Adult care bereft of cash for current pressures and long-term reforms, warn MPs

Covid funding ended prematurely, while government has 'no roadmap, timescales or measures of success' for reforming sector, says select committee

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Story updated 5 August 2022

Adult social care is bereft of funding to tackle current pressures and longer-term reforms, MPs warn today.

The government ended Covid-19 funding prematurely, has inadequately equipped councils to deal with mounting inflation and unmet need and has underestimated the costs of its changes to the funding system, they said.

In a report, the levelling up, housing and communities select committee said ministers had hobbled councils by a series of one-year funding settlements that did not allow authorities – and their providers – to plan for the future.

It also found ministers had “no roadmap, no timetable, no milestones, and no measures of success” for its ideas to reform the sector set out in a white paper last year.

The government has pledged £5.4bn over the next three years to fund pledges in the white paper, with £3.6bn allocated to introducing an £86,000 cap on personal care costs, a more generous means-test for care and a drive to ensure councils pay providers a fair cost for care.

funding

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However, the committee, drawing on past estimates, said funding needed to rise by £7bn a year to meet funding pressures and deliver the reforms.

‘Several billions needed’

In the shorter-term, it said ministers needed to provide an immediate cash injection to tackle inflation and unmet need, and announce this as soon as possible.

“Ultimately, whether it relates to immediate cost pressures or on wider structural issues in the sector, the fundamental problem is that there continues to be a large funding gap in adult social care which needs filling,” said committee chair Clive Betts. “Those who need care, their loved ones, and care workers deserve better.”

He added: “Wherever the money comes from—from allocating a higher proportion of levy proceeds to social care, or from central government grants – the government urgently needs to allocate more funding to adult social care in the order of several billions each year.”

The report is the latest in a string of studies to highlight the severity of the pressures on the system – including mounting workforce shortages, backlogs for assessments and care packages and pressures on carers – and to claim that the longer-term reforms are underfunded.

Sector at risk of ‘collapse’

The government has provided additional funds for adult social care in 2022-23, by:

  • enabling authorities to raise council tax by 2% without the need for a local referendum;
  • allowing them to raise the adult social care council tax precept – which is ring-fenced for the sector – by 1%, or by more if they have not made maximum use of the precept in previous years;
  • increasing its social care grant – which can be spent on adults’ or children’s services – by £636m to £2.346bn;
  • a 4.4% rise, to £7.2bn, in the Better Care Fund, a combination of government grants to councils and NHS resources, designed to fund services to help people remain independent at home for longer.

However, the committee said this was inadequate in the context of significant unmet need, staff shortages, the pressures brought by a 6.6% rise in the national living wage (NLW), which many care staff receive, and mounting inflation. It said the Local Government Association had calculated that inflation and wage pressures alone necessitated £400m more funding this year than had been provided.

It also found carers were under increasing pressure and not enough of them were getting a break.

MPs said they strongly disagreed with comments made to the committee by former local government minister Kemi Badenoch that funding for the sector was sufficient, “having received compelling evidence that there is an immediate need for additional funding”.

‘Severe impact of Covid’

The report said that Covid-19 had had a “severe impact” on the sector, leaving many people without care, increasing their needs, and leaving staff burnt out, exacerbating the need for immediate funding.

The committee criticised the government’s decision to end Covid-specific funding to control infection and support hospital discharge, at the end of March.

As government guidance was for care staff to self-isolate if they test positive – unlike in other sectors – MPs said it should revive the infection control fund, which had enabled providers to pay staff their full wages when off sick or self-isolating.

It also urged ministers to reinstate its discharge grant, which had funded up to six weeks’ care after people left hospital. This had supported the discharge to assess policy, brought in at the start of the pandemic, under which people are assessed on their ongoing needs after leaving hospital.

Department of Health and Social Care (DHSC) director general for adult social care Michelle Dyson had told the committee that some areas had continued to fund post-discharge support since April, though this was not at the same level and was on a short-term basis.

The committee said it did not find this reassuring and that, given the fragile state of social care and the scale of the NHS backlog, the discharge grant should be revived.

Underfunded reforms

In relation to the government’s funding reforms, which will be implemented next year, the committee received significant concerns that their cost had been underestimated, and urged the DHSC to review its costings.

Sector bodies also highlighted the significant challenges of simultaneously introducing the cap on care costs and more generous means-test, ensuring councils pay providers a fair cost for care and enabling self-funders to request that authorities arrange their care home placements, through the full implementation of section 18(3) of the Care Act 2014.

The latter measure would enable self-funders to take advantage of the much lower care home fees councils pay. Like the cap on care costs and more generous means-test, it is expected to encourage many thousands of self-funders to come forward to have their needs assessed, requiring a significant increase in councils’ social work capacity.

The DHSC recently announced section 18(3) would initially only be available to self-funders moving into care homes from October 2023, and rolled out to existing residents over the subsequent 18 months.

The committee said that, while this would help local authorities to stagger the additional assessments they would need to undertake, it was still concerned about councils’ ability to carry out the extra work at a time of existing assessment backlogs.

As part of its proposed review of the costings of the reforms, it said the DHSC should also interrogate the recruitment and training needs of assessors.

‘No timescale or measures of success’

The committee said its witnesses had largely welcomed the 10-year vision set out in the white paper, of improving choice, control and independence for people needing care, enhancing the wellbeing and skills of staff and better supporting, and recognising, unpaid carers.

However, several criticised the lack of detail on how it would be delivered. The committee also found ministers were uncertain about how the £1.7bn allocated to the wider reforms would be spent, as just £1.1bn was accounted for in the white paper.

It added that the DHSC had not provided any rationale for the funding levels for different initiatives, for example, at least £500m for workforce development and wellbeing, at least £300m to “transform” housing with support and at least £150m to improve technology and digitisation.

Witnesses also commented that much of the funding was small-scale and designed to initiate change, rather than provide core funding to deliver ongoing services.

“The government currently has nothing more than a vision,” the committee said. “We are alarmed that so much of the detail within the [white paper] has yet to be worked out, and that there is no roadmap, no timetable, no milestones, and no measures of success.”

Age UK backed the MPs’ conclusions and urged the government to find immediate funding to boost care worker pay, support carers and invest in services.

‘Millions living diminished lives’

Charity director Caroline Abrahams said: “At the moment millions of our fellow citizens are living diminished lives because the reliable, high quality care services they need just aren’t there for them.

“The consequences are deeply damaging for them and for the rest of us too, with older people becoming sicker more quickly, unpaid carers being forced to give up work to support the person they love, and disabled people who could work and live rich and fulfilling lives stuck within their own four walls – all amounting to a terrible waste of human and economic potential and piling extra strain on the NHS.”

Think tank the Nuffield Trust said MPs were “right to be concerned about the lack of a comprehensive plan that addresses deep-rooted problems across the sector”.

Its deputy director of policy, Natasha Curry, said: “Urgent action is needed to tackle workforce shortages, instability in the provider market, as well as shoring up the shaky financial foundations that the current plans for reform sit on.”

‘Thousands quitting care jobs’

UNISON’s head of business and community, Donna Rowe-Merriman, said the “urgent priority” was a “proper pay rise” for care staff.

“Low wages and inadequate sick pay explain why thousands of staff are quitting for better paid jobs elsewhere,” she added.

Carers UK chief executive Helen Walker highlighted the report’s findings in relation to unpaid carers, who she said were “now providing more care than at the height of the pandemic and many thousands have not had a break in over two years as they prop up a crumbling system”.

“Many are having to leave their jobs to care, and the situation is simply unsustainable,” she added. “We want to see an immediate investment of £1.5bn from government to ensure that all unpaid carers have access to the breaks they desperately need, as well as support to stay in work.”

Responding to the report, a DHSC spokesperson said: “This year, we have made available £3.7bn of additional funding to local authorities, which they can spend on adult social care.

They also said that in delivering its £5.4bn reform package it was “taking decisive action to reduce pressures on the system” by ending “unpredictable costs” through the cap, and supporting staff through its £500m investment in training and wellbeing.

“We are also delivering on our ambitious 10-year vision for adult social care, which provides detail on the measures to implement over the next three years to reform the sector and deliver for people, said the spokesperson.

 

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2 Responses to Adult care bereft of cash for current pressures and long-term reforms, warn MPs

  1. Chris Sterry August 10, 2022 at 9:57 pm #

    At long last there is action in Parliament, albeit, reports from Select Committees, it is a start from a less than zero base, one that has been around for many years, maybe from when Social Care became evident, even pre 1948. No Government has bothered to look at Social Care and it has been left to meander its course for far too long. For without a fully functioning Social Care there is no hope for the NHS, for they are, forever, interrelated. So any crisis in Social care only adds to the crisis in the NHS, while not providing reasonable care for those in need of Social Care, so they are left to suffer causing vast declines in health, not only for the individuals concerned but also their families.

    Whie the NHS was created in 1948, so should social care have been incorporated fully in the service and not been left outside to fail.

    Fail it did not only because of the workers within social care, but they and social care have been left without adequate funding and recognition, hence the forever increasing crisis in social care. Made much worse by 10 years of austerity cuts to Local Authorities, (LAs)  and then massive costs for going on another 2-3 years due to COVID. During this time those in need of social care have been ever increasing numbers and not only that, much increase in complexities for care required.

    Many Safeguarding concerns have arisen, but blame has only been made to in dividual social workers and their respective councils and not where it should have been, on this and all previous Governments. Thus causing unnecessary pain  and suffering and at times, deaths to both children and adults.

    But the Government and government funding has been the ‘elephant’ in the room, which has never to be mentioned. 

    This completely wrong and should never have been left to arise.

    even when some funding has been made available, it has always been so far short of what is really required and never sustainable. Addition responsibilities have been place on LAs by Governments and never been, seriously funded, if funded at all.

    The Select Committees are saying additional funding of £5-7 billion is required now and not the miserly amount offered by this government, but even that is way sort as it has to be, at least £12 billion now, but even that would only bring funding to 2010 levels, which was way short then.

    Government and Government Ministers need to take the crisis in social care seriously and give it the extreme priority in needs and deserves.

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