Story updated 18 June
Just 4% of directors of adult social services are fully confident their council can afford to meet their statutory duties this year, a survey has found.
The situation was the result of the impact of Covid-19 on councils’ finances on the back of a decade of austerity, warned the Association of Directors of Adult Social Services (ADASS), as it released the results of its annual budget survey.
Without an emergency injection of cash from government to “plug the financial black hole that has been blown in local government finances”, the sector would face devastating consequences, said the association’s president, James Bullion.
“Without such action, local authorities will run out of money, care providers will go to the wall, many of us will not get the care and support we need, and the economy will take a further hit as more of us are forced to give up work to fill the caring gaps,” Bullion said.
“Prioritising social care is the right thing to do morally, ethically, economically and politically. We must act now, for all our sakes.”
Specifically, the association called for over £1bn to ensure councils and providers could meet the immediate costs of Covid, and a two-year settlement to stabilise services, pending the development of a long-term funding settlement that the government, like its predecessors has repeatedly promised.
The budget survey is the second in a series of reports – the first, issued last week focusing purely on the impact of Covid-19 – designed to shine a light on severity of the challenges authorities, providers and people who need support face. It was carried out in May and responded to by 146 of the 151 English authorities with social services responsibilities.
- Covid-19 driving mounting demand and unmet need across adult social care, say directors
- One council left suspending Care Act duties as authority subject to legal challenge returns to full compliance
- Care providers may face bill of up £6.6bn in Covid-19 costs by September, research finds
- ADASS head attacks ‘intolerable burdens’ in accessing coronavirus infection control money
The 4% of directors who reported that they were fully confident they could afford to meet their statutory duties marks a dramatic fall from the 35% who reported the same in 2019-20. At the same time, 35% now have no confidence they will meet their Care Act 2014 duties – up from 6% in 2019-20.
The fall has been driven principally by Covid-19. Prior to the pandemic, councils were planning to make £608m in savings to enable them to meet additional demands, with £520m required to maintain services at 2019-20 levels as a result of demographic pressures.
However, in the light of Covid, seven in ten directors said at least 41% of their planned savings were at risk, while at the same time, ADASS members calculated that they would lose £190m over the year in client contributions, due to service closures, higher occupancy rates in care homes and NHS funding for post-discharge care.
At the same time, councils have faced additional bills from providers’ need to spend substantially more on personal protective equipment (PPE) and staffing, for example due to the need to prevent care home staff moving between homes.
Separate analysis by ADASS and the Local Government Association has found that councils may incur up to £5.9bn in additional costs – as well as £0.7bn in lost revenue – as a result of Covid from April to September of this year, with £3.3bn of the bill falling on councils.
The ADASS survey found that councils had been helping providers by paying for scheduled care whether it was delivered or not (72% of councils), paying invoices immediately (72%) and paying in advance (55%).
The LGA has said that, of £3.2bn allocated by government to councils in non-ringfenced emergency Covid cash, £1.41bn has been allocated to adult social care. With the additional £600m provided to manage infection control, this leaves councils facing a shortfall of £1.3bn to cover provider bills
Bullion said that government needed to stump up this sort of sum immediately to ensure councils were able to make the savings they needed and balance their budgets.
“We are reaching an end point quickly in August and September,” he said. “The resource is running out and needs to be repeated or extended.”
Without it there were real risks of a “collapse in the care market” in some areas, whose fragilities were laid bare by the survey, including occupancy falls in care homes due to Covid-19.
Over three-quarters (78%) of directors said they had seen a drop in occupancy rates in care homes used mainly by state-funded residents, while 51% had seen a fall in those used mainly by self-funders. Also, over half (53%) said they had had requests for support from homes that had had a significant fall in self-funding residents.
Responding to the survey, Natasha Curry, deputy director of research at health think-tank the Nuffield Trust, said: “The figure that only 4% of directors believe they have enough money to meet their statutory duties is truly shocking, a massive drop from 35% last year when the situation was already very bad.
“This would mean care services restricted to a bare minimum, contributions jacked up for often vulnerable people receiving care, and many providers shutting up shop.
“We must adopt a fair, transparent system that gives people of all ages the care they need and protects them against catastrophic costs. The social care system was already on its knees before the pandemic.
“If this government becomes the fourth in a row to fail to deliver on promises of reform, it now seems possible that the system will fall apart entirely.”
Beyond the current crisis, ADASS said that councils needed a two-year ringfenced settlement to enable them to ensure continuity of care for existing service users, stabilise care markets, and meet ongoing costs of Covid-19 and those relating to the recovery from the pandemic.
During this time, the government should develop, consult on and implement long-term reform of the care system to last 10-20 years, which should “thoroughly reshape social care markets” and “address the deep inequalities” faced by disabled and older people, black and minority ethnic groups and poorer communities.
On reshaping markets, Iain MacBeath, ADASS’s honorary treasurer and the director at Herfordshire council, said the current situation offered the opportunity to shift care out of care homes into home-based support, if done carefully.
The government is committed to long-term reform of social care funding but sees this as principally dealing with the issue of people being forced to sell their homes to pay for care, a focus that would benefit older people with assets rather than younger disabled people, or focus on the wider agenda articulated by ADASS. The BBC recently reported that ministers may revive the idea of a cap on care costs – legislated for under the Care Act 2014 but never implemented – as the core of these reforms.
New employment deal for care staff
ADASS also called for “a new employment deal for care staff” including a “wage that matches the compassion and skill that social care staff show on a daily basis”.
It also called for improved training, career progression and the “registration and regulation” of care staff. The latter was originally due to happen under the New Labour government but was dropped by the incoming coalition administration in 2010 and never revived. Care staff are regulated in every other part of the UK besides England.
Cath Roff, the director at Leeds and joint chair of ADASS’ resources policy network, said: “The fundamental issue is that social care work is skilled work. Increasingly we’ve seen government interested in care workers taking on health care tasks so with these increasing responsibilities there needs to be recognition of the need for increased remuneration.”