Written evidence submitted by Mencap [ASC 061]

 

 

About Royal Mencap Society and learning disability

 

  1. We support the 1.5 million people with a learning disability in the UK and their families. We fight to change laws and improve health and care services as well as access to education and employment.

 

  1. A learning disability is caused by the way the brain develops before, during or shortly after birth. It is always lifelong and affects intellectual and social development.

 

How has Covid-19 changed the landscape for long-term funding reform of the adult social care sector?

 

  1. The pandemic has not only shone a light on the current state of the sector, but it has exacerbated long standing financial and demand pressures. It is crucial that the built-up demand for social care as well as the financial impact of the pandemic are considered and accounted for when long-term reforms are brought forward.

 

  1. To provide context of the pressures of the pandemic on the social care sector and the Government’s inadequate response, the Local Government Association (LGA) estimated that adult social care services face additional costs of over £6.6bn in tackling the pandemic[1].

 

  1. While additional funding has been provided by the Government through the social care grant, and other ad hoc funding during the pandemic, this has not been sufficient to address needs. To put this in context;
    1. The £1bn in additional funding in September 2019’s Spending Round was utilised in meeting the increase in the National Living Wage (NLW)[2]. While a welcome boost for care workers it was not enough to make a real difference in increasing care provision.
    2. The £3.2bn provided by the Government to local authorities in the early stages of the pandemic[3] has had a mixed impact on social care provision. The initial £600m for ‘infection control’, and it’s increase by £546m[3] in October 2020 and £341m in March 2021 is another welcome pot of money but as the LGA states it is likely that PPE costs alone could total £4.179bn up to the end of September [4].

 

  1. The report from Social Care Sector COVID-19 Support Taskforce, which we were involved with, outlines a series of useful recommendations[5] for which adequate additional funding should be provided. This includes:
    1. Consideration of funding to cover the costs of PPE included by the social care sector during this financial year. (Recommendation 2)
    2. Commit to provide funding to meet the outcomes of the short-term workforce planning group. (Recommendation 14)
    3. Commit to provide the resources required to meet the outcome of the project to open day centre provision across the country. (Recommendation 45)

 

  1. To understand the experiences of family carers of people with a learning disability during the first lockdown of the pandemic we carried out a survey. From the 1,069 respondents:
    1. 7 in 10 (69%) people with a learning disability had their social care cut or reduced
    2. 4 in 5 (79%) family carers have been forced to take on more unpaid care for their family member
    3. 72% of families are scared of more cuts to social care happening in future[6]

 

  1. And in November, we carried out a further survey to evaluate people’s experience of social care during this lockdown and whether any changes had occurred between the two lockdowns. From the 410 respondents:
    1. Nearly 9 in 10 people with a learning disability has not had all their social care support reinstated.
    2. Almost 3 in 4 of respondents are worried that there more cuts to care packages to come.
    3. Almost 2 in 3 of family members and carers said their loved one’s support needs had increased.
    4. Over 7 in 10 family members and carers said the amount of care and support they provided had increased.
    5. Almost 1 in 2 of family members and carers said the amount of social care support their loved one receives from the local authority has decreased a lot (meaning they receive half or less than half the hours they received before the COVID-19 pandemic).

 

  1. The National Audit Office’s (NAO) recent report on Local Government Finance in the Pandemic 2021[7] concluded that many local authorities will be relying on reserves to balance their 2020-21 year-end budgets and are setting budgets for 2021-22 in which they have limited confidence, having to balance cuts to service budgets and the use of reserves. The NAO priority concerns include:
    1. The Cost of Covid: Local authorities have forecast that COVID-19 will create £6.9 billion of cost pressures in 2020-21
    2. The Funding gap between costs and central funding: Some 30% of authorities will see a gap between their total COVID-19 financial pressures and their additional funding equal to 5% or more of their revenue expenditure in 2019-20
    3. Projected cuts to services: 94% of single tier and county councils and expect to reduce service budgets in 2020/21
    4. Risk of bankruptcy: 9.4% of single tier and county councils are at acute or high-risk of financial failure

 

  1. As we come out of Covid-19 restrictions and the social care easements have lapsed, the Government must provide at a minimum £3.2bn in additional funding to stabilise the social care sector until a long-term settlement can be reached.

 

  1. This will enable local authorities and providers to meet the needs of vulnerable people across the country, many of which have seen their needs increase during the lockdown. We are calling for this as a substantial amount of the announced additional funding will be consumed by the increase in the NMW.

 

  1. It is right that pay is increasing for the social care workforce, and we want to see it go even further. But the Government must provide a level of funding which covers both an increase in workforce wages as well as the funding local authorities require to meet demand for services.

 

  1. Overall, the pandemic has demonstrated that funding reform for the social care sector is a pressing issue which can no longer be delayed.

 

Funding for day services

 

  1. We were disappointed that last year’s Spending Review and the recent Budget failed to bring forward a package of support for day services. These services provide a vital opportunity for people to gain independence and, as is the case with respite provision, to afford family carers a break from their caring responsibilities.

 

  1. Day services are currently receiving support from local authorities however, this short-term plan will finish at the end of March. Additionally, funding is only being provided for the number of places attended. Given that pre-COVID levels of staffing are required but attendance is reduced to meet safety guidelines, this placed services under extreme financial pressure.   The Social Care Winter Plan makes specific mention of the need for local authorities to “work with social care services to re-open safely, in particular, day services or respite services”[8], but this ambition will not be realised unless additional money is provided to support them. The Government must bring forward a financial support package for day services to support them and those they support through this difficult period.

 

Social care funding reforms

 

  1. Mencap is a member of the Care and Support Alliance (CSA) which is an alliance of over 75 of Britain’s leading charities which are calling for:
    1. Immediate funding must be sufficient to stabilise the social care system and ensure it does not collapse in the worst affected areas.
    2. Risk must be pooled on a compulsory whole (adult) population basis, funded through taxation.
    3. Care should be free at the point of use.
    4. There must be an independent, standardised national eligibility threshold and assessment process for social care.
    5. Eligibility should be set at a ‘moderate’ level to enable those in need of community and preventative support to access it; any proposed solution must not tighten eligibility criteria or otherwise reduce access to social care.
    6. Any proposed solution must address the care and support needs of working age sick and disabled adults as well as those of older people
    7. Any proposed solution must ensure increased support for unpaid carers, e.g. increased breaks and core support, including helping carers to juggle work and care and increased Carer’s Allowance and carers’ benefits[9].

 

  1. Finding and implementing a long-term funding solution requires a political decision which we very much hope will be made with a cross-party consensus as this is the only way to put in place a long-term sustainable model.

 

  1. But we do know that significant funding will be required, at least £3.2bn, over the coming year to address the impact of COVID-19 and stabilised the sector until a long-term settlement is brought forward.

 

  1. It is also crucial that any long-term funding solution works for all users of social care, not just older people, especially given that half of all social care spending in England is on working-aged disabled adults.

 

  1. Many working-aged disabled adults, including people with a learning disability, do not have either savings or assets which can be drawn upon by the Government. Therefore, solutions which heavily rely upon housing and other types of wealth and assets cannot be the sole solution to funding and risks splitting any future system into separate older people and working-aged disabled adult streams.

 

How should additional funds for the adult social care sector be raised?

 

  1. As mentioned above we believe adult social care should be funded through general taxation. This method is the fairest option available and will ensure that enough funding is raised to provide social care for all those that require it.

 

  1. Many working-aged disabled adults, including people with a learning disability, do not have either savings or assets which can be drawn upon by the Government. Therefore, solutions which heavily rely upon housing and other types of wealth and assets cannot be the sole solution to funding and risks splitting any future system into separate older people and working-aged disabled adult streams.

 

  1. It is crucial that any long-term funding solution works for all users of social care, not just older people, especially given that half of all social care spending in England is on working-aged disabled adults.

 

How can the adult social care market be stabilised?

 

  1. In the short-term, the Government must provide an urgent injection of funding to stabilise the social care system until a long-term funding settlement is brought forward. This funding should equate to at least £3.2bn to help ensure that local authorities and providers have the means to meet people’s needs, keep them healthy during the new lockdown, reduce social isolation and loneliness and fund the increase in the NLW for the workforce.

 

  1. In addition, we want to see the Government commit to bringing forward a workforce strategy which addresses the key issue of reward.

 

  1. The Covid-19 pandemic has demonstrated what those in social care already knew; that the social care workforce is highly skilled and dedicated to delivering the best care and support. As a service provider, we have seen first-hand the dedication and personal sacrifice of our staff who have put themselves at risk.

 

  1. Despite this, the care workforce is sadly undervalued and underpaid with poor recruitment and retention rates. There are approximately 112,000 vacancies in adult social care[10] and a 42% staff turnover per year. While they have gone above and beyond the call of duty during the pandemic, it is simply not possible for this to continue for a sustained period.

 

  1. Building resilience, both for now and into the future, requires additional immediately targeted resources. While the Government’s focus is rightly on the immediate pressures of COVID-19 in order to properly address the inevitable pressures on the social care system the sector must have a properly recognised, supported and resourced workforce now.

 

  1. This requires a funding package which should include:
    1. Better pay to create a truly sustainable workforce that can meet the needs of all users of social care. There should be parity of esteem between the NHS and social care and a Real Living Wage (RLW) introduced as a minimum
    2. A plan for greater professionalisation of the workforce that can help to attract new people to the sector and retain staff through the opportunity to develop and build a career in social care

 

  1. Beyond providing much needed care and support to those who need it, the social care workforce has a significant economic impact on the UK. The workforce is larger than the NHS and it is estimated that the sector contributes £41.2bn per annum to the economy[11].

 

  1. The large number of vacancies in the sector, estimated to be at 112,000[12] should be seen an opportunity to help tackle the higher rates of unemployment as a result of the pandemic. While the Government have launched a recruitment drive, the sector must have the funding to pay staff a decent wage to both attract staff and as importantly incentivising them to stay in the sector. Providing a RLW as a minimum will go a long way towards helping to achieve this.

 

  1. As a member of the Future Social Care Coalition, Mencap echoes their calls for a People Plan[13], including:
    1. Parity of esteem for the social care sector with the NHS: if social care is to improve and increase health and wellbeing outcomes, the social care service must no longer be treated as the ‘forgotten frontline’
    2. A comprehensive social care workforce strategy designed to generate skills training, professionalism and improve pay and conditions for social care workers
    3. A substantial and immediate funding boost for social care and, in the longer term, a social care funding solution that is both equitable and sustainable

 

How can the adult social care market be incentivised to compete on quality and/or innovation?

 

  1. The ability to compete on quality and innovation is contingent on the freedom and resource to do so. As has been mentioned before, local authorities are currently only able to fulfil their statutory duties and providers are being under-funded for the additional support they have provided as a result of social distancing measures. As such, a key element of this is additional funding to provide the flexibility and resource to pay staff a fair wage, improve the quality of provision and innovate around new solutions.

 

  1. Mencap is concerned that current commissioning approaches reward those offering the cheapest solutions rather than those who provide the best quality solutions. Those with a more expensive tender are then undercut or must make up the additional funding required to deliver their service from their own pockets. This is not sustainable.

 

  1. As such, Mencap would like to see commissioning arrangements change to be based on outcomes rather than on price. This would encourage more innovative approaches as well as driving up quality.

 

 

April 2021


[1] https://www.local.gov.uk/lga-social-care-providers-face-more-ps6bn-extra-covid-19-costs

[2] https://www.gov.uk/government/publications/spending-round-2019-document/spending-round-2019

[3] https://www.gov.uk/government/news/more-than-500-million-for-social-care-to-reduce-coronavirus-transmission-over-winter

[4] https://www.local.gov.uk/sites/default/files/documents/COVID-19%20Financial%20pressures%20in%20adult%20social%20care.pdf

[5] https://www.gov.uk/government/publications/social-care-sector-covid-19-support-taskforce-report-on-first-phase-of-covid-19-pandemic/social-care-sector-covid-19-support-taskforce-final-report-advice-and-recommendations#adult-social-care-action-plan

[6] https://www.mencap.org.uk/get-involved/campaign-mencap/socialcarecrisis

[7] https://www.nao.org.uk/report/local-government-finance-in-the-pandemic/?slide=1

[8] https://www.gov.uk/government/publications/adult-social-care-coronavirus-covid-19-winter-plan-2020-to-2021/adult-social-care-our-covid-19-winter-plan-2020-to-2021

[9] https://careandsupportalliance.com/about-us/

[10] https://www.skillsforcare.org.uk/About/News/News-Archive/Social-care-needs-to-fill-more-than-100000

[11] https://www.skillsforcare.org.uk/adult-social-care-workforce-data/Workforce-intelligence/documents/State-of-the-adult-social-care-sector/The-state-of-the-adult-social-care-sector-and-workforce-2020.pdf

[12] https://www.skillsforcare.org.uk/About/News/News-Archive/Social-care-needs-to-fill-more-than-100000-vacancies.aspx

  1. [13] https://futuresocialcarecoalition.org/