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.
Photo: Michail Petrov/Fotolia
However, the committee, drawing on past estimates, said funding needed to rise by £7bn a year to meet funding pressures and deliver the reforms.
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.
The government has provided additional funds for adult social care in 2022-23, by:
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.
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.
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.
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.”
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.”
The Department of Health and Social Care (DHSC) has been approached for comment on the report.
In response to an Association of Directors of Adult Social Services report last month detailing directors’ funding concerns, published last month, a DHSC spokesperson said it had provided record annual funding to help councils respond to rising demands and cost pressures”.
They said its £3.6bn funding reforms would “end the lottery of unpredictable care costs and enable all local authorities to move towards paying providers a fair cost of care”. The additional £1.7bn to implement the white paper would “begin major improvements across adult social care”, including £500m to boost career opportunities for care staff.
adult social care funding, cap on care costs
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