Raise pay, cut charges and provide rights to support: report for ADASS sets roadmap for ‘saving social care’

Paper charts route from context of unmet need, workforce shortages and lack of choice and control to personalised, accessible and fair care system, but warns journey requires significant investment and political will

Image of crossroads (credit: 1STunningART / Adobe Stock)
(credit: 1STunningART / Adobe Stock)

Care worker pay should be raised, charges for services cut and people be provided with clear rights to support as part of a shift to a more personalised, accessible and fair adult social care system, set out today.

However, significant investment and political will are required to realise this ambition from a context of significant unmet need, workforce shortages and lack of choice for people needing care and carers, said the study, commissioned by the Association of Directors of Adult Social Services.

Sarah McClinton

Sarah McClinton, ADASS president from 2022-23

Launching the report today, outgoing ADASS president Sarah McClinton said it came at a time in which the adult care system was “close to breaking point”, with millions “in pain or distress because they aren’t getting the care they need and family and friends picking up the pieces are being pushed to the edge”.

“We’ve been trying to patch-up social care for years, but we’ve run out of road,” said McClinton, director at the London Borough of Greenwich. “We need to act now to save social care. We don’t expect the government to wave a magic wand, but we do need the political will to invest in a long-term plan to ensure good care is available to everyone, everywhere.”

Higher vacancies, waiting lists and reduced provision

The report, by policy consultants Anna Dixon and Kate Jopling, said adult social care faced immense challenges, including a 52% rise in staff vacancies in 2021-22, more people requesting help with fewer receiving long-term care and almost 250,000 waiting for an assessment, as of August 2022.

However, the report stressed that the sector had many strengths, including providing jobs for 1.5m staff, delivering care for a similar number of people, while there was, broadly, a shared vision for its future, set out in a string of previous reports.

This was for a system that was focused on improving wellbeing, personalised to need, preventive, integrated, community-based, value for money, fair and accessible.

The report then set out 10 changes the authors saw as being necessary to achieving this vision, with short-, medium- and long-term actions for each. While long-term changes required government backing and investment, the report said there was much that directors of adult social services could achieve off their own bat in the short-term.

Proposed changes for care system

  1. Reimagine care and support with people who draw upon it.
  2. Improve assessment and care planning to put people in the lead.
  3. Build community capacity for wellbeing and prevention.
  4. Enable more people to live at home or in a place they call home.
  5. Improve support for carers.
  6. Join up care and support to enable people to live fulfilled lives.
  7. Make care and support accessible and affordable for all.
  8. Foster diverse and sustainable providers, focused on outcomes.
  9. Harness the potential of digital technology.
  10. Redesign and reward the workforce.

The report urged a shift from social care being seen as a service where decisions about provision were made by councils to a support system rooted in rights, where decisions were made by and with people using care and support and their families.

As part of this, the report said assessments and care planning needed to be much less bureaucratic, with people defining the outcomes they wanted to achieve and social workers freed up from excessive paperwork to work directly with people on achieving this.

People should be enabled to direct their support, including by increasing access to individual service funds, while councils should invest in community-based support and in roles, such as local area co-ordinators, that connect people to sources of term.

Universal social care offer urged

Over time, with government investment, there should be “a core universal, non-means-tested and open-to-all offer of care and support
that should be available in all areas”.

Linked to this, the authors said care and support needed to become “accessible and affordable to everyone”, with the costs currently falling “unevenly and unfairly” on those who needed it, leading to unmet need.

While it highlighted work by some councils to reduce care charges, the report said tackling this required government investment over the medium-term to significantly cut the costs of support.

It proposed going beyond the Department of Health and Social Care’s current plans to raise the upper capital threshold, above which people are ineligible for means-tested care, and an £86,000 cap on people’s liability for care, now due for implementation in October 2025.

It said the DHSC should also introduce free care for disabled adults under 30, make charges consistent across local authorities, potentially extend eligibility for free NHS continuing healthcare and, over the longer-term, provide a more universal system of care and support, similar to the NHS.

The report also urged better support for informal carers, so their role was truly voluntary and staff no longer made unreasonable assumptions about their capacity to care, and, over the longer-term, they have a right to paid leave from work and to breaks.

Call to raise pay

In relation to the workforce, it urged a shift to one that was “poorly paid” and felt “undervalued” to one that was “motivated”, which required short-term action to raise remuneration for the lowest paid.

Over the medium term, the study said that a body should be tasked with setting national pay scales for social care roles and, in the long term, pay parity with NHS staff in similar roles, who are currently paid far more.

These pay uplifts should be coupled with national and local workforce plans, with the latter including a focus on improving social work capacity.

Though the report was written independently of ADASS, the association is, broadly, backing the agenda it sets out and will use it as a basis for its lobbying of government.

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7 Responses to Raise pay, cut charges and provide rights to support: report for ADASS sets roadmap for ‘saving social care’

  1. Chris Sterry April 27, 2023 at 3:45 pm #

    Not often I agree with the Association of Directors of Adult Social Services, (ADASS), in fact, virtually never, but in this I do agree for if something is not done urgently, then social care will continue to diminish to where it is really non-existent and that is not that far away. Perhaps, even 2025 could be too late for action really needs to be now and really many years ago.

    If social care is left to expire, then this will seriously affect the NHS, way much more than it is currently, which is now very much. Both social care and the NHS have to be saved, for the loss of one will seriously affect the other, as we can see already. We all want to save the NHS, well this also includes saving social care for if social care reduces any further the NHS will go into even more serious decline, perhaps to never recover.

    This government and all future governments have to take urgent decisions and that is to safeguard social care, I so do hope that 2025 will not be too late, but do fear it could be.

    We need a listening government, like never before, but will we get one, well I so hope so, but really can’t see one coming, that is so depressing. How much more depressing can the UK take?

  2. Alec Fraher April 27, 2023 at 8:57 pm #


    It was the EU Equal Pay Settlement (which was well overdue) for the, then, domiciliary or home care staff of Council’s that triggered the whole sale SALE of care services.

    In competition law one can’t ask, in the tendering process, what staff will actually get paid ~ it’s illegal.

    The original DH guidelines for outsourced care in 2004 was written on the assumption that ‘outsourced’ care would be for upto 10hrs/week only.

    That providers by and large weren’t interested in such meager offerings, and were already tied into spot-purchases of bigger packages for over 100/168hrs/week through a spot-contract and waivers of the Standing Orders from Compulsory Competition and Tendering wasn’t thought about, properly.

    The cart was truly infront of the horse. The aggregated spot-contracts per provider exceeded and by massive margins the then EC spend thresholds for exemptions to competition. The cat was out of the bag ~ competitive rivalry had arrived and with great gusto. And, to the extent that, again in Competition Law, public services known as State Owned Enterprise had to subject themselves to competitive bidding.

    Worker’s have always taken the hit with this approach to care services since Thatcherism.

    One remedy, today, given the intractable mess of this market, and as long as there are Government advocates of a market approach, is to finally establish ‘commissioning’ as a bespoke public procure procedure within Part A of the Contracting and Public Procure Procedures. Part B procure procedure aren’t designed for Social Work or Social Care, at all.

    This is a high end ask but guarantees protection against contestability. And, forsure Brexit will be tested against this in the not too distant future.

    It does though require that carer’s are considerd as ‘caring professionals’ and treated and viewed as technically competent staff, ratherthan manual workers and allied to the ‘helping professionals’ more generally speaking.

    The Scottish Health Partnerships have done this ages ago. And, without a condition of being degree educated to create the distinction between manual and technical.

    This does come at a cost and requires what is called a Master Wicked Messy Problem Plan ~ I know ?

    Alternatively, and under the rules of a Most Economically Advantageous Tender all services are brought back in-house or let by contract by strategic and primary partner, usually a State Owned Enterprise, to trusted other providers. Staff then have an automatic career path with obvious lines of progression and can be given the real choice of employer.

    This is called having Requiste Variety and Agility and both Councils and the NHS have it spade fulls, if only it was not drowned in the ideologies of Choice, and more recently behavioural medicine ~ both of which clinically speaking have meritwhich sadistically politically abused.

    VolOrgs, can then be properly locally commissioned to do the edgy cutting edge work which was once their bread and butter – and on behalf of and instead of public services.

    It’s not rocket science. I suspect though that going back isn’t within the mindset of those interested only in ‘moving or going forward’ and this includes VolOrgs and NGOs who are aping the commercial sector knowing it doesn’t work.

    The late Russell Akoff, notably said how does one make a difference that truly makes a difference when one keeps doing the wrong things wronger ~ any time served local government officer will tell you this. Local Government remains the only democratically elected Public Body that can be truly brought to account, and something with difficulties ~ Social Services and Social Work the means by which to do it.

    Just saying….

    * I started out as a Thatcherite conscripted home care worker for £10 plus dole having been laid off as a Royal Ordnance Engineer – I was also a Care Leaver living in an empty flat so could empathise with the, mainly homeless, client group*

    • Alec Fraher April 27, 2023 at 10:50 pm #

      btw The idea that increased digitisation is a panacea is fundamentally and fataly flawed ~ big data creates it’s own correlations (called ontic quales)and are algorithmically designed to weed out suspected fraudulent claims creating false pictures of people and their needs.

      They are also designed for demand damping ~ a term used in making sure that the computationally determined outcomes are satisfied and are contract compliant.

      The DWP handling of PIP assessments is all about this and after years of passports between benefits to maximise entitlements the new kit, separated by provider contracted functions, and based on the Royal Mail post code data information and Social Security Fraud Act generalised population profiles, is highly discriminatory.

      I live in a caravan. My surname is Irish. I am an Irish traveller, right?

      The address doesn’t show up as registered for Post Office post code coding. I am, technically, temporary accommodated and NFA.

      Yet the postie delivers everyday.

      I have lived where I am for 12 years and pay Council Tax which is in credit.

      Yet I meet the criteria set into ‘govtechsolutions’ as more likely to make a fraudulent claim.

      This was the jist of a conversations had with Council staff on my inquiries about the Cost of Living initiatives.

      All IT must have a human in the loop. Those humans must have values. Those values are part of the Social Work Code of Ethics.

      Digitisation reduces Ethics and Values to Zero.

  3. Alec Fraher April 27, 2023 at 11:58 pm #

    An EU Social Protection Committee, in 2009, and produced largely by Leeds University (I forget the title and authors) called time on ‘Personalisation’ as having a long term and detriment impact on both the recipient and their carers.

    In short, the ‘shifting of the burdens’ for entirely self-directed care were to the psychological and emotional detriment of the people it was meant to help. It was considered to have failed. A finding echoed in the HofC Health Select Community Inquiry on Commissioning published in January 2010.

    Long run perspectives are very in short supply. The State, and successive Governments, clearly have no desire for such responsibilites anymore.

    But what next requires a level of discernment free of the existing dualistic hostilities of X v Y and vested economic interests.

    Surely ?

  4. Blair Mcpherson April 28, 2023 at 9:21 pm #

    Other than number 9 these 10 changes are neither new nor contentious. Efforts have been and continue to be made to make a reality of these 10 points. The inescapable fact is the overriding imperative is to adequately fund social care so that social workers and others can provide the help and support we all agree is desperately needed.

    • Alec Fraher May 2, 2023 at 2:43 pm #

      It’s the lack of transparency and imagination in financial modelling that’s missing.

      Where is the public engagement with the, now, not so new, anthroposophical banking sector, like Triodos Bank UK Ltd?

      Talk about damage done by neoliberalism, and how this anthroposophical banking system is it different. Publicise where it’s tested in the real world. Has it added to local democracy by including those traditionally excluded. Demonstrate the ability and flexibility of working with the State Owned Enterprise ~ it’s nothing new.

      There’s lots of illustrations of such, like the Camphill Movement, Steiner-Waldrof, The Corquet Trust, Johnny Johnson, Edward Lloyd and and and….

      The dereliction of actual State responsibilities and accountabilities in the wake of decade’s of unnecessary competitive process has hurt the very people now called on, again.

      This is what neoliberalism does – the anthroposophical movement forming to counter authoritarianism 100 years ago has now got to put money where people in society need it.

      It’s the local elections on Thursday and we’re not far off the general election.

      Let’s see coverage of the likes of Triodos Bank UK Ltd. Who are they and what’s their offer? Make it visible and real. Something people can really and locally relate to ratherthan merely an ethical financial product tied to property and land grab.