A new report from the Communities and Local Government Committee (CLG) says that major reform of social care funding and provision is needed. Recommendations include the Care Quality Commission (CQC) oversees councils’ market shaping, commissioning and procurement activities, a care workers’ charter be published and the status of care work be improved.
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 also welcomes the Government’s Green Paper and recommends it looks at a range of all possible revenue options, including hypothecating national taxation (eg income tax or a compulsory new social insurance scheme) and age-related expenditure (eg state pension, winter fuel allowance). In doing so, the Committee recommends the Green Paper also considers 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.
The report also 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. The Committee believes that greater investment in preventative measures could produce savings for the NHS in the longer term.
The Committee also 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.
The Committee says that 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 social care providers.
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’.
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.
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 Committee says that the Government must be realistic about the improvements which integration can deliver and 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.