ADASS (ASSOCIATION OF DIRECTORS OF ADULT SOCIAL SERVICES) – WRITTEN EVIDENCE (ASC0135)

1.             THE INVISIBILITY OF ADULT SOCIAL CARE AND ITS CONSEQUENCES

1.1      In some ways the invisibility of social care is surprising.

1.2      One in eight adults (around 6.5 million people) are unpaid carers in the UK (Carers UKa 2022).

1.3      In 2020/21, 841,245 adults received long-term support in England, and 246,600 episodes of short-term support were provided to adults with the aim of maximising their independence (NHS Digital 2021).

1.4      There are 1.54m people working in adult social care in England (Skills for Care 2021), which is more than the 1.37m people working in the NHS (NHS Digital 2022).

1.5      For 2020/21, the adult social care sector in England was estimated to have a total economic value of £50.3bn (Derbyshire et al 2021).

1.6      Approximately 41m hours of homecare were delivered from January to March 2022 (ADASS 2022c).

1.7      As of February 2022, 506,131 people were waiting for assessments, reviews, and/or care support to begin. This is a significant increase from the 294,353 people reported as waiting in September 2021 (ADASS 2022c).

1.8      Nonetheless, adult social care does not seem to be well understood by the public.

1.9      Analysis of the British Social Attitudes survey shows the satisfaction question about social care attracts a relatively high proportion of ‘don’t knows’ and of ‘neither satisfied nor dissatisfied’ responses than questions about GPs and outpatients. (‘Don’t know’: 9% social care; 1% GPs; 3% outpatients. ‘Neither satisfied nor dissatisfied’: 31% social care; 13% GPs; 15% outpatients). This hints at those people surveyed finding it difficult to form an opinion about social care, which may be linked to a lack of knowledge and experience of social care (Hemmings 2019). It also hints that those who are drawing on social care are least likely to have access to or be able to respond to such surveys, for a variety of reasons.

1.10 Research undertaken by BritainThinks for the Richmond Group of Charities found that people often conflated NHS community services with social care (Knox et al 2021). This is not surprising, as over the years social care has picked up many of the activities that once were delivered by the NHS. In the 1990s one of the key points of debate in practice was about whether helping someone to bathe (which had previously been done by District Nurses) was health or social care. Over the years, more and more complex needs and behaviours are met by social care. People who would have had sometimes lengthy stays in community, learning disability of mental health hospitals now frequently have their needs met by social care.

1.11 In 2018, Ipsos MORI explored public attitudes to social care in England for The Health Foundation and King’s Fund. It found the key themes people associate with social care were: caring for vulnerable elderly, children and disabled people; helping people maintain

independence; care homes and carers; and support with transport, shopping and personal care in the home (Ipsos MORI 2018).

1.12 In 2021, Ipsos undertook further public perceptions research for The Health Foundation. This found that around half of the public (53%) are neutral towards the quality of local social care services, likely linked to limited knowledge and / or use. More of the public disagree that social care services are good (32%) than agree (13%) (Duxberry et al 2022).

1.13 Adult social care’s reach is much broader than this. It supports people with their mental health, because of physical disabilities, because of learning disabilities, because they are older and need additional support, because they experience domestic abuse, because they experience addiction, and/or because they are carers. It supports people to be safe, to work, to socialise, to provide care and support for loved ones, and to play an active role in their communities.

1.14 However, social care often happens behind closed doors. And while every one of us is only one life event away from needing care, support or safeguards, it is not the norm within our society to contemplate, discuss or plan for this. Through our work, we are also aware that many people who pay for care and support probably do not consider this to be ‘social care’ and would not label it as such. All of these factors contribute to the invisibility of adult social care.

1.15 Making It Real (TLAP 2018) – co-produced by people with lived experience – provides a helpful description of what good person-centred and coordinated care looks like. It does so from the perspective of people accessing health and care (through ‘I Statements’) and from the perspective of people working in health and care (through ‘We Statements’). ADASS was a member of the Making It Real working group and endorsed this description of good person- centred coordinated care. We believe it would be helpful if everyone worked towards the shared vision of Making It Real, whether that be through local or national outcomes and priorities. We welcome the citing of Making it Real in the People at the Heart of Care: Adult social care reform white paper, as well as its incorporation into the Care Quality Commission's draft Assessment Framework.

1.16 We support Social Care Future’s Vision for the Future of Social Care (SCF 2021). This vision has been developed by people who draw on or work in social care, and through extensive public audience research.

1.17 The invisibility of adult social care, aside from through a lens of older people and care homes, has consequences.

1.18 These include (but are certainly not limited to) years of underinvestment in adult social care. As we entered the COVID-19 pandemic, spending on adult social care was still less than a decade earlier in real terms (Charlesworth 2021).

1.19 A workforce that feels under-recognised, undervalued and under-appreciated. This is getting worse. In the most recent adult social care workforce survey undertaken in September/October 2021, 70.6% of respondents reported that maintaining staff morale was more challenging than in April 2021 (DHSC 2021).

1.20 A focus on the NHS when it comes to funding, reform and workforce considerations, even when the issues facing the NHS are inextricably linked to parallel considerations in adult social care or when an absence of investment in social care has detrimental impact on the NHS (and the criminal justice system – too many people with mental ill health or learning disabilities are in prison).

2.             BETTER SUPPORT FOR UNPAID CARERS

2.1      Adequately invest in adult social care now, as an essential bridge to reform.

2.2      We must respond to unmet, undermet and wrongly met need by providing more care and support and by solving the workforce crisis. Alongside funding recovery in the NHS, we must give urgent and equal focus to re-establishing adult social care, support and safeguards.

2.3      There have been significant increases in the amount of care delivered in recent months. From 1st February to 30th April 2021, 34,635,217 homecare hours were delivered. From 1st January to 31st March 2022, 40,288,271 homecare hours were delivered. This represents a 16% increase in home care hours (ADASS 2022c).

2.4      Despite these increases in the amount of care delivered, more is still needed than there are frontline social care staff to deliver it (ADASS 2022a, 2022b, 2022c). ADASS has submitted relevant written evidence to the Health and Social Care Committee’s Workforce recruitment, training and retention in health and social care inquiry1, and to the Public Services Committee’s Designing a workforce fit for the future inquiry2.

2.5      This means that excruciatingly painful choices are being made about who gets support and how much. It means deciding between helping someone to get out of bed and ensuring they are able to eat and drink during the day. There is currently no national workforce plan for adult social care.

2.6      This has inevitably had an impact on unpaid carers. As of March 2022 – toward the end of the worst winter most Directors of Adult Social Services had experienced – a third of councils (33%) were asking carers to provide more support to replace a reduction in commissioned support, for example by taking paid or unpaid time off work (ADASS 2022a). We asked the Government to provide an additional £1.5 billion in the 2021 Comprehensive Spending Review, through which to provide a significant package of support for unpaid carers, including extra payments for those on Carer’s Allowance to enable them to have a break (whether weekly or saved up for a longer break) so as to protect their physical and mental health and wellbeing. We argued this investment would far outweigh costs of carer breakdown and admission to hospital.

2.7      Legislate so that unpaid carers have the same carers’ leave entitlements as parental carers.

2.8      Government has committed to “creating a new leave entitlement of one week of additional leave for unpaid carers” (BEIS 2021), though this was not provided for within the recent Queen’s Speech. Government should go further and legislate so that unpaid carers are entitled to 18 weeks’ leave for each adult they care for, limited in a year to four weeks for each adult (unless the employer agrees otherwise) – in parallel with parental leave.

2.9      Increase Carer’s Allowance to mitigate the cost-of-living crisis.

2.10 Carers receiving Carer’s Allowance received an increase of £2.10 per week in April 2022. This was based on inflation rates of 3.1% that were set last year. The real rate of inflation could now be as high as nearly 8%, meaning the increase represents a real terms cut in benefits. According to Carers UK’s research report ‘Under Pressure’, thousands of carers are now having to decide

1 Written evidence submitted by the Association of Directors of Adult Social Services (ADASS) (RTR0047): https://committees.parliament.uk/writtenevidence/42675/pdf/

2 Association of Directors of Adult Social Services (ADASS) - Written evidence (FFF0047): https://committees.parliament.uk/writtenevidence/106838/pdf/

whether they eat or heat their homes, and a quarter of carers receiving carer benefits were already using a foodbank in February 2022 (Carers UK 2022b).

2.11 This is not sustainable and without intervention, will lead to carers breaking down and being unable to continue caring for friends and family – instead passing the costs of doing so onto local authorities and the state. The value of care and support provided by unpaid carers is estimated to be £193 billion per annum (Carers UK 2020). This is more than the annual cost of the NHS (King’s Fund 2022).

2.12 Through devolution of carer benefits in Scotland, the Scottish Government has awarded unpaid carers an additional Carer’s Allowance Supplement beyond the base level of Carer’s Allowance. Unpaid carers across the UK are facing the same financial pressures.

3.             PUTTING CO-PRODUCTION AT THE HEART OF CARE

3.1      It is important to recognise that co-production is different from activities like consultation, engagement and co-design, as it doesn't just ask for people's ideas, experience and opinions; it also includes their skills and expertise. Co-production needs people's actions. It also involves people from the very beginning, so that they are helping to identify the problems being solved or questions being answered, and not just commenting once decisions have started to be made. Co-production means that power is shared more equally between those who use services and those who provide them. We commend the TLAP co-production ladder as a helpful way of understanding and visualising this (TLAP 2021).

3.2      ADASS’s ‘Nine Statements to Help Shape Adult Social Care Reform’, published in 2020, set out that: “Reform should be built on the principle of locally determined integrated care that achieves person-centred, person-led, co-ordinated care, treatment and support… The primary role of the local authority, through social work, will be to advise and advocate with people, to commission and coordinate care that works for individuals, their families, and carers, to join up support with health and housing, and to safeguard people at risk”.

4.             ABOUT ADASS

4.1      The Association of Directors of Adults Social Services (ADASS) is a charity. Our objectives include:

        Furthering comprehensive, equitable, social policies and plans which reflect and shape the economic and social environment of the time;

        Furthering the interests of those who need social care services regardless of their backgrounds and status; and

        Promoting high standards of social care services.

4.2      Our members are current and former directors of adult care or social services and their senior staff, including Principal Social Workers.

26 May 2022

BIBLIOGRAPHY

ADASS (2020). Nine Statements to Help Shape Adult Social Care Reform.

ADASS (2021). ADASS Submission to the Budget and Comprehensive Spending Review

ADASS (2022a). Social Care Winter Contingencies and Waiting Surveys.

ADASS (2022b). Commissioning or Providing Day Services.

ADASS (2022c). Waiting for Care and Support.

Carers Trust (2022). Pushed to the Edge: Life for unpaid carers in the UK.

Carers UK (2020). Underseen and undervalued: The value of unpaid care provided to date during the COVID-19 pandemic.

Carers UK (2022a). Facts & figures [webpage].

Carers UK (2022b). Under Pressure: Caring and the cost of living crisis.

Charlesworth, A. (2021). Years of underinvestment made the UK’s death toll so much higher than it need have been. The Health Foundation

Derbyshire, K., Halsall, D. & Parkin, J. (2021). The value of adult social care in England. Skills for Care

Department for Business, Energy and Industrial Strategy (BEIS) (2021). Carer’s Leave Consultation: Government Response.

Department for Health and Social Care (DHSC). (2021). Adult social care workforce survey: December 2021 report.

Duxberry, K., Rutherford, S. & Alvarez Garcia, D. (2022). Public perceptions of health and social care polling (Wave 1: November to December 2021). Ipsos & The Health Foundation

Hemming, N. (2019). What does the British public think about social care? Nuffield Trust Ipsos MORI (2018). Understanding public attitudes to social care funding reform in England. King’s Fund (2022). The NHS budget and how it has changed.

Knox, A., Summers, J., Seaman, L., Aberdeen, S. & Giles, S. (2021). Attitudes towards and public experiences of the NHS during Covid-19. BritainThinks & Richmond Group of Charities.

NHS Digital (2021). Adult Social Care Activity and Finance Report, England – 2021/21.

NHS Digital (2022). NHS Workforce Statistics – January 2022.

Skills for Care (2021). The state of the adult social care sector and workforce in England.

Social Care Future (SCF) (2021). A vision for the future of social care.

Think Local Act Personal (TLAP) (2018). Making it Real. TLAP (2021). Ladder of co-production.