The Association of Directors of Adults Social Services (ADASS) welcomes the opportunity to make this representation for the 2017 Budget preparations.

Social care provides care, support, and safeguards for those people in our communities who have the highest level of need and for their carers. We believe it should be treated as a national priority. Nearly two million people rely on these essential services and around 6.5 million carers support people alongside and beyond the formal social care sector. It makes a contribution of £43b to the national economy in direct and indirect costs.

However, successive governments have failed to sufficiently address what is an overwhelming issue: the recognition of and funding for these vital services and supports. Adult Social Care spending as a percentage of GDP (UK) in England has fallen in recent years and will continue to fall from around 1.2% in 2009 to around 0.9% in 2020.

This representation covers both the short and longer term issues in relation to social care funding.

The Adult Social Care System is at tipping point now.

The Government will be well aware of concerns about the underfunding of adult social care. Funding does not match the increased needs for, and costs of, care for older and disabled people.  The depth of shared concerns about the quality, safety and sufficiency of social care services, based on in-depth analysis, has precipitated ongoing articulation of this for many months from national and local organisations from across the public, private and voluntary sectors and from affected individuals. Expert commentary from the Care Quality Commission, the King’s Fund and Nuffield Trust together with the Chairs of Select and Public Accounts Committees, that have looked at this in depth, all concur. The impact on care markets, care workers, the NHS and most of all is felt by older and disabled people and their families. 

Councils have been making efficiencies and savings for the past six years and the effects are now evident. A snap survey of ADASS members in October 2016 demonstrated the fragility of the care market:  80 councils (62%) had experienced residential and nursing home closures. If this happens in an unplanned way it has impacts on wellbeing and mortality. In addition, 74 councils (57%) had had home care providers hand back contracts and 27 (21%) have had residential and/or nursing care providers hand back contracts. The closure of services and hand back of contracts had affected an estimated 10,820 people using council funded care services in 129 councils.

The circumstances also impact on quality: 79% of councils had quality concerns with one or more home care providers and 84% with residential and nursing care providers. When reporting our budget survey last summer we referred to social care being in jeopardy: the Care Quality Commission in their State of Care report in November referred to social care reaching a tipping point.

Finally, that survey revealed that three quarters of councils had an in-year overspend on their adult social care budgets. Taking into account over and under spends, if extrapolated to all English councils,  the combined predicted overspend for 2016/17 will be in the region of £441 million (in 2015/16 this was £168m). If those overspends cannot be funded from savings in other council services or from reserves then there will need to be even greater reductions in social care services in the next few months.

Social and health care are inextricably connected. The pressures are impacting severely on the NHS. Delayed transfers of care have been increasing due to difficulties in securing packages of care for people at home and non-acute health services. It is not right that for want of care at home older people end up in hospital and cannot get back home quickly: not right for them and not right for the economy. This winter was always going to be difficult because of the funding situation and indeed the in the first week of January there were unprecedented levels of Accident and Emergency attendances, across the age range, of course, and some systems very fragile. Whilst ambulances queuing outside of Accident  and Emergency are a most visible sign, there are equal risks, particularly in some parts of the country, that care market failure might be the first domino to topple the system, particularly as there are more care home than NHS beds and more staff that work in social care than in the NHS.

The settlement to date has been overstated, inequitable and inadequate.

Whilst welcoming recognition of the social care funding crisis in the Local Government Finance Settlements for the last two years, these will at best slow the deterioration of the system, leaving some areas at particular risk, and will not nearly address the longer term sustainability of social care.

ADASS Budget Surveys have shown that successive years of cuts took £4.6bn (31%) out of council social care budgets between 2010 and 2015 whilst need grew significantly. Further savings of £941m are being made: a cumulative total of £5.5bn from budgets by the end of this financial year. This figure would have been even higher if it had not been for the decision in the 2010 Spending Review to transfer resources from the NHS to adult social care.  These resources, now in the Better Care Fund, amount to £1.1 billion – of this £900m have been used by local authorities to avoid further cuts in adult social care.

The settlement fifteen months ago introduced the social care precept that allows councils to raise council tax by 2% a year, on top of the 1.99% that they can raise without a referendum, over the life of the Parliament.  The Social Care Precept exacerbates distributional inequalities without covering increased need and cost, except in a small number of councils. In all regions bar one the Precept raises less than National Living and Minimum Wage requirements alone. In two regions it raises less than half. Looking at money raised per capita as a result of a 2% rise, the City of London would be able to raise £136 per person over 65, whilst Dudley could only raise £39 per person. That is a difference of well over three times the value.

That settlement also introduced the Improved Better Care Fund for some councils  to partly compensate for the differential impact of the precept, but that Fund only commences in 2017 and only reaches a significant contribution to the crisis in 2019/20. The total amount quoted as additional to social care is only the case if every council raises council tax every year over the life of the Parliament.

The most recent settlement further acknowledges concern but does not introduce additional funding: it redistributes the New Homes Bonus to form an Adult Social Care Grant of £241m and re-profiles the ability of councils to raise the precept by up to a total of 6% in the next three years. The recycling of New Homes Bonus money will leave some councils with less to spend on adult social care.

It does not address the current funding gap nor that projected to the end of the Parliament and the Office for Budget Responsibility has reported that ‘this will only alter the profile of spending in medium term, not the level it reaches in 2021-22, this announcement has no effect on our long-term projections as the starting point for them is unchanged’.

There has also been overstatement. The calculations for the precept in the 2015 Spending Review were stated as being based on ‘up to’ £2bn being raised by the precept over the Spending Review period, the equivalent of £500m per year.  However, the government’s more recent figures show that just £380m was raised in year one. So, even with the 3% precept raising powers announced, it is likely to total no more than £1.74bn over the period. The 2017/18 Local Government Financial Settlement (LGFS) confirmed this by reporting that a further 1% increase in 17/18 would raise a maximum of £208m.

ADASS took a snap poll of Directors of Adults Social Services between Christmas and New Year and had a 75% response rate. 28% thought that the measures announced in the Local Government Finance Settlement would have no effect on adult social care. A further 70% considered the measures to be likely to make very little difference. Just three councils thought the measures would be substantive.

We understand that there are no perfect formulae for identifying the precise funding that is required. Providers, commissioners, academics and independent think tanks all arrive at slightly different figures, dependent upon the variables incorporated and what they are trying to address. However, the Local Government Funding Settlement is more than £1 billion less than all leading sector experts (King’s Fund, LGA and Nuffield Trust) say is needed to fund adult social care next year and the fact remains that the precept raises less in areas with the greatest need. Money in the last two years of this parliament simply comes too late to help nearly 2 million people who rely on care and support. There is a very real risk that many local authorities will have tipped over and be failing to meet their obligations due to the lack of resources.

 

Demand continues to increase and costs to rise.

Our population, including the population of disabled people, is living longer, which is a cause for celebration. However, we are also experiencing longer lives with multiple long term conditions and increased complexity of need. Between 2001 and 2015, the number of people with a limiting long-term illness increased by 1.6 million (16%) and the number of people aged over 85 is expected to double between from 1.3 million in 2015 to 2.9 million in 2035[1]. Equally, more people with learning disabilities and complex support needs are living long lives.

 

2015

2020

2030

15 yr. change

Over 85 population [ONS]

1,600,000

1,900,000

2,800,000

75%

Adults with a (severe) learning disability [PSSRU]

240,000

260000

290,000

21%

 In 2016 the social care precept raised less than two-thirds of the cost of the welcome National Living Wage.

 

There is a need for immediate action to stabilise the sector and to prevent exacerbating current risks:

We are clear that the settlement is not sufficient to stabilise a care market in crisis. It will not enable us to recruit the front line care workers needed, it will not ease the pressures on our hospitals but most of all, it is not sufficient to provide older and disabled people and their families with dignified, respectful care.

Last year the second part of the Care Act was deferred. We supported this decision on the clear understanding that the £6bn that would have been needed to fund the changes was used instead to support the crisis in core social care funding. However, that additional funding has not found its way to Adult Social Care.

During this hard winter and throughout next year we will continue see more older and disabled people not getting the care and support they rely upon to survive each day, an even greater toll being placed on those 6.5 million family members and other carers, increasing delays in the NHS, and even more care homes closing and growing gaps and failures in the care market.

We are aware that others ask for more, but emergency assistance of £1b, distributed on a needs based formula, to prevent further deterioration whilst working on longer term solution, would go some way towards stabilising the system.

 

Longer term solutions will need to be found:

We welcome the stated intent to address the challenges of funding sustainable social care  in the longer term and are keen to work with government and the sector and to bring the knowledge and experience of ADASS to a fundamental review of this. There have been a number of previous commissions over a number of years, including Dilnot and Barker, all of which have been shelved and the impact of this is now being felt.

The whole care sector, including senior leaders from the NHS, local government and the independent sector, stands united in recognising the importance of an adequately funded social care system in promoting the country’s wellbeing and ensuring the right care is available.

Any long term solution will need to be debated with the public and look at the full range of funding sources and how they may be fairly distributed in future. Current solutions go nowhere near what is needed.  Some of the options that should be considered will have to include pensions, property, benefits, housing, real incentives for family members to care for relatives which will need to give fair compensation for loss of employment income and rights to leave, insurance and taxation.

 

Conclusion

We welcome statements of intent to address the longer term funding issues for social care and in the shorter term ask that the Government:

  1. Immediately assists the shortfall in next year’s budgets by injecting £1b in order to stabilise the sufficiency and quality of the market.
  1. Makes provision for the gap in funding to 2020, ensuring that social care funding is protected, transparent and sustainable. Whilst not the only answer, recurrent additional funding to local government, based on need for social care is integral to any solution.  
  1. Helps us to address the workforce recognition, recruitment and retention issues by affording care staff, social workers and social care nurses the same recognition and attention as doctors and other key professionals and by resourcing this. Enhances the status of care workers, addresses pay issues, reviews key worker housing, training, and the contribution of DWP/work programme providers, funds apprenticeships, and skill mix. Engages with us on a national recruitment campaign and addresses our concerns about the uncertainty for non UK EU citizens who are a crucial part of our workforce.
  1. Addresses the longer term resourcing issues for social care for 2020 and beyond. This will necessitate radical reconsideration of how to incentivise family and other informal carers, revisiting the role of the individual, family, community and the state and consideration of all funding options.

  

About Us

The Association of Directors of Adult Social Services is a charity. Our objectives include;

  • Furthering comprehensive, equitable, social policies and plans which reflect and shape the economic and social environment of the time
  • Furthering the interests of those who need social care services regardless of their backgrounds and status and  
  • Promoting high standards of social care services

Our members are current and former directors of adult care or social services and their senior staff.

 

[1] ONS 2012-based principal population projections for England