reform of adult social care, but in order to get to the future it needs to save the sector from the brink of collapse. Covid-19 has highlighted the underlying structural challenges of rising demand, … Read more The Government is focused on long-term reform of adult social care, but in order to get to the future it needs to save the sector from the brink of collapse. Covid-19 has highlighted the underlying structural challenges of rising demand, unmet need, and difficulties recruiting and retaining staff, and has also exacerbated them. On top of that, there are severe current pressures arising from increases in the National Living Wage and the National Minimum Wage, and from rising inflation. We strongly disagree with the former Minister for Local Government, Faith and Communities that adult social care has adequate funding currently, having received compelling evidence that there is an immediate need for additional funding. The Government should allocate additional funding this year through the adult social care grant, cover inflationary pressures and unmet care needs, and should announce this as soon as possible so that local authorities can plan how to cope best with the pressures they are facing. (Paragraph 21) Funding gap Show less

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We recognise the benefits of raising a proportion of funding for adult social care locally. As we have argued in previous reports, we support greater fiscal devolution. In finding the right balance of funding sources for adult social care, however, … Read more We recognise the benefits of raising a proportion of funding for adult social care locally. As we have argued in previous reports, we support greater fiscal devolution. In finding the right balance of funding sources for adult social care, however, we are concerned by the increasing reliance on locally raised tax revenue as currently constituted. In our previous report on local authority financial sustainability and the section 114 regime, we recommended a variety of ways in which the mix of funding to local authorities could be improved, including: resetting business rates, implementing the Fair Funding Review, 75% business rates retention with additional funding put towards an equalisation grant, and revaluing council tax. For this inquiry, we heard that the amount that areas can raise through council tax is not related to need: often the places with the lowest income from council tax have a higher proportion of adults who are eligible for state support for their care. We also recognise that the decision to raise social care precept will become a harder sell for councils when residents have already seen their National Insurance Contributions increase to pay for health and social care. In deciding how much additional funding to provide from the centre for adult social care, the Government must proceed with the aim of rebalancing the sources of funding so there is not such a reliance on council tax. Show less

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One-year funding settlements and short-term grants are hampering local authorities’ ability to plan and to deliver value for money, which in turn affects local care markets as it makes it more difficult for local authorities to enter longer term contracts … Read more One-year funding settlements and short-term grants are hampering local authorities’ ability to plan and to deliver value for money, which in turn affects local care markets as it makes it more difficult for local authorities to enter longer term contracts with providers. The Government must provide a multi-year funding settlement to give local authorities the visibility they need both for their own sustainability and also to help shape sustainable local care markets. It should also aim to make announcements about grants and social care precept at an earlier stage in councils’ budgeting cycle. Show less

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The Department for Health and Social Care is drip-feeding numerous policy changes in adult social care, many of which are welcome, but many of which will have a significant impact on local authorities in terms of their spending and capacity. … Read more The Department for Health and Social Care is drip-feeding numerous policy changes in adult social care, many of which are welcome, but many of which will have a significant impact on local authorities in terms of their spending and capacity. These include the cap and new means test, commencing Section 18(3) of the Care Act 2014 in respect of residential care, the fair cost of care, reforms in the People at the Heart of Care White Paper around housing, data, and assurance, and reforms in the Joining up Care for People, Places and Populations White Paper around health and care integration. We understand that local authorities are working closely with central government on these reforms. But we are concerned that the Government does not have a handle on what the total impact on local authorities will be. The 76 Long-term funding of adult social care Government should publish a new burdens assessment by the end of the year to determine the level of resource needed by local government in terms of staff, expertise, and funding to deliver the full package of adult social care reforms. (Paragraph 77) People at the heart of care: the direction of travel for reform Show less

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The Minister for Care and Mental Health asserted that the chapter on the workforce in the People at the Heart of Care White Paper is the Government’s social care workforce strategy, but the number of further calls for a social … Read more The Minister for Care and Mental Health asserted that the chapter on the workforce in the People at the Heart of Care White Paper is the Government’s social care workforce strategy, but the number of further calls for a social care workforce strategy that have been made since the White Paper’s publication clearly indicates that the contents of that chapter do not amount to a strategy, or are not what the sector expected to see from one. The Government should publish a 10-year strategy for the adult social care workforce. It should develop the strategy in collaboration with care workers, providers, local government, the NHS, unpaid carers, and people receiving care. The strategy should not just be a wish-list but needs to be a clear roadmap with core milestones, outcomes, and measures of success. We agree with the Government that retention should be a key performance indicator, but it is important that measures of success also include opportunities for progression, reduced prevalence of zero-hour contracts, and whether care workers feel valued for the highly skilled nature of their work. (Paragraph 117) 78 Long-term funding of adult social care Show less

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We welcome the addition of care workers, care assistants and domiciliary care workers to the Shortage Occupation List, acknowledging that these roles are in short supply within the UK resident labour market. The Government should monitor the impact of adding … Read more We welcome the addition of care workers, care assistants and domiciliary care workers to the Shortage Occupation List, acknowledging that these roles are in short supply within the UK resident labour market. The Government should monitor the impact of adding care workers to the Shortage Occupation List on vacancies and be prepared to extend the visa period beyond 12 months, to lower the salary threshold, or both. (Paragraph 119) Unpaid carers Show less

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The Government claims “the money is there” to support carers’ breaks, but the evidence we received is that not enough carers are getting a break. There are many carers who have not had a break since the start of the … Read more The Government claims “the money is there” to support carers’ breaks, but the evidence we received is that not enough carers are getting a break. There are many carers who have not had a break since the start of the pandemic. Providing intimate care, under pressure, for such a prolonged period, is bound to have an impact on a person’s mental and physical health. It is imperative that the Government announce additional ringfenced funding to enable more carers to take a break this year. (Paragraph 129) Long-term funding of adult social care 79 Show less

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We welcome the Joining up Care for People, Places and Populations White Paper and commend the Government for making the integration of health and social care a policy priority. We particularly welcome the Government’s ambitions around shared outcomes, workforce integration, … Read more We welcome the Joining up Care for People, Places and Populations White Paper and commend the Government for making the integration of health and social care a policy priority. We particularly welcome the Government’s ambitions around shared outcomes, workforce integration, and ensuring every citizen has a shared care record by 2024. However, we are concerned that inconsistent geographical boundaries could result in gaps which could also hinder the successful pooling of budgets. In Spring 2023 the Government should review how many places have established governance and accountability models and their geographical footprints, and should work with local partners to modify boundaries if necessary to ensure all citizens can benefit from effective arrangements. The Government should also publish without delay its review of the arrangements that govern pooled budgets under Section 75 of the NHS Act 2006. The Government should seek to enable localised place-based arrangements between the NHS and individual councils, and pool budgets on that basis. Show less

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Barriers to data-sharing between health and social care have been a long-standing challenge, so we particularly welcome the Government’s ambition to have shared care records for all citizens by 2024. It is vital that this ambition becomes a reality. 80 … Read more Barriers to data-sharing between health and social care have been a long-standing challenge, so we particularly welcome the Government’s ambition to have shared care records for all citizens by 2024. It is vital that this ambition becomes a reality. 80 Long-term funding of adult social care The Government should set up pilot schemes for shared care records, co-produced with people receiving care, carers, and care workers, and should report regularly on progress towards its 2024 target. Beyond 2024, the Government should publish annually the proportion of citizens who have shared care records and take steps to address any areas with particularly low take-up. Show less

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The covid-19 pandemic has had a severe impact on adult social care. People have received less care and often care workers have been compelled to deliver only the basics. More people are going without care and many people’s needs are increasing significantly. Social care workers and unpaid carers are burnt …

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The covid-19 pandemic had the effect of raising public awareness of adult social care. It also achieved general support for a tax increase specifically to plug the long- standing funding gap. However, the Government has missed this opportunity. It has done so firstly by allocating the vast majority of the …

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While the changed timetable for rolling out Section 18(3) will help to stagger the additional assessments local authorities will need to conduct, we are nevertheless concerned about local authorities’ capacity to conduct tens of thousands of additional assessments, particularly given the size of the backlog that already exists. We are …

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We heard repeatedly that an absolutely critical lever for stabilising the adult social care market was tackling staff shortages and low retention. This would widen access to care and help to give unpaid carers a much-needed break. There is also the very real risk that the Government’s charging reforms do …

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We are not reassured by the Director General for Adult Social Care’s comments that some places have found ways to continue discharge to assess funding from their own funding streams, not least by her admission that these workarounds are only short-term and only “for the bits of it they think …

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