‘The injustice exposed by Covid has left me angrier’, says outgoing social care directors’ leader

After leading ADASS through the most turbulent year in living memory for social care, James Bullion reflects on the pandemic, his hopes for reform and the need for a unified voice in social care

James Bullion is leaving the role of Association of Directors of Adult Social Services president “angrier than when he went in”.

“Because of what I’ve seen of the injustice, the need for reform, the frustration of the delay and the need to constantly stand up for social care in the Department of Health and Social Care who often default to the NHS.”

The Norfolk director, who is due to hand over the presidential baton to Oxfordshire’s Stephen Chandler later this month, held the post in one of the most turbulent and challenging years for social care in living memory.

Already in a perilous state thanks to years of austerity and delayed reform, the care sector was devastated by the pandemic both financially and in terms of human loss of life.

But despite the tumultuous year that was, Bullion is proud of the proactive way the sector responded to Covid, the ways in which it tried to minimise the impact and how organisations spoke out about the impact on social care.

‘Stressed state’ of sector pre-pandemic

The social care sector was in a ‘stressed state’ prior to the pandemic, Bullion said, with a high level of vacancies and turnover, an unresilient care market and insufficient funding to meet demand.

When the pandemic came along, that stressed state really played out, he says:

Had we gone into Covid with much lower levels of vacancies and a lower level of turnover and a bit of a plan around how we were going to deal with the market resilience, then we’d have been stronger quicker.”

The result was a tragically high death toll in care homes in those early months, both from Covid and other causes. Office for National Statistics (ONS) data shows that between 28 December 2019 and 12 June 2020, there were 93,475 deaths of care home residents in England and Wales, 45.9% higher than the previous year.

In addition to high numbers of deaths in care homes, a survey of directors of adult social services (DASSs) in June 2020 found Covid-19 had driven increased demand and mounting unmet need due to providers not accepting referrals, service closures and people declining services.

How social care recovered

Bullion says that the sector eventually recovered because of the work of local authorities and providers and because the government intervened with funding and support – putting the sector in a much stronger position by July/August.

From May 2020, with the launch of the then £600m infection control fund, the Department of Health and Social Care allocated a number of sector-specific grants, to fund testing and additional staffing, particularly in care homes. It also established, in June 2020, a social care taskforce, whose report in September led to the roll out of free personal protective equipment for care providers, alongside an extension of the infection control fund.

While there is much to be critical of regarding the treatment of the sector during the pandemic, Bullion says that, to some degree, Covid highlighted the value of social care.

“We did see evidence during the pandemic that people were starting to clap for carers as well as clap for the NHS, that’s evidence that a lesson was being learned that actually the people working in social care are frontline key workers.”

Workforce is key

The main lesson Bullion hopes has been heeded is the need to strengthen the workforce which, at the last count, was carrying over 100,000 vacancies.

“That’s in the context of: we need half a million new jobs in the next ten years in social care, so you’ve got the issue of attracting people into the social care workforce at a time when maybe from the outside it doesn’t look like a great career.”

However, changes to the immigration have, arguably, made the situation harder.

In January 2021, a new points-based immigration system came into force, which effectively prevented people from coming to the country to work as care workers.

This position has been softened since, with senior care workers added to the government’s shortage occupation list, enabling migrants to carry out these roles. However, local authority, provider leaders, unions and charities have warned the points-based system still risks deepening the sector’s already grave workforce shortages.

The government has said it wants UK workers to join the social care sector, on the basis of raising wages; however, sector bodies have said this is not realistic, with one describing it as “idiotic” given the rates paid to providers by councils.

Meanwhile, ADASS’s repeated calls for a national care wage, worth £10.90 an hour compared to the current national living wage of £8.91, have seemingly fallen on deaf ears.

Nevertheless, Bullion is optimistic.

“I can see in some of the messages that the government is now giving about reform that workforce is recognised as a key underpinning priority,” he says.

Speeding up service change

The other key challenge, says Bullion, is that the pandemic has accelerated the shift from residential to care at home.

“For example, people expressing a desire to be supported at home or have a live-in carer rather than residential care – some of that’s to do with worry about the pandemic, some of that’s to do with the isolation that comes with some of those institutional settings now, but some of it is just the direction of travel that we were already heading in,” Bullion adds.

“So the big challenge is, how do we get the care service to adapt to those models without having problems of care continuity and companies going bust?”

Meeting this challenge remains problematic given current levels of funding for social care.

Ongoing funding problem

In the November 2020 spending review, Chancellor Rishi Sunak granted local authorities access to an extra £1bn funding for social care in 2021-22, reliant on authorities increasing council tax by 2% and levying an additional 3% through the adult social care precept, a ring-fenced top-up to council tax.

But despite ministers suggesting this would increase council budgets by 3% in real terms, Bullion says most local authorities are experiencing a real-terms reduction in their local care spend in 2021-22, because of demography and the cost of social care rising faster than national funding.

“My worry is that the sustainability of the care sector is still a problem that’s been postponed [and] it will become a problem later this year.”

This problem is already making itself felt, with charities already raising concerns about councils increasing charges for those receiving care and support, and providers warning that most councils have either failed to announce fee rates for 2021-22 or set inadequate ones.

Hopes for reform

In this context, the spotlight turns to the long-awaited, and long-promised, reform of the sector, including its funding.

Many previous ADASS presidents have said they “expect reform this year”, but Bullion says that, from his point of view, this year it does look like a “realistic prospect”.

“We have heard from the prime minister and the secretary of state at recent committees in parliament confirming that reform is still intended in this year,” he said.

He recognises that social care is now competing with “a range of national issues”, people have grasped the fact that reform of the sector is an investment in jobs and an economic recovery aid to the country.

“People have now probably grasped the fact [social care’s] worth at least £20bn of public spend; it should be £27bn but, in to that primary spend, it’s another £8bn to £10bn, so that’s bigger than tourism and fisheries.”

Reform must consider full range of social care

To date, government pronouncements on the reform agenda have pointed to the need to address the issue of older people having to sell their homes to pay for residential care, by insuring people, in some way, against the prospect of catastrophic care costs.

However, Bullion says he also wants to see “the breadth of social care” included in reform.

“There’s a much broader picture of care at home, of prisoners, of disabled people, of people who are rough sleeping and homeless, for people who have mental health issues that are in the community already, domestic abuse – all of that is social care, so we need the government not just to recognise that one question about how do you pay and who pays but how do you fund the whole thing.”

The need for a unified voice 

The prospect of reform highlights the need for social care to speak with a unified voice in its lobbying of government. However, one thing that became glaringly clear for Bullion during his time as president was the fractured nature of social care leadership.

“Across many organisations such as Skills for Care, care providers associations, Think Local Act Personal, ADASS itself and the Local Government Association, one of the things that strikes me is you see the inability of all of those leaders to give a single message.

“I think in order for social care to be successful it needs to have some single joined-up messages that aren’t always joined up, so there’s something about making sure that the ADASS presidency and other roles play a strong leadership role right across the sector, not just for our particular organisation that we’re representing,” Bullion says.

He compares this to the NHS, which has a single chief executive – the head of NHS England, Simon Stevens – who speaks very powerfully, whereas social care is divided.

“That strikes me as a thing that needs rectifying going forward [and] I have every confidence that social care leaders will go on and do that.”

6 Responses to ‘The injustice exposed by Covid has left me angrier’, says outgoing social care directors’ leader

  1. Colin Slasberg April 17, 2021 at 10:17 am #

    James joins a long list of failed past Presidents, none of whom have risen to the challenge of acknowledging the need to change the system they lead that so timidly and uncomplainingly has allowed itself to diminish what it recognises as ‘need’ to whatever resource the democratic system may have happened to hand out to social care. That is why the care sector was so impoverished and so vulnerable going into the pandemic. Its why there is a 60%disparity in levels of provision around the country which the sector knows about and brushes under the carpet,; its why not one council has any record of unmet need; its why the Public Accounts Committee and Health Select Committees are assured all ‘eligible’ needs are being met. Its all well and good saying social care needs more money with one face, while with another making sure it doesn’t.

    Maybe Stephen Chandler will be different, although its hard to find reasons to believe so.

  2. Nigel April 19, 2021 at 11:32 am #

    Agree wholeheartedly. Performance of ADASS in this period has been woeful. A new leader is irrelevant, the set up is compromised by a timid mindset.

  3. Janet April 19, 2021 at 2:52 pm #

    Hear hear! Pleased to see I’m not the only one thinking this. It’s woeful that a man in his position talks as though this has come as a surprise/shock to him. Some of us have known it for years.

  4. Susan April 19, 2021 at 3:10 pm #

    Not angry enough to call out the hedge funds though.

  5. Peter Tempest April 28, 2021 at 4:49 pm #

    Pot holes. Ask the person on any street should we spend more of your money on pot holes or someone else’s personal care? The answer has always been, pot holes.
    What is a local politician’s first priority? No , not pot holes or social care, it’s to be re-elected. So she works on what is perceived to be likely to help that cause.
    Central government of every colour despise local authorities. It constrains spending of any kind and unlike the NHS cannot spend what it hasn’t got. It is controlled with a relative iron fist. Look at those councils which have gotten into financial difficulties. And then there’s the media. Just look at the histrionics every time the subject of inheritance tax reform or enforced insurance comes up as a partial solution to funding your own care. Chief Executives & Directors and Leaders of top tier councils do raise social care priorities with Government and civil servants almost every time they have the opportunity; you would be surprised how expert these people are in understanding the key issues. James is right Government has always listened to the sacred cow that is the NHS and has little understanding of the breadth and complexity of what constitutes personal care and support for those people who rely on others every day often foregoing their dignity into the bargain. We have an opportunity now to capitalise on the small gains James highlights and start a grown up conversation at every level in our country on what our vision is for a decent society that leaves no-one behind at any stage of their life and create a consensus on how we use our ingenuity and resources to actually drive for whatever is agreed. Perhaps then politicians can be intelligently assessed on how well they contribute to its delivery. We need a David Attenborough or Greta Thunberg to champion change and to shame us all into understanding doing nothing is not an option.

  6. Colin Slasberg April 29, 2021 at 4:01 pm #

    You have to ask why sector leaders consistently fail to cut through to political leaders. Is it really that they are all so indifferent to the wellbeing of older and disabled people? Or is it because they completely undermine their own arguments for more funding to meet unmet need when the circular, resource led process to define need that they employ to control spending means they never identify any unmet need. Or is to because they leave the public utterly bemused as to what social care is about when they describe their purpose as meeting something called ‘eligible’ needs when no-one has a clue what that means? Or is it because they are so out of touch with their front lines and the lived experience of the older and disabled people they serve that they can only talk about social care in cold and legalistic terms?

    I don’t think social care needs a Grete Thurnberg. It needs a social care system built on the lived experience of older and disabled people and leaders who can relate to that and champion their cause.