The government has placed ‘intolerable burdens’ on councils and care providers in accessing money to control the spread of coronavirus in social care settings, the Association of Directors of Adult Social Services (ADASS) has warned ministers.
In a letter to care minister Helen Whately, ADASS president James Bullion said both directors and providers had “deep concern” over the £600m infection control fund, which was launched last month to help care homes in particular tackle the spread of coronavirus.
Bullion criticised “extremely detailed accounting” that placed “unnecessary and intolerable burdens” on councils and providers, and said conditions on the use of the money were “so restrictive” that providers would struggle to justify expenditure.
The Department of Health and Social Care’s conditions for the grant (see below) include significant reporting requirements for both councils and providers to justify their use of the money and specify a limited of valid uses for it – with the risk that money would be clawed back if it were not used appropriately.
‘Confused and overly bureaucratic’
Bullion also questioned why the money could not be used for personal protective equipment (PPE), which was not one of the specified uses, despite this being “the biggest single issue for many local areas” and given the inflated prices councils and providers were being charged for it.
He added that Department of Health and Social Care requirements that councils ensure they comply with European Union state aid law in their use of the grant – a particular issue in relation to funding care homes with only self-funding clients – involved authorities having to make “extremely complex” legal judgments.
He added: “The result is a confused and overly bureaucratic system which makes it difficult for providers to claim and impossible for local authorities to deliver within the required timescales. This is creating unnecessary local tensions between providers and local
authorities. Providers are already incorrectly blaming councils for flaws in this national system.”
Bullion’s concerns have been echoed by the Local Government Association who, in a briefing, described the grant conditions as “unusually prescriptive”, raised concerns about the “highly complicated” state aid issue councils would have to navigate, and warned about the narrow range of uses for the money and strict reporting requirements.
Both the LGA and Bullion referred to their two associations having lobbied the DHSC about their concerns about the use of the fund but without success.
The concerns are also shared by Care England, the largest provider representative body, a spokesperson for whom warned that “the spirit of the funding has been misconstrued into a bureaucratic nightmare and is not forthcoming to the front line” and that it “seems absurd that the £600m can’t be used retrospectively for PPE or staffing costs”.
Council engagement with providers criticised
However, in an echo of Bullion’s comment about tensions between councils and providers, the spokesperson also warned that “our data shows us that many local authorities are yet to engage meaningfully with their providers”.
In response to the criticisms, a DHSC spokesperson said: “Since the start of this outbreak we have been working closely with the sector and public health experts to put in place guidance and support for adult social care, as a result over 60% of care homes have had no outbreak at all.”
On PPE, the DHSC said it would not prohibit use of the infection control fund for this purpose, but added: “The department is leading the sourcing and payment of all PPE for the public sector and we have ensured millions of items of PPE are available for social care.”
This has included agreeing contracts to manufacture two billion items of PPE in the UK, creating a distribution network that delivers to 58,000 settings and providing millions of items to local resilience forums – partnership bodies of councils, NHS and emergency services providers – to deal with local spikes in demand.
Significant conditions on accessing fund
The fund was unveiled by the Department of Health and Social Care (DHSC) in mid-May as concerns about deaths in care homes from Covid-19 mounted. Unlike the £3.2bn provided to local authorities up to that point to respond to coronavirus, the £600m came with significant conditions attached, both for councils and providers:
- Councils were paid half the money in May but will only be able to access the second £300m, due in July, if they completed by 29 May a plan setting out how they were supporting local care homes, and ensure that the first £300m has been spent in its entirety, on infection control and that 75% has been allocated to local care homes, including ones with which they do not contract, on a per bed basis.
- However, councils were prohibited by the grant conditions from providing any of the first tranche of money to any care home that had not completed the capacity tracker, which tracks bed availability in real time, and committed to completing it on a consistent basis. In relation to the second tranche, councils are prohibited from giving the money to any home that was not consistently completing the tracker.
- Councils have also been told not to provide funding to homes unless they were satisfied it was being used for infection control.
- The 75% of the grant passed to care homes has to be used on the following measures only: ensuring staff who are isolated because they have suspected or confirmed Covid-19 receive their normal wages; ensuring, as far as possible, that staff, including agency workers, work in one home only; limiting staff to working with individual groups of residents and segregating Covid-positive residents; supporting recruitment to enable staff to work in only one home or with specific residents; taking steps to limit public transport use by staff, or providing accommodation for staff who choose to stay away from family to limit their social interaction.
- As part of this providers have to certify that they have spent the money in this way by 23 September and, if requested, provide the local authority or DHSC with receipts evidencing this.
- The council should make it a condition of providing the funding that providers account for their use of it and keep appropriate records, and withhold allocations from the second tranche of money from any home that it believes has not used the first tranche as expected and seek to recover any money not used for infection control. Providers are also be obliged to return any money not spent on infection control.
- The money cannot be used for fee uplifts for providers or activities for which the council has already earmarked expenditure.
- The remaining 25% can be used on other providers, including domiciliary care services, and does not have to meet the specific conditions of use for the 75%, however councils will need to be sure that the money is being used for infection control measures.
- As well as the care home support plan due by 29 May, councils must complete two returns on the use of the grant to the DHSC, by 26 June and 30 September.
- The DHSC may require the return of all or part of the money if grant if it not convinced that the money has been spent as expected or in its entirety by the end of September.
- Local authorities must ensure they comply with European Union state aid legislation in allocating funds through the grant, a particular issue when funding homes with only self-funding clients.
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As a social worker who has been put through the wringer at placements/resource panels to justify funding requests and who probably can’t quantify how many times has been asked to revise care assessments to fit seemingly arbitrary criteria, I am baffled why ADSS are advocating for a light touch accountability for care providers. If we accept that care provision should not be state provided, why are we expecting the state to not only step in to subsidise these companies but also not expect them to account for how they spend tax generated public money? I too find it onerous to spend hours filing in finance forms which are never good enough for approval at the first presentation. When I complain about overly bureaucratic processes, I told these are necessary for accountability. Why is it a surprise that in a profit based market place suppliers raise the price of goods in high demand? ADSS should be asking care providers why they don’t have cash reserves to meet health and safety needs of staff and residents and maintain basic infection control measures. Many other private businesses have not pled for PPE funding from the government, why is their business continuity plans more robust? Supermarkets have employed extra staff without expecting state payment for their staff costs, why should the government subsidise care providers; many of which are private equity concerns with inbuilt debt subsidising share dividends. My case notes are awash with manager e-mails reminding/admonishing me to be prudent with tax payer money. Surely the same standards should be expected of care companies.
I am truly shocked and baffled why ADASS representing a profession that champions social justice and human rights should be an advocate for care companies who fought against the minimum wage and champions zero hours contracts. One provider paid £48.5 million in share dividends in two years. Shamelessly they are now using Covid-19 as a pretext to hike charges by fleecing self funders for an extra £100 per week. How is this standing up for and being on the side of vulnerable people ADASS? Makes me ashamed to be a social worker.
There is of course the flipside to James and Nina’s replies!
Lets not lose sight of the fact that we are in the midst of a global pandemic and ALL options to help reduce the effects and impact of this terrible virus should be taken. We should be pulling together at times such as these, together we are stronger and together we defeat this virus.
On to the reply – the article highlights the issue of funding released by central government being cascaded in the guise of an IC grant to help support providers in their battle to reduce the risk of infection as a result of C-19. A noble cause. However, government has not sufficiently detailed how exactly they would like this money invested, BUT will hold councils and providers to account if it is spent incorrectly.
I work for a provider and have been in discussion with our local council, who are ‘pulling their hair out’ as they have received a command from DHSC, told to implement and police it with next to no guidance on how exactly to do either! Given the tight deadline imposed by DHSC the councils have done all that they could and passed the problem down to the providers who are now asking the question – how should we invest these funds in order to support the funds intention, without recourse? In other words, how should we spend this grant, as intended, in order to reduce the risk of infection as a result of C-19?
James – ‘light touch accountability’ is not the request, guidance on spend is. However, I agree that our healthcare system is overly bureaucratic and I would much prefer that less of all of our time is spent filling in paperwork and more time is thus available to work with the individuals we have dedicated our carers to help.
Nina & James – you both allude to the point that providers should not be recipients to such funding. I wholeheartedly disagree and suggest you take a step back to view the whole picture. For years Social Care has suffered from chronic underfunding, many council run homes closed or transferred to private ownership as they were not sustainable given the funding levels available. For the past 9 years, capacity in Social Care has decreased, in 2019 for every new home that opened two closed. Southern Cross is a stark reminder of how close to the edge many providers sail. We are in the midst of a crisis. This crisis makes both yours and my jobs extremely difficult but we should be singing off the same hymn sheet. You should be working with larger budgets, the state should be allocating more funding to social care. When costs are cut or frozen, as they have been in Social Care, corners are cut and this risks safety for those living and those working within social care.
NMW – I would love to pay my team double what they currently earn. I can’t! There are a number of reasons driving this answer, a simple solution would be to employ less people BUT our clients are joining us at a far older age and thus require far higher levels of support and assistance and so staff numbers are imperative in order to offer safe and effective care. Our only income is that received from the councils contracting care or private individuals paying for their own care, so if costs go up, as per NMW, then fees must also?!? I’m sure we all agree that carers should receive more pay, then pay more in fees to help that happen, rather than freeze income, as has been the case in Social Care regardless of political party colour! If you take a look at council funded placements pretty much across the nation they would be insufficient to fund a bed in a Premier Inn and that is just the bed, now factor in 24hour care, all food, laundry, activities and the sums simply do not add up hence the number of firms collapsing.
£100 top-up – I do not condone that measure but equally appreciate the financial struggles at the heart of this debate and so if it is a case of ‘we need extra funding or we close’ then top-ups would be preferable. Nobody foresaw C-19, you cannot stockpile products with a shelf life and thus we are being held to ransom by suppliers of PPE amongst other essential items, who have massively inflated their costs, some legitimately i.e. air freight costs, others not quite so legitimately! The government could have acted far more proactively in this situation and designated itself the national PPE supplier for example – you would have no arguments from me in having the ability to purchase PPE at fair prices from our own government. Interestingly enough the IC Grant suggests PPE is NOT one of the areas you can use the IC grant allocation!
The only other way of making the sums work is for less profits to be taken – put simply, we are what I would call a successful care home, 48 beds split between residential and nursing care and the providers earned insufficient to pay higher rate income tax last financial year! Profits are not excessive, costs are and funding is requiring a severe redress. I only hope that the increased limelight that C-19 has brought onto healthcare, both our NHS and Social care, gives the impetus as national appetite is at its highest, to invest in the future of our Health and Social Care infrastructure and national offering.
I want to be proud of our healthcare system, not continually battling for survival!
Dominic, its because I am looking at the big picture that I can’t accept the narrative that tax payers should be paying for ‘shortfalls’. Southern Cross is actually a good example of the way social care provision should not be provided so we don’t have residents held to ransom and arbitrarily threatened with potential evictions.
Southern Cross was bought in a management buy out for £80 million in 2002. Two years later it was bought by a private equity concern for £163 million. Their model was to expand into buying property and selling these while holding on to long term leases. This built in debt to their profit projections which were offset for tax purposes. How is speculative property portfolios a good basis for care provision?
Inevitably Southern Cross got into financial difficulties when they couldn’t pay back £43million in debts on these properties they could not sell off. During this chaos and with residents and families frantic with anxiety about their placements, one of their Chief Executives made £36.6 million from selling off some of his Southern Cross shares. Yet I remember well how care providers fought against and then threatened closures because the minimum wage went up from £7.50 to £7.83 two years ago.
Ofcourse we should pull together for the common good, but it’s difficult to do this when in the good times profits are ploughed into the pockets of shareholders but now rises in costs are expected to be met by the public purse. Looking at the accounts of private equity owned care providers we see the money parked in off shore tax havens, with their major shareholders paying no UK income tax. Surely the moral expectation should be that they pay for PPE and these new costs. The state should increase funding for social care but there is no certainty that companies will not siphon this for share dividends.
I too want care provision to be proud of but I would prefer it to be funded by our governments like the NHS. I would prefer to see my taxes funding dignified care so that my parents in their most vulnerable years don’t fret about whether they will be turfed out because their private provider can at any moment decide looking after them is no longer profitable. Council provided care homes were shut because competitive tendering rules were skewed to help private cartels undercut them. Shamefully some councils also saw this as an opportunity to cut their wage bill by closing down homes staffed by unionised workers who would not be bullied into new contracts turning them into lower wage insecure workers.
And frankly I have never stayed in a Premier Inn that cost £700 a week.