By Patrick Grafton-Green and Mithran Samuel
Councils would require an “unfeasible” increase in adult social work numbers to implement the government’s care reforms unless they change systems, according to a report last week.
English authorities would need to carry out an estimated 105,000 extra Care Act assessments a year because of an influx of self-funders into the system on the back of the reforms, which are due to be fully implemented in October 2023, found the study by the County Councils Network and consultancy firm Newton.
This would require 4,300 more adult social workers under councils’ current operating model, roughly a quarter of the workforce of 15,655 practitioners. However, councils also had 1,600 vacant posts, as of last September, meaning they would have to find about 6,000 additional social workers, amid a mounting backlog of assessments, care packages and reviews.
A quarter of the 4,300 additional practitioners would need to be found by councils in the South East, where 44% of care home residents are self-funders against an national average of 35%, according to Office for National Statistics figures released yesterday.
The report – based on data analysis, a survey of CCN members and engagement with other sector leaders and bodies – said it would “not be a feasible solution to find the additional workforce required”, meaning councils and government would need to “consider how the operating model for conducting assessments and managing caseloads fundamentally changes moving forward”.
How reforms will drive workloads
Three aspects of the reforms will increase demand for assessments, reviews and care planning work under the Care Act:
- A more generous means-test: the planned rise from £23,250 to £100,000 in the upper capital limit – the savings ceiling for council-funded care – will make many existing self-funders eligible for council support. The report assumed all such people would come forward and seek support, resulting in an additional 88,000 Care Act needs assessments per year, with all those eligible requiring annual reviews and ongoing care management.
- The £86,000 cap on personal care costs: to access the cap, self-funding care users will need to have their needs assessed and then reviewed annually, and open a “care account” to meter their progress to the £86,000 limit. The report assumed 80% of affected self-funders would do so, resulting in an additional 17,000 assessments per year.
- Access to care brokerage: the full implementation of section 18(3) of the Care Act will mean self-funders can access council support to access a care home place – at council rates, which are typically lower than what self-funders pay. The report assumed half of affected self-funders would do so.
Outsourcing assessments and boosting student numbers
The Department of Health and Social Care has already admitted that councils will need to recruit more social workers to implement the reforms, which it said it plans to support by increasing the number of training routes into the profession, and thereby the number of trainees.
It also suggested councils could also consider outsourcing needs assessments to external organisations, such as the NHS, care providers or charities, and make greater use of self-assessments by people with care and support needs.
The CCN and Newton report backed both of these approaches, saying the DHSC needed to fund a national recruitment campaign to attract people into the profession, and that councils should make greater use of digital self-assessments by care users and use health professionals and providers as “trusted assessors” to carry out assessments or reviews. It suggested provider assessments would be appropriate for people already receiving long-term support, who would be unlikely to move as a result, while provider reviews would enable them to adjust care packages and support in line with the person’s assessed outcomes.
More social work assistants needed
However, it also called for social work time to be focused on more complex casework, which would require the hiring of more social work assistants and other non-qualified staff to carry out assessments and other care management work. It said this should be backed by a recognised training pathway.
“A social work assistant qualification should be rapidly developed, to increase the pool of workforce who can complete assessments and reviews,” the report said. “This would need to be developed as an attractive career path into social care, but with a comparatively short period of qualification to help to provide the workforce in a timely way.”
It also said that councils needed to continue to increase the “productivity” of the social work workforce – an area of work that Newton focuses on – by streamlining processes, particularly case management systems.
“When combined with effective scheduling, some local authorities have been able to increase their assessment and review throughput from two to three assessments per social worker per week to around five,” said the study. “This increase in productivity could enable authorities to manage a proportion of the additional demand being forecast.”
Reforms ‘a huge challenge adding to existing pressures’
Liz Howard, professional officer and lead of the adults’ group at BASW England, said the need to recruit many more social workers presents a “huge challenge” on top of existing workforce pressures.
“What we would like to see is clarity about the funding that’s going to be made available to support the existing workforce, which needs to be addressing issues around recruitment but also retention,” she said.
In relation to the proposal to develop a social work assistant qualification, she warned: “We wouldn’t want any proposals around new qualifications to be at the expense of the [social work] profession”.
Association of Directors of Adult Social Services president Sarah McClinton said the reforms were not deliverable in the context of current pressures without more social workers.
She said: “There are currently over half a million people waiting for this care and support as well as the increased needs that charging reform will bring. Without more social workers it’s not doable and critical issues about quality and people’s options will be missed.”
Reform costs ‘£10bn more than government estimates’
The CCN and Newton said that the reforms – which also include action to ensure councils pay providers a fair cost for care – would cost considerably more than the government’s estimates, as set out in the DHSC’s impact assessment. On a like-for-like basis, last week’s report gave the cost of the reforms as £29bn-£32bn over 10 years, as against a DHSC estimate of £19bn *.
The CCN and Newton said a key reason for the difference was that their analysis found many more people would become eligible for means-tested support because their assets were between the upper capital limit than the DHSC had assumed.
To address, the government would need to increase the proportion of the new health and social care levy – involving a 1.25 percentage point increase in national insurance rates and dividend tax – devoted to adult care to half by 2031-32, yielding roughly £6bn a year for the sector in today’s prices.
Over the next three years, just 10% of the levy (£3.6bn a year) is due to be allocated to implement the care reforms, with adults’ services granted a further £1.7bn over that time for investment in service development and the wider care workforce.
Martin Green, chief executive of Care England, said the report “demonstrates that the government has significantly underestimated the funding required by a phenomenal amount”, putting additional pressures on an “already overburdened sector”.
In response, a DHSC spokesperson said: “Modelling has been through extensive peer review and we are confident in the department’s estimate for charging reform. We’re working closely with local authorities, providers and care receivers to deliver a smooth national transition into the new system.”
* The DHSC’s impact estimate gave the 10-year cost of the reforms as £23.25bn. The CCN and Newton have used £19bn to establish a like-for-like comparison with their own estimates, by excluding the costs of implementing a fair cost of care for services other than care homes.