Delay cap on care costs by a year to tackle social work recruitment challenge, councils urge DHSC

County Councils Network joins Local Government Association in calling for delay to avoid "loading pressure on an already teetering system".

Calendar showing the month October 2023 with a sandtimer and plant
Photo: JeromeMaurice/Adobe Stock

The government must delay its adult social care funding reforms by a year in order to tackle the social work recruitment challenges they entail, amid significant financial pressures.

That was the warning from a County Councils Network (CCN) report that urged ministers to push back the implementation of the cap on care costs and more generous means-testing regime to October 2024, to avoid “loading pressure on an already teetering system”.

The CCN is the second major local authority body to urge a delay, following the Local Government Association, which called for a six-month deferral, to April 2023, in August this year. In response to the CCN report, a third body, SIGOMA, which represents urban authorities outside of London, also suggested a delay may be worthwhile to shore up the sector’s resources.

However, the DHSC said it was sticking to its timetable to implement reforms that were “vital to protect people from unpredictable social care costs”.

The adult care reform workforce challenge in numbers

  • 15,655: the number of social workers in council adults’ services as of September 2021, down 1.5% on the year below .
  • 9.5%: the vacancy rate for local authority adults’ social workers as of September 2021, up from 7.5% in September 2020. This was equivalent to 1,600 vacant posts (source: Skills for Care).
  • 4,300: the number of additional social work staff required by councils to implement the adult social care reforms without mitigating action, according to the CCN and consultancy Newton.
  • 105,000: the number of additional Care Act assessments the CCN and Newton estimate councils will have to undertake a year because of the adult social care reforms. This is a 48% increase on current assessment levels.
  • 295,000: an Association of Directors of Adult Social Services (ADASS) survey. the waiting list for assessments as of the end of April.

‘Perfect storm’

The CCN said that adult social care was facing a “perfect storm of financial and workforce pressures”. The Association of Directors of Adult Social Services found that councils had a backlog of 542,000 assessments, care packages, direct payments and reviews as of April, while Skills for Care has found vacancies rose by 52% across the sector from 2021-22.

Meanwhile, the CCN has previously reported that councils faced £3.7bn in increased costs from 2021-23 because of inflation, wage rises and growing demand.

This would be exacerbated by the reforms because of the significant additional pressures it would load on authorities, including overhauling IT systems and carrying out an estimated 105,000 extra assessments a year.

In a report in May, CCN and consultancy Newton said this would require the recruitment of an “unfeasible” 4,300 extra social workers without mitigating action, such as making greater use of non-social work staff and external bodies to carry out assessments. This is in a context when 9.5% of social work posts – equivalent to 1,600 positions – were vacant as of September 2021 (see box above).

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 £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.
  • 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. Under the government’s plans this will first be opened up to new self-funding care home residents, in October 2023, with existing residents becoming eligible over the next 18 months.

The CCN said delaying the reforms would give local authorities the time to recruit the necessary workforce and fundamentally review their operations to identify how they could manage increased assessments at a time of severe backlogs and workforce shortages.

Delay to CQC assessments urged

Besides delaying the introduction of the cap and extended means-test for a year, the CCN also urged two further delays. It said giving self-funding care home residents the right to request that their council arranges their placement should be deferred entirely until April 2025. The DHSC’s plan is for this to be phased in from October 2023 to April 2025, starting with new residents.

The CCN also joined the LGA in urging a 12-month delay, to April 2024, in the introduction of Care Quality Commission assessments of council adults’ services, saying this would give time for a “fit for purpose” system to be designed.

Its adult social care spokesperson, Martin Tett, warned that going ahead with the DHSC’s timetable risked making services worse and increasing waiting times.

“Loading these reforms onto a system that is already in crisis could worsen care services by the time these reforms to ‘fix’ social care are introduced. Newly eligible people next October could face substantial waits for a care assessment whilst the quality of care for those already provided for could worsen as councils struggle with the extra demand amidst rising costs.”

The LGA confirmed that its position was still to support a six-month delay to the introduction of the funding reforms, and a year’s delay to the CQC system.

Municipal authorities also suggest delay may be needed

SIGOMA chair Stephen Houghton said the sector faced a significant funding gap that had been exacerbated by Covid and inflationary pressures.

“The most important issue here is properly funding social care, and if a pause in the implementation of the reforms allows additional resource for the social care sector, then this may be the best course of action,” he added.

A DHSC spokesperson said: “Our charging reforms are vital to protect people from unpredictable social care costs, and we are working with local authorities, care providers and other stakeholders – including the Local Government Association – to implement them.”

The spokesperson pointed to the additional £5.4bn the government is investing in the sector across the UK over the next three years. Of this, £3.6bn has been allocated to implementing the funding reforms, as well as a drive for councils to pay providers a fair cost of care, in England.

They also referenced the £500m the DHSC has provided for adult social care this winter to support faster hospital discharges and improved recruitment and retention.

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