People at the heart of care

The LGA has published a briefing on the adult social care white paper

The Government set out its 10-year vision for adult social care last month, in a long-awaited white paper, ‘People at the heart of care’.

The white paper is based around three key objectives: that people have choice, control and support to live independent lives; can access outstanding quality and tailored care and support; and find adult social care fair and accessible.

It follows the September 2021 publication of ‘Build back better: our plan for health and social care’, which sets out a range of measures, including reforming the way adult social care is paid for and funded. 

The key elements of the plan’s social care proposals included: a cap on care costs and more generous financial means-test thresholds; the ability for self-funders to ask their council to arrange their care; and moving towards a fair rate of care in respect of councils’ fees to providers. 

The plan also announced the creation of a new Health and Social Care Levy to fund the changes. Read more on LGA response to “Build Back Better: Our plan for health and social care“.

Since the plan, we have had the October Spending Review. This announced new government grant funding of £1.6 billion per year for councils over the next three years, but did not provide additional funding to address the pressures facing adult social care now. You can read our response to the Spending Review at the LGA website.

The LGA fully supports and endorses the positive framing of social care in the white paper, which mirrors much of the language we have used in recent years to describe the importance and value of care and support. 

The Government’s ambition for social care, as defined through the various statements about what people can expect from social care, and what the sector will do to achieve this, is helpful. 

It reflects what the LGA and many others have articulated in terms of what social care needs to be for people to live their best life and an equal life.

There is welcome recognition in the white paper of existing good practice, and of the importance of taking forward reforms from the foundation of the Care Act 2014, which remains a well-supported piece of legislation. 

The focus on the workforce, prevention, unpaid carers, innovation, and the links between care and housing are also helpful. However, councils will be unable to play their part in delivering the Government’s ambitions if the central issue of funding is not tackled. 

Mirroring previous moments of change, this white paper, the Spending Review, and the ‘Build back better’ plan have done very little to deal with the here and now challenges.

Funding to stabilise core services, tackle unmet need, stabilise the provider market and address care worker pay remains absent.

Without this, the white paper is attempting to build a better future from inadequate foundations.

The table (below) sets out the main issues that need to be addressed. The figures in the table do not include core pressures. In our Spending Review submission, we estimated that councils face future demographic and inflationary base annual pressures of £1.1 billion. 

We estimate that the Spending Review measures will enable these pressures to be met this year, but will be insufficient to cover the pressures in full in 2023/24 and 2024/25.

We are not convinced that the £5.4 billion allocated for social care through the new Health and Social Care Levy is sufficient to fund the charging reforms set out in the Government’s September plan. We question whether the funding set out in the white paper for its associated reforms adequately matches the Government’s stated level of ambition. 

For example, throughout the white paper there is helpful recognition of the crucial role played by unpaid carers, and a clear commitment to empower them and provide them with better support. 

However, the only dedicated funding aligned to this priority is £25 million to kickstart a change in the services provided to support unpaid carers. This is not a significant investment, particularly when set against the estimated value of care provided by unpaid carers since the start of the pandemic (£111 billion).  

Through our work on our own green paper for social care and wellbeing in 2018, we called on government to make the case for increases in national taxation to raise additional funding for adult social care. 

Through the new Health and Social Care Levy, the Government has done this, but the clear majority of the funding raised in the first three years has been allocated to the NHS. We therefore call on ministers to immediately redirect a significantly greater share of the levy to frontline adult social care.

2020/212024/25
Fair price of care (including the cost of self-funders accessing care at the council-commissioned rate)Minimum of £1.5bn for all councils to hit benchmark ratesMinimum of £1.8bn for all councils to hit benchmark rates
Adult social care pay – parity with comparable roles in the NHSEstimates of £1bn (LGA) – £1.8bn (Health Foundation)Estimates of £1bn (LGA) – £1.8bn (Health Foundation)
Provide care for all older people who need it (based on estimates of unmet need among older people by Age UK)£3.2bn£4bn
Provide care for all people of working age who need it (estimates based on broad assumptions, see full briefing)£1.6bn£1.9bn
Total£7.3bn – £8.1bn£8.7bn – £9.5bn

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