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Communities and Local Government Committee Report: social care funding needs urgent Government review

Just published today (31st March), the Communities and Local Government Committee’s report on its inquiry into adult social care.

Background information and links to the Report here on the Committee’s website .

Some depressing reading (Key Facts, Impact Analysis) from the Reports Executive Summary. (Read on for its recommendations).

Key facts

  • Fewer than one in twelve Directors of Adult Social Care are fully confident that their local authority will be able to meet its statutory duties in 2017–18 (Paragraph 13)
  • 28% of care services are inadequate or require improvement (Paragraph 18)
  • Some councils pay £2.24 an hour for residential care (Paragraph 42)
  • 96% of people paying for their own care pay on average 43% more than state funded residents in the same home for the same room and the same level of care (Paragraph 53)
  • The turnover rate for nurses working in social care is 35.9% (Paragraph 78)
  • 47.8% of care workers leave within a year of starting (Paragraph 78)
  • The median hourly pay for a care worker is £7.40 (Paragraph 80)
  • 160,000 to 220,000 care workers in England are paid below the national minimum wage (Paragraph 81)
  • 49% of home care workers are on zero hour contracts, compared with 2.9% of the workforce nationally (Paragraph 85)
  • 27% of care workers received no dementia training and 24% of those who administer medication were not trained to do so (Paragraph 86)
  • Between 2010–11 and 2013–14, the number of unpaid carers increased by 16.5%, while the general population grew by 6.2% (Paragraph 102)
  • In Leicester, although 30,000 people identified themselves as a carer in the 2011 Census, only 2,200 carers were in contact with the council (Paragraph 107)
  • One in five unpaid carers providing 50 hours or more of care each week receives no practical support from the local authority (Paragraph 110)

This report should be read with Adult social care: a PreBudget Report. Taken together these reports describe the funding pressures on adult social care and their very serious consequences, and make the case for immediate extra funding. In addition, this report explores progress on integration of health and social care services and innovation in the provision of social care. We also set out what needs to happen to ensure that social care is funded sustainably in the medium and long terms.

The impact of funding pressures on adult social care

We believe that inadequate funding very seriously affects the quantity and quality of care that is being provided to people, the National Health Service, care providers, the care market, the way that care is commissioned and the workforce and unpaid carers. We examine the evidence in paragraphs 8 to 119, and conclude that constraints on funding have led to:

  • Councils providing care and support to fewer people and concentrating it on those with the highest needs.
  • Care becoming the minimum required for a person to get through the day.
  • A deterioration in the overall quality of care, which is likely to continue.
  • Increases in the number of delayed discharges from hospital and in emergency admissions, related to councils increasingly directing their resources towards services for people with higher levels of need rather than preventative services.
  • Serious threats to care providers’ financial viability, which mean providers failing, exiting the market and handing back contracts for provision of care services.
  • Reliance by care providers on their privately paying clients to subsidise local authority funded clients by paying higher costs for the same care.
  • Increase in demand, problems with supply and significant shortages in the workforce, which have affected the stability of the care market.
  • The undermining of councils’ abilities to fulfil their duties to shape the care market in order to provide diverse and high quality care for all people in their area.
  • The pursuit of low fees becoming the driving factor in commissioning for many councils, undermining their relationships with care providers.
  • Severe challenges in the care workforce, manifested in high vacancy and turnover rates, which result from low pay not reflecting the amount or importance of the work involved, poor employment terms and conditions, lack of training and lack of opportunities for career progression.
  • Increasing reliance on unpaid carers, who are providing more hours of higher level care as councils have reduced the amount of care they provide.
  • Councils being unable to fulfil their statutory duties to identify, assess and meet carers’ needs for support, which has consequences for carers’ health and well-being and their ability to stay in work.

This is why, in our Pre-Budget Report, we recommended that extra funding (in the form of the £1.5 billion 2019–20 tranche of the improved Better Care Fund) should be made immediately available to meet the shortfall in 2017–18 and that the Government should commit to closing the adult social care funding shortfall for the years to 2019–20, in line with the amount that the National Audit Office estimates is needed. While we welcome the Government’s commitment to provide an additional £2 billion for social care over the next three years, this falls short of the amount we believe is required to close the funding gap.

We recognise that increased funding alone is not the solution, and make a range of other recommendations (which are set out in full at the end of this report) for action. Our key recommendations concern care commissioning, monitoring of care services, and the workforce

Excellent article by Rachel Carter just published in Community Care Online with headline Councils stripping back social care to bare minimum, MPs warn .

Well worth a read. Includes this quotes…

From  Committee Chair Clive Betts MP: “A long-term fix, working on a cross-party basis and involving the public and social care sector is urgently necessary to meet the ever-increasing demographic pressures on the system. This review must be ambitious and consider a wide range of potential funding sources, looking again at age-related expenditure, options such as a hypothecated tax for social care, a compulsory insurance scheme, and differences in how individuals contribute. It must also take a wide look at what we will spend this money on in the future – on support, preventative care and intervention, the care workforce – and ensure that care users are at the centre of how care is organised and that they get the assistance they deserve.”

from David Pearson, honorary treasurer of the Association of Directors of Adult Social Services (ADASS):  The report highlights the worrying consequences of pressures on the sector. Social care needs to be treated as a national priority to ensure thousands of elderly and disabled people and their families get the personal and dignified care they deserve. Not only are people living longer and with increasingly complex needs, care workforce challenges, including the welcome national living wage and retention of staff, are creating further pressures – the need to future-proof the social care system cannot be ignored.”

from a spokesperson for the Department of Communities and Local Government: “We recognise the challenges councils face in delivering social care and the need for a long-term sustainable solution. That’s why we’re giving councils an extra £2 billion to help deliver these services, taking the total to £9.25 billion over the remainder of this Parliament. It’s also why we’re committed to having a fair and more sustainable way of funding adult social care for the future, especially given people are living longer. We’ll be setting out our proposals in a forthcoming green paper.”

(So that’s another Green Paper to look forward to!)

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