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.”
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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.
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So so predicable. Start with “most social workers are out of their depth incompetents so we need forensically sharp specialists” and end with “once we have our experts the rest can be anyone”. A teacher overseeing the replacement of teachers by teaching assistants comes to mind. Sir Alan, “Josh”, Hudson and now this. What a neat little squaring. Anyone actually surprised that a consultancy firm recommends outsourcing?
Exactly this. And get providers telling us people need to stay in long term placements! While they carry out their new LPS assessments! ?
The most clarifying and obvious point is if all Social Workers in adults or children’s local authorities just ‘worked to rule’ (i.e. 9am – 5pm), the whole system would collapse and implode overnight. The system is propped up by Social Worker’s doing ridiculous amounts of overtime in their own time.
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The arrogance of this government knows no bounds. The assumption that health professionals and care providers have the capacity to just pick up thousands of assessments as part of their existing roles would be laughable if the potential consequences weren’t so terrible. And yet again proudly displaying their contempt for the social work profession and the sector that they have starved of resources and cynically subjected to public hate campaigns to deflect their own culpability when things have predictably gone wrong. We all know that self assessments don’t work, and the scope of work that can be undertaken by staff without a formal social work qualification is rightly limited. Regardless of whether the reforms go ahead, we need more social workers. The problem is repeated government failings have ensured that it isn’t an attractive career path.
Actually these recommendations are a real challenge to the prevailing orthodoxies in social work leadership. It also echoes the emerging ideology of inching towards an ever more specialised practice. It’s a bit rich for BASW to bemoan the excessive bureaucracy preventing social workers from doing relationship based work than object when the thing they are asking for is offered in the shape of “assistant social workers”. Why wouldn’t an employers weigh reduction in social worker hours for doing care assessments with a commensurate reduction in qualified staff when recruiting assistants? It’s naive to play the ” we are overburdened exhausted social workers” and expect a “we love you let’s give you what you want” response. Politics and ideology rules social work not twitter self affirmation by the likes of BASW and their hangers on. Actually, I think there should be fewer qualified social workers. That way when the fees for SWE reduce and they are forced to increase them social workers might get a functioning regulator and a voice beyond the usual carping about being always badly done to. Lets hear from the PSW network put their ‘reputations’ and privileges on the line by challenging their employers as well as their political masters. Aren’t PSWs meant to be our link into the government? It’s time real social workers were heard not just the ‘profession’ obsessives with an eye on preferment.
If any UK government had taken social care seriously, the current serious underfunding would not be so. Every Government has ignored social care and thereby caused the serious underfunding and the last 12 years has seen the underfunding increase to extreme crisis levels.
This is not just for Local Authority (LA) social care costs, but also for social care in the community for both children and adults. Even if assessments were done the insufficiency of care workers is also extreme and those that are working are extremely underpaid with unreasonable working conditions. No wonder there is a reluctance for people to enter the care profession. Some of this could have been slightly minimised by allowing non-UK persons to enter the UK, but to a large extent the restrictive immigration policies stopped many coming to the UK, it would have not solved the insufficiency of care workers, but every little helps.
UK Governments have failed to understand social care, either by error or by design, the allowing of COVID patients to be transferred from hospitals into care homes at the start of the COVID pandemic proves that. Even when there are discussions about social care it appears to be centred on care homes, as though other forms of social care don’t exist.
While reforms are required, so is funding and much more recruitment and , nothing will be achieved unless all is done.
I have a long memory: perhaps the roots of the crisis go back to the origins of the present system?
When “community care” was first introduced, there was an assessment gap identified by ADSS at some 90,000 assessments p.a., which DH rejected because it included self-funders who “would not need assessment until their money for care home placements ran out”. Not one single assessment of a self-funder with remaining assets above the threshold would be required in the whole of England and Wales! Sounds familiar? Later, the DH and NHS denied that they had under-estimated the cost of long-term continuing healthcare, because they did not see out- of- hospital care for anyone with dementia as a health responsibility. Sounds familiar?,
Liam
It’s not the recruitment crisis but the retention attrition that needs addressing.
A landmark shake-up in leadership in health and social care is worthless without a better deal for social care providers. If local authorities continue to pay below the cost of care, care providers are going to go out of business and that will leave thousands of vulnerable older people deprived of the care they desperately need. Already the number of hospital beds being blocked by older people who are unable to receive care elsewhere has increased from 5 to 10 percent per day resulting in a cost increase of £2.4 billion to the NHS. To protect the NHS, which is set to receive a £36bn fund, social care needs an equal share of that.
Dr Sanjeev Kanoria, Founder and Chairman, Advinia Health Care
Quite right , we are at risk of losing the initiative and money . The plan needs to be a joint plan of action from the foundation up and services geared more to prevention and keeping people at home for as long as they are safe and well .
The problem I feel is that we have people heading up the strategy who have no practical knowledge or skills to put this into effect who will waste a lot of tax payers money on stupid off beat projects .
There also needs to be more supported housing not less and currently a lot of councils are reducing care packages and moving people when they know they should not .
Unlike some golden chances , social care due to the pandemic has a chance to reshape and build a more positive image of all the workers in social care .
The reason I say this is because it could not get any worse unless we keep doing the same things in the same reworked dogmatic way .
Some may disagree with the hike in national insurance but its now in play so ,
You cannot sort out the NHS without first addressing where you may be able to discharge older or vulnerable people to .
Care homes > Full ,understaffed and over expensive .
Care agency’s> No staff cannot pick up packages of care .
LA inhouse services > reduced , frozen or actually closed down from the austere policy of bash welfare under Cameron and Osbourne which has never ended .
+ Ridiculous policy changes like LPS , the care gap , mental health Act reform etc .
The needle is at zero , there is no more gas in the tank and even when you get the metaphorical gas in terms of any new funding the care will not budge as your brakes are frozen .
We need to start again at the foundation of social care and I personally would welcome a more mixed but correctly trained work force which has increased in numbers but I would like to see local authorities taking some initiative and acting now not later .
I have been critical of the dearth of leadership in the UK but I keep getting the ammunition to put into my critical spud gun .
Come on , surely someone has some better ideas we have been chasing the argument now since Mrs Thatcher and I think we all know what might work but no one it seems is doing anything about it at all .