Major reform of social care funding and provision is needed, say CLG Select Committee

The Government needs to urgently review how social care is funded in the long term and address serious threats to social care provision, say the Communities and Local Government Committee in a report published today.  

The report finds inadequate funding very seriously affects the quantity and quality of adult social care provision, impacting on those receiving care, the NHS, care staff, carers and providers. The report sets out a number of recommendations relating to the monitoring of care services, care commissioning, and the care workforce.

The CLG Committee welcomes the Chancellor’s commitment to provide an additional £2bn for social care over the next three years but finds this falls short of the amount required to close the social care 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. The Committee welcomes the Government’s Green Paper and recommends it looks at a range of all possible revenue options including hypothecating national taxation (e.g. income tax or a compulsory new social insurance scheme) and age-related expenditure (e.g state pension, 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.

Clive Betts, Chair of the Communities and Local Government Committee, 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. This review must be ambitious and consider a wide range of potential funding sources, looking again at age-related expenditure, options such as a hypothecated tax for social care, a compulsory insurance scheme, and differences in how individuals contribute. The review must take a wide look at what we will spend this money on in the future – on support, on preventative care and intervention, on the care workforce – and ensure that care users are at the centre of how care is organised and that they get the assistance they deserve”.

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.