The LGA's letter to Secretary of State for Health and Social Care regarding adult social care funding and reform.
Rt Hon Steve Barclay MP
Secretary of State for Health and Social Care
Department of Health and Social Care
39 Victoria Street
London
SW1U 0EU
Copied to: Gillian Keegan, Minister for Care and Mental Health
1 August 2022
Dear Secretary of State,
Adult social care funding and reform
I am writing with regard to the Government’s reform agenda for adult social care. We have previously welcomed both the Government’s ‘Build Back Better Plan’, and its white paper, and believe these constitute important first steps in getting on with reform of care and support. At the same time, we need to be honest about what is needed to ensure the most successful implementation and delivery of the reforms.
Last month, we published two key findings from a recent LGA survey of all adult social care Lead Members across the country on the Government’s social care reforms, particularly charging reform and assurance. First, 98 per cent of respondents indicated that they do not have confidence in the adequacy of funding Government has earmarked for the reforms. And second, three quarters of respondents said they are not confident that they have the frontline capacity to deliver the reforms.
These findings echo what we have heard time and again from councils in recent months. Councils are telling us that the likely and significant underfunding of the reforms will mean a serious struggle to deliver a balanced budget. Some are reporting that the reforms will tip them over the financial edge and others are saying that implementation will come at the expense of cutting back other vital council services.
While we support the general thrust of the Government’s reform agenda, we must do all we can to avoid a situation that is going to place councils under even greater pressure and further destabilise adult social care. That existing instability is plain to see. The recent annual spring survey by the Association of Directors of Adult Social Care (ADASS) shows that just 12 per cent of directors are confident that they have the resources required to deliver all of their existing statutory duties. It also shows significant increases in requests for support; concern about the position and experiences of unpaid carers; providers closing, ceasing trading or handing back contracts; reductions in quality and choice in local care markets; and a need to deliver service savings totalling just under £600 million this financial year.
Previous recent ADASS surveys have shown that half a million people are now waiting for a care needs assessment, a care package, or a review of an existing care plan. The particular problem of recruiting and retaining care workers also remains a major issue, with low pay driving much of the challenge. We continue to call on the Government to commission an independent inquiry to promptly review existing pay levels in the sector and consider how they support the recruitment and retention of the high-quality workforce the public requires and rightly expects.
The serious and precarious nature of our existing adult social care system, and the very real consequences of current pressures on people who draw on care and support, is
unquestionable. Most, if not all, of the immediate challenge can be traced back to historic under-funding, which continues to this day on a significant level. While the Government’s measures to support the system are welcome, they are far from sufficient.
It is in this context that the Government’s reform agenda needs to be considered. Funding and capacity for reform go hand in hand and so it is no surprise that 62 per cent of respondents to our Lead Member survey indicated that they are not confident in delivering the reforms to the Government’s planned timescale. Following on from this, 86 per cent of respondents indicated their preference to delay all (20 per cent) of some (65 per cent) of the reforms.
These survey findings, along with the wider context set out above, were considered carefully at the LGA’s Community Wellbeing Board meeting on 13 July. Our Members also reflected on the Government’s recently announced change to the implementation of Section 18(3) of the Care Act, which will now be pushed back to April 2025 for existing people living in residential care. The Board was unanimous in welcoming this recognition by Government of councils’ concerns. However, they were also unanimous in agreeing that this concession does not go far enough in the face of significant existing pressures, major challenges facing the social care workforce, and the confluence of so many resource-intensive reform elements to similar timescales. After extremely careful consideration, our cross-party position is therefore as follows:
1. Given the fragile state of the provider sector, the significant work councils are already doing on ‘fair cost of care’ and market sustainability plans (MSP) should continue uninterrupted and to the planned timescale. However, and in the context of continued capacity pressures, we continue to question the utility of the requirement for a draft MSP by October 2022 and suggest this is removed, with councils instead only being required to submit a final MSP in February 2023.
2. This work would be far easier to do if it was not being done alongside demanding preparatory work associated with other strands of the reform agenda. We therefore call on the Government to defer implementation of the care cost cap, changes to the financial means test thresholds, and Section 18(3) of the Care Act to April 2024.
3. A short deferment such as we are proposing would be beneficial for the following reasons:
a. It would significantly ease the pressure on councils’ adult social care teams as they tackle immediate pressures, prepare for what is widely expected to be an extremely challenging winter, and continue their important work on ‘fair cost of care’.
b. It would allow for a longer period of reflection and deliberation on the crucial learning from the work being conducted by the social care reform trailblazer sites; this learning should continue, though thought should be given as to whether their ‘go live’ date is realistic.
c. It would provide more time to ensure necessary software systems are up and running effectively and to recruit staff ahead of increased numbers of assessments and the start of metering as part of implementing the new means test, care account and care cap.
d. It would provide space for the Chancellor to use the Autumn Budget to address any specific funding issues surfaced through discussions between national and local government on learning from the trailblazers and the outcome of cost of care exercises and market sustainability plans. For instance, once councils know how much funding they will be allocated for 2023/24 to support moving towards paying a fair cost of care, we will be better placed to build a firmer and more transparent assessment of the effect of the policy, including the adequacy of earmarked funding.
4. Given the significant and serious pressures facing adult social care, we call on the Government to defer implementation of the new assurance regime by at least 12 months and adopt a more phased approach. This would allow more time to: ensure the proposed regime is fit for purpose; better consider how to align sector-led support and improvement with the proposed national improvement offer from the Department; ensure that councils can collect and submit the data that CQC will require; and better identify and understand the sorts of issues that assurance is likely to surface and how they would need to be addressed. As set out above, we know councils are struggling, and will continue to struggle, to meet all of their existing statutory duties. While the charging reforms help address important issues, they do nothing to tackle system underfunding – even with a deferral, such as we are proposing. There is therefore a serious risk of councils being set up to fail under the new assurance regime if the issue of core funding for adult social care is not resolved.
We of course recognise that the actions we are calling for above would constitute an important change of approach. However, we are confident that they are proportionate and – more importantly – we are certain that they would create far better conditions in which to make progress with the Government’s reform agenda. We strongly believe that a failure to take these steps will significantly weaken an already over-stretched and under-funded system, with more severe consequences for people who draw on social care to live an equal life and the workforce that continues to deliver support to people with dedication and commitment.
Having waited so long for care and support reform, we have not arrived at this position lightly. But we think that adjusting the timescales for delivery in this way will build in time for learning from trailblazers and provide a better chance of smooth implementation. Most importantly, the additional time would help strengthen our collective understanding of the real costs of the reform agenda and the adequacy of earmarked funding. This remains a major risk and serious concern for councils, particularly given that any additional funding pressures will worsen an already fragile system. That is why, as an immediate priority, we continue to call on the Government to urgently inject additional funding from the new Health and Social Care Levy to social care now and offer assurances that, should a new Prime Minister decide to end the Levy, replacement funding will be found to deliver the reform programme.
In the ongoing spirit of coproduction which has underpinned much of the reform agenda, colleagues and I would be very happy to meet with you and your team to discuss these matters further.
Yours sincerely,
Cllr David Fothergill, Chairman of the LGA Community Wellbeing Board
Copied to: Gillian Keegan, Minister for Care and Mental Health