Reforming adult social care

Adult social care and support is a vital public service that helps people of all ages, with different needs and in different settings, to live the life they want to lead. 

It helps support people’s independence, wellbeing, relationships and contribution to their local community. In this way, it helps strengthen the places in which we live, our economy and the capacity of other local services. 

Funding and reform are needed to bolster social care’s potential to best support people and communities, and in September the Government published its plan to strengthen the NHS and social care as we move forward and recover from the pandemic.

‘Build back better: our plan for health and social care’ sets out a number of initiatives, including a cap on care costs, to be funded through a new 1.25 per cent health and social care levy based on National Insurance (NI) contributions. 

We recognise that protecting people from ‘catastrophic care costs’ and having to sell their home to pay for care is a government commitment. This is a potentially important first step in changing the way social care is paid for and funded, which we acknowledge is an important issue. 

It is also helpful that the Government has looked beyond just this issue, outlining action on, for example, the workforce and supported housing. The Government has also committed to publishing a new adult social care white paper by the end of the year. 

While these are all potentially positive developments, we have serious concerns and question whether they make the kind of progress needed to help adult social care deliver for people, especially given the announcement provided no extra funding for frontline social care.

For example, we question the adequacy of the levy to fund all of the plan’s adult social care commitments and need to know what proportion of it will reach adult social care beyond the three-year period covered in the plan. 

The levy is expected to raise around £36 billion, with £5.4 billion going to adult social care over the next three years. This is expected to fund:

  • an £86,000 cap on maximum care costs that people are required to pay themselves
  • an increase in financial means test thresholds, so those with assets of less than £20,000 pay nothing, with a sliding scale of contributions up to assets of £100,000
  • funding to enable councils to pay providers a ‘fair cost of care’ and to help tackle the problem of self-funders paying more for their care than people funded at the council rate
  • £500 million for new measures to support the care workforce
  • action to ensure unpaid carers have the support, advice and respite they need
  • investment in the Disabled Facilities Grant and supported housing
  • improved information for people who draw on social care and support.

“Proposals must be backed up by new additional funding

However, there is nothing concrete about the profile of the £5.4 billion over the three-year period. While the NHS will receive funding to tackle its immediate and longer-term issues, there appears to be no similar funding for the pressing issues facing social care now. Indeed, one reading is that there will be nothing for adult social care until April 2023. 

We are left to infer that after three years, the levy allocations will divert from the NHS to social care but the Government needs to clarify this and guarantee they will get through to the sector. We also need a breakdown of social care’s allocation for the coming three years, and an explanation for why none of the funding is targeted at addressing significant current pressures.

Other than the £500 million earmarked for measures to support the care workforce, none of the initiatives funded by the levy are itemised. This is unhelpful and makes it difficult to have any confidence in the adequacy of the £5.4 billion.

It is helpful that the plan makes clear that public sector employers will be compensated for their increases in higher NI contributions so as to avoid a reduction in their spending power. 

However, councils routinely commission from a range of private, independent and voluntary sector partners, all of whom will likely want or expect an increase in their fees to reflect their higher NI contributions. The plan says nothing about these potential associated costs, which our initial analysis suggests could cost £100 million a year – just for adult social care.

Meanwhile, it is deeply troubling that the Government’s solution for addressing the inflationary and demographic pressures on social care appears to be the use of council tax, social care precept and long-term efficiencies. This is wholly unrealistic. 

A continuing reliance on these measures will further destabilise social care and other vital council services, many of which contribute to people’s wider wellbeing. 

As we have repeatedly said, council tax (and therefore the social care precept) raises different amounts in different parts of the country and has no relationship to need; councils with higher levels of deprivation tend to have a lower potential amount to raise.

It also has the potential to create confusion and frustration among the public: people are being told that the new levy will fund adult social care but may see potentially significant increases in their local taxes to fund the very same service. 

Rather than create a simpler system of funding, the plan risks entrenching the complexity of funding that has beset social care for so long.

Finally, the Government must honour its commitment to publishing a white paper by the end of the year and it must be informed by, and reflect, the considerable body of work that partners across social care have done in recent years – not least the LGA’s own 2018 green paper and subsequent publications.

It must also draw the right links to other relevant services, particularly public health which the plan makes no meaningful reference to. You cannot fix the health system without also fixing social care. We need long-term sustainable funding and proposals for reform must be backed up by new additional funding.

The Government’s plan for adult social care is extremely light on detail. Over the coming weeks we will be seeking to fill this void through ongoing discussions with ministers and officials. 

There are also many links to be made with the upcoming Spending Review and we will be raising the issues and concerns set out above in all of our work on this agenda. 

We recognise that councils will have their own concerns and questions and we want to ensure that our work best reflects those. Therefore, if there are points you wish to raise with us, please contact your council’s regional principal adviser or email us at info@local.gov.uk

This article is based on the LGA’s briefing on the Government’s ‘Build back better: our plan for health and social care’. You can read it in full on our website.

The LGA’s next podcast will be on social care and will explore the new proposed reforms from government and what this means for councils. We will hear perspectives from experts in the sector, and from those with lived experience on what matters to them.

Read more about this topic in £5.4bn for adult social care reforms

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