Cllr Charles Margetts is the Executive Member for Adult Services and Public Health on Wokingham Borough Council.
The social care sector has been underfunded and in crisis for many years. Adult social care affects every single person in the country – everyone will have someone in their family who will get old, or with increased need, and who will need to use adult care services.
Respective governments of all colours have not tackled the problem and this has led the sector into crisis.
This shows itself in three key areas:
- The cost of care to the individual. Stories in the national media of people facing 6 figure care bills are no exaggeration. The current system places almost all the costs of care on the individual. This had led to people having to sell their homes to fund their own care. Unlike the NHS, Councils have to administer this unfair system and chase people to pay for their care.
- Staff shortages and low wage levels. If a direct comparison is carried out between an equivalent post in the NHS and the care sector, the employee in the care sector is paid approximately 30 per cent less. The NHS is very effective at lobbying for extra pay for its staff and the result has been that care staff have been left a long way behind. This has resulted in significant staff shortages in the care sector. This situation has been exaggerated by the 40,000 care staff who lost their jobs because they refused the vaccination in comparison to the 80,000 NHS staff who have been allowed to refuse vaccination and retain their jobs.
- Increased demand and more complex needs. People now live a lot longer than they did 20 – 30 years ago. The result of this is that social care has to deal with increasing numbers of elderly people with more complex needs. The result of this at local authority level is that in Wokingham if we make no changes, year to year costs will go up by four per cent a year. This percentage pressure will only climb in the current climate of inflationary pressures and the need to invest in care workers pay.
We welcome the attention of the government in this area and also note that they have endeavoured to make progress with social care. However, the proposals fall well short of what is needed and will, I fear, impose crippling financial burdens on local authorities
The Government announced a rise in national insurance levels which comes into force in April which is claimed to be ‘a social care levy’. This had led to various government ministers touring tv studios claiming they have ‘fixed social care’. However only £1.8 billion of the £127 billion raised is being passed to social care. The balance is being passed to the NHS. All estimates suggest that Adult Social Care needs a circa £8bn investment to address these issues.
The planned charging reforms have several key parts.
The care cap is being set at £86,400 a year per person. This means the individual will pay for the first £86,400 – and all eligible care costs after this will be paid by the local authority responsible.
Local authorities currently get a discount for the care they commission directly. Part of the reforms involve the abolition of this discount between private payer and Local Authority rates. This will mean higher care charges for almost local authorities across the country.
The proposed reforms make it the responsibility of local authorities to manage and track financial assessments of when a resident passes the cap. There is currently a specified need for an annual financial assessment of every resident using care services.
The planned reforms are also silent on some of the key issues in the sector. There is no attempt to deal with the inferior way the sector is treated in comparison to the NHS. There is little meaningful attempt to raise wages to comparable levels within the NHS. It is difficult to see, with the measures proposed, that there will be any change to the staff shortages in the sector. Although the government has asked each Local Authority to do a ‘fair cost of care’ exercise, this will be fruitless if there is also no long term plan to explain how the sector can cope with the ever-increasing demand without any additional funding
The main financial effect of the changes proposed is to transfer the costs of care from the individual to the local authority; to remove the local authority care discount; and to pass all the administrative burden of the scheme (means testing / financial assessments) with the relevant costs to the local authority
Central government has correctly stated it has given local authorities extra money to fund this change. However the money provided is a fraction of the overall additional cost burden. Any area with high numbers of people paying for their own care and where there are high care costs will face a significant additional cost.
The additional costs will come from the following areas:
- The local authority will have to pay the care costs of every resident above the cap of £86,400. Not only will the local authority have to pay the care costs of the individual; it also loses the money the individual currently pays – this is a double whammy.
- Local authorities will face care costs 30-40 per cent higher than before due to the removal of the current discount.
- We estimate the amount of financial tracking and assessment required by the legislation will be triple what is currently required. This will require notable numbers of additional staff.
To achieve better healthcare for all, it is vital that social care is funded properly and integrated with the NHS. There is no realistic way for hospitals to process healthcare efficiently if social care cannot support the level of discharges needed.
For Wokingham, assuming all the £5.4bn over 3 years is paid out to Local Authorities, we estimate that we will face additional costs leaving a shortfall of £26 million a year. The only way we can sustain this additional expenditure would be to slash significantly any non statutory services (highways, education etc).
The state of local authority funding is well known. Several authorities have had to declare a Section 42 notice indicating they cannot cover their costs and are in essence bankrupt. If no change is made to this legislation there will no doubt be a significant number of additional councils going bankrupt. Every local authority with high numbers of self funders (people paying for their own care ) and high care costs will face similar levels of increase in costs. This level of cost is simply not realistic or sustainable – the Government has simply got its sums wrong.
We are calling on central government to revise its proposals. It needs to allocate more funding to support the bill – or else expect widespread financial failures of local authorities across the country.