Government needs to “urgently review” long-term funding for social care and address “serious threats” to its provision a key parliamentary oversight report has found.
Compiled by the Communities and Local Government Committee (CLG) the report reinforces the link between inadequate funding and the quantity and quality of care options – impacting on those receiving care, the NHS, care staff, carers and providers.
Supporting the findings, the LGA says any review must put “all options on the table” including councils using additional business rates revenue to address shortfalls in social care funding once 100% retention comes into effect.
The report sets out a number of recommendations relating to the monitoring of care services, care commissioning, and the care workforce to be addressed on a cross-party basis.
While the committee welcomes the Chancellor’s commitment to provide an additional £2bn for social care over the next three years, the report records this sum as falling short of the real financial commitment needed to close the funding gap.
The committee believes expenditure on adult social care will need to rise as a proportion of total public expenditure and recommends an urgent review of how to fund social care in the long-term.
Acknowledging the government’s Green Paper, the report recommends an examination of all possible revenue options including hypothecating national taxation – such as income tax or a compulsory new social insurance scheme – and age-related expenditure like the state pension and winter fuel allowance.
In doing so, the committee recommends the Green Paper also consider the wide range of uses for which social care funding is required including care and support, early intervention and prevention, and the training and development of care staff.
CLG chair, Clive Betts, said: “During our inquiry we heard mounting concerns about the serious impact which inadequate funding is having both on the quality and on the level of care which people receive.
“We heard compelling evidence of acute threats to care providers’ financial viability and an increasing reliance on unpaid carers.
“It is clear there are also severe challenges in the care workforce, with high vacancy and turnover rates, and low pay, poor employment terms and conditions, lack of training and inadequate career opportunities the norm across the sector.
“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.
Summarised, the report’s key findings are:
Quality of care – social care becoming the minimum required
The report finds that funding constraints are leading to councils providing care and support to fewer people, concentrating it on those with the highest needs, with care becoming the minimum required for a person to get through the day.
The committee also concludes that gaps in funding have led to a deterioration in the overall quality of care and that this is likely to continue.
Fewer than one in twelve directors of social care are fully confident that their local authority will be able to meet its statutory duties in 2017-18.
The committee believes that greater investment in preventative measures could produce savings for the NHS in the longer term.
Financial viability and private clients subsidising local authority clients
Funding gaps are pushing providers to the brink of financial viability, leading to them failing, exiting the market and handing back contracts for provision of care services.
The committee finds that care providers are relying on their privately paying clients to subsidise local authority funded clients by paying higher costs for the same care.
Evidence pointed to 96% of people paying for their own care paying on average 43% more than state funded residents in the same home for the same room and the same level of care.
Local councils commissioning – ‘price first, quality second’
Councils are increasingly taking a ‘price first, quality second approach’ in their commissioning of social care, with accounts of some councils paying as little as £2.24 an hour for residential care.
The committee found evidence of councils involved in poor consultation and unfair contracts with providers in the social care sector.
To combat a shortfall in accountability in this regard, the committee recommends the Care Quality Commission (CQC) oversee the market shaping, commissioning and procurement activities of councils.
The report also recommends that councils annually audit the services they commission, regularly carrying out spot checks to ensure people are receiving the care they need and ensure providers pay the national minimum wage, covering care workers’ travel time, travel costs and ‘sleep-ins’.
Workforce challenges – low pay, poor career prospects, lack of training
The high vacancy and turnover rates, particularly among nurses in social care, point to severe challenges in the social care workforce.
The turnover rate for nurses working in social care is 35.9% while 47.8% of care workers leave within a year of starting.
Low pay, lack of status and inadequate or non-existent training opportunities, and limited career progression were significant barriers to an improvement of prospects for those working in the social care sector.
The committee recommends the government work with the Local Government Association to publish a care workers’ charter, drawing upon UNISON’s Ethical Care Charter, setting out what care workers can expect from their employer on wage levels, employment terms and conditions, training and career development.
The committee also recommends the status of care work be improved through better pay, commensurate with skills and responsibilities, and better terms and conditions, and a stronger career structure—from apprenticeship to registered nurse— with centrally delivered training with national standards and qualifications, similar to the NHS Knowledge and Skills Framework.
Health & Social Care integration
The report finds that the integration of health and social care has the potential to bring benefits but it alone will not solve the problem of social care funding in the long term.
The government must be realistic about the improvements which integration can deliver and the committee recommends decisions on health and social care budgets should be made locally, with local government involved in the commissioning to ensure decisions about local health services are informed by local needs and existing local public services.
Social Care: the breakdown
- 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
- 28% of care services are inadequate or require improvement
- Some councils pay £2.24 an hour for residential care
- 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
- The turnover rate for nurses working in social care is 35.9%
- 8% of care workers leave within a year of starting
- The median hourly pay for a care worker is £7.40
- 160,000 to 220,000 care workers in England are paid below the national minimum wage
- 49% of home care workers are on zero hour contracts, compared with 2.9% of the workforce nationally
- 27% of care workers received no dementia training and 24% of those who administer medication were not trained to do so
- Between 2010–11 and 2013–14, the number of unpaid carers increased by16.5%, while the general population grew by 6.2%
- One in five unpaid carers providing 50 hours or more of care each week receives no practical support from the local authority.
In response to the report, LGA chairman Lord Porter said the Green Paper offered the opportunity for a much-needed meaningful national conversation over care and support while the any review required “all options on the table” to secure a solution.
“Councils are clear that the recommendations that come out of the Green Paper cannot end up being kicked into the long grass like other social care reviews, inquiries, and commissions have been in the past decade.
“It is vital that political differences are put aside in the interests of real leadership so that we can tackle this crucial public policy question.
“We have long called for income generated by localised business rates to be used to cover existing pressures before any new responsibilities are considered.
“So we are pleased that the Committee is recommending that local government should be allowed to use some of the additional business rates revenue to close any adult social care funding shortfall that exists when 100 per cent business rates retention comes into effect.”
The County Councils Network (CCN) stresses that reform must be underpinned by a ‘thorough review’ of options – on the basis that funding alone will not deliver a long term solution.
Cllr Colin Noble, CCN spokesman for health and social care said: “The Government’s needs-based review could provide an opportunity to create a simpler and fairer methodology for distributing council funding, based on the true cost drivers of delivering services. Currently, counties receive the lowest social care funding despite facing most acute demand pressures”.
To CCN, the need to improve the operation of Disabled Facilities Grant (DFG) is a key challenge for upper tier councils in improving preventative care.
Noble said: “A fragmented approach to installing home adaptions is impacting upon delayed discharge rates attributable to social care; almost two thirds of delayed days in county areas are attributable to waits for adaptions and community equipment, compared to just under a quarter in county unitary areas.
“It is important that we work with our district partners through the to ensure those requiring adaptions receive them in a timely and efficient manner.
“However, we recognise that the forthcoming Green Paper may need to explore reforms to better integrate DFGs with upper tier social care services, as recommended.”