Written evidence submitted by Nottinghamshire County Council [ASC 064]

The Committee is inviting submissions primarily focusing on the following points:

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

Has changed patterns of social care need and demand, and it is unclear as to the duration of these impacts. In summary, these changes are:

• Decreased demand from older adults for support due to excess deaths through Covid-19
• Decreased the confidence in care of older adults and especially care homes. The ongoing restrictions on peoples lives in care homes has had a negative impact on their reputation as a good place to live
• Increased supply of both residential and nursing care but threatened the stability of the supply and reduced choice through the unplanned closure of some homes.
• Decreased the availability of independent housing through social housing pathways
• Increased the cost of community packages as health and mobility impacted by Covid-19
• Increased the cost of care both at home and in placements – staffing, insurance, infection control

Covid-19 has demonstrated the ability of services to use new models , such as digital and technological solutions for access or service delivery. The inequality of digital has also been emphasized with patterns of access showing disadvantage of age, deprivation, and disability.

The emergency funding has proven useful to cover crisis cost but had added strain to NHS and Social Care interface. The relationship between the two has been drawn into focus, but funding mechanisms are not flexible to enable any shift to hospital care in either mental health or physical health. Fragility of social care is driven by NHS behavior and Covid-19 has given more examples. For example, the excess deaths created by discharge to care homes from hospital in March 2020.

Social Care is also funded directly by people as self-funders, or indirectly to Councils through an assessed contribution. For some this will include contribution of their benefits, therefore DWP funding. Covid-19 has impacted on wealth disproportionately and in areas of deprivation which links to use of social care. The impact of these factors is not yet well understood, but personal finances have been affected.

Not all Councils now feel confident to take the precept given the significant impact of Covid-19 on people’s lives.

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

Mapping of existing funding and cross government funding flows – precept, council taxation, DWP and benefits impact on social care contributions/self-funding, state pension, NHS funding through BCF and discharge monies, grants, Public health grant for social exclusion, MHCLG and housing funding. All of these elements contribute to the social care services people access.

Options include use of NHS budgets and capping of NHS spend in certain areas of tariff, pooling of government funding into one stream, national taxation, insurance scheme.

      How can the adult social care market be stabilised?

The market we have is unlikely one we would design. In reality, the will of providers dictates the range of service available unless a local authority directly provides. Self-funders are mini-commissioners, so unless self-funding ceases, it is unlikely full market control would be achieved. Full market control is unlikely a desirable goal.

Reform should include the reshaping of services and a move towards a different model of care that individual politics of councils currently prevents, given the weight if support for traditional models of care from a number of stakeholders.

If the current model of care is maintained, the following actions would help stabilize the market:

• NHS role in prescribing care on discharge and influencing providers to cease
• Fee increases so providers are supported by realistic funding that creates a multi-dimensional and trained workforce
• Fees that have a realistic understanding of return on capital, staffing costs and hotel costs
• National strategic approaches rather than local piecemeal initiatives
• Funding/Wages need to reflect the valued work they do.
• Shift in funding from Hospital/Residential to Community.
• More resources back in the community in primary care and primary care services to have a clearer role in supporting people at home

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

Outcomes based commissioning has proven challenging to balance limited Local Authority budgets with paying a fair price for care. However, this should be the way services are paid for, including incentives for quality, improving quality of life and outcomes defined by people themselves.

This would be supported by improvements to support planning in social work teams and a focus back on self-directed support.

Fees could include payment for organizational structure as well as cost of care (not currently affordable) to include payment for:

• Deliver as trusted partners – take on care act tasks
• Engagement with academic partners and providers involved in social care research
• Workforce development and qualification

April 2021