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.