ASSOCIATION OF DIRECTORS OF ADULT SOCIAL SERVICES (ADASS) – WRITTEN EVIDENCE (PSR0089)

Introduction

1. The Association of Directors of Adult Social Services (ADASS) welcomes the opportunity to submit evidence to House of Lords Public Services Committee.

2. Adult social care provides care, support, and safeguards for those people in our communities who have the highest level of need and for their carers. Social care has value in its own right in transforming lives. It is about much more than just washing, dressing and helping people to eat, or simply a service that exists to support the NHS. Adult social care also protects people’s interests and rights in vulnerable situations, such as where people are being abused or neglected or where they lack the capacity to make decisions for themselves.

3. There is trauma and grief at the very large number of people who have died in so short a space of time, not just of Covid-19, but of all of the other causes that have featured in excess deaths during the pandemic. It has disproportionately hit those of us who are in the most vulnerable circumstances: older people at the end of our lives, particularly in care homes, and people with learning disabilities. Concerningly, it has affected black and minority ethnic people and poorer communities that already experience ingrained inequalities.  And it has hit hard the incredibly courageous, largely female, low paid but skilled and committed care staff, who have died at higher rates than the rest of the population. They have nonetheless continued to provide care at huge risk to their lives and to their families.

4. In addition to those who have died or had the disease, there has been an impact on millions of others; those of us who have advice, care and support needs ourselves, care for a family member who does, or provide care as care professionals.  Around 4.5 million people are new to caring.[1] This population is different – younger and much more likely to be working age.  Many more are juggling work and care.  If you reach the tipping point where there is a crisis and insufficient care, you start pulling unpaid carers from the working population which will impact on the economy. This impacts more on women.

5. These are real lives, real experiences and real pressures.  People whose lives have been profoundly affected and changed by Covid-19.  The millions who have been locked down and shielded, who have faced disruption of routines, who have been impacted by increased domestic abuse and mental ill health, who have had to care for themselves and family, and who have lost their usual contact with others. Ultimately thousands have lost their lives prematurely in social care and were not sufficiently considered as part of wider health and community systems. And normality has not yet returned.

6. This response sets out for the committee the context in which adult social care entered the Coronavirus Pandemic, the impact of Covid-19 on the sector, and concludes with a statement of our key ‘asks’ of government.

Pre-Covid-19

7.                                                                                                        Prior to the pandemic, adult social care already faced significant and ongoing challenges. These included, but are not limited to, the following:

-       The use of short-term and time-limited funding settlements to support adult social care budgets, including the Improved Better Care Fund (iBCF);

-       Fragile care markets;

-       Increasing demographic pressures.

-       Increasing levels of unmet and under met need;

-       Insufficient resources to invest in early intervention and prevention in a meaningful way;

-       Recruitment and retention of the workforce.

-       Inability to invest in prevention due to funding constraints

8. Results from the ADASS Budget Survey 2020 clearly show that care markets were in an unhealthy position. In the past six months 43% of local authorities reported that providers in their area had closed, ceased trading or handed back local authority contracts. This resulted in 3,198 people accessing home care being affected and 1,178 people in residential and nursing care.

9. Adult social care has, and continues, to face significant workforce challenges. The sector has high vacancy rates of 122,000 FTE, (or 7.8% in 2018, up from 110,000 2017) and turnover (440,000 leavers in the last twelve months)[2], this results in recurring recruitment and training costs. Adult social care has the highest turnover of any sector at 30.8%.[3] The impact of Covid-19 and the recruitment drive running during this period have yet to be quantified.

10. In the past few years adult social care, and local authorities as a whole, has been reliant upon significant amounts of temporary funding to deliver balanced budgets year on year, which is a legal requirement. In the current financial year alone, adult social care in reliant upon £3.487bn of temporary funding, of which to-date there is only clarity that £1bn per year of this total will continue for the remainder of this Parliament.

11. Prevention activity to increase independence and limit the need for more expensive ongoing care and support is core to national policy and is intrinsic to the Care Act 2014. However, spend on prevention by adult social care has remained at around 8% of net adult social care budgets for the past 3 years.[4] This is a result of local authorities being  trapped in a vicious cycle of having insufficient funds to be confident they can meet all their statutory obligations, whilst being unable to release funding to invest in approaches that might reduce the number of people with higher levels of need in the future. This approach would also support the NHS in reducing the number of people entering acute care.

Since the onset of Covid-19

12. The onset of the Covid-19 has shone a light on and magnified the challenges facing those of us who need or work in adult social care. ADASS has been at the heart of the adult social care response during the pandemic, and across the country Directors of Adult Social Services (DASSs) and their teams have worked with local partners, and national bodies to meet needs and protect the interests of people needing support, many of the most vulnerable in our society. 

13.                                                                                                   The initial pandemic response made protection of the NHS a priority.  This was understandable as there was uncertainty about incidence and the likely hospital capacity that would be required.  However, this priority had a detrimental impact in adult social care.  In the early response people were discharged from hospital as quickly as possible, often without testing, and the spread of the pandemic, particularly among those who were asymptomatic, compounded by lack of community testing and lack of PPE, all contributed to the well documented high rate of deaths in care homes. 

14.                                                                                                   It is the view of ADASS that social care should have been given, and should now, and in future, be given equal priority to the NHS - we need genuine parity of esteem uniting the NHS and social care and a recognition from Government that social care plays a huge societal role that goes well beyond supporting hospital discharge. For too long social care has been seen through the lens of the NHS and the Government’s Recovery Plan published on 11 May 2020 repeats the mistake of referencing social care principally in relation to its role in maintaining capacity in the NHS. This disparity is further highlighted by the fact that a letter was sent from Sir Simon Stevens on 17th March 2020 to all parts of the NHS setting out the next steps on NHS response to Covid-19, this included the intention to undertake the rapid discharge of all inpatients who are medically fit to leave. An Adult Social Care Plan was published on 16th April, almost one month later.

15.                                                                                                   Inevitably the focus has been on care homes, and we share the Government’s ambition to build support to maintain resilience in the care home sector. However, the role of domiciliary care, direct payments and personal budgets and the opportunity to support people to remain connected and active in their communities are essential aspects of what social care has to offer. While the focus has been rightly on care homes, councils support far more people outside care homes and we need a wider recognition of the sector’s role (and the risks) in supporting older people and people with disabilities as well as unpaid carers among others. Successive ADASS Budget Surveys have shown that the majority of spend in adult social care budgets now relates to advice, support and care for working age disabled people.  It is important that as we plan the future shape of care and support, that we recognise and address this. 

16.                                                                                                   The additional financial and demand pressures faced by local authorities as a consequence of the pandemic has led to a significant change in the Directors’ confidence in meeting their statutory duties relating to adult social care. For the current financial year (2020/21) only 4% of Directors are fully confident that their budget will be sufficient to meet their statutory duties; this compares to 35% in 2019/20.[5] These statutory duties include ensuring that people have access to relevant information and advice, assessments, personal budgets, care, support, safeguarding and deprivation of liberty safeguards/liberty protection safeguards. The ability of local authorities to be able to deliver these will directly impact upon the ability of individuals and their carers in terms of staying alive and living the lives they want to lead.

17.                                                                                                   In June, ADASS published its annual budget survey. The first part focused specifically on the response by ADASS members to the Covid-19 pandemic.[6]  The key findings included:

• Nearly a quarter of Directors (23%) felt that there has been an increase of 1-5% in unmet need and 11% indicated that there has been an increase of 6-10% since the onset of the pandemic. There were concerns that a proportion of councils had seen a reduction in safeguarding referrals and that people were experiencing abuse and neglect behind closed doors.
• There is a concerning proportion of Directors who believe that there are insufficient primary and community services in their local areas. 15% expressed concerns about sufficient support for ‘Discharge to Assess’, 17% for reablement and rehabilitation, and approximately a third, or more, of Directors highlighted concerns around the availability of enhanced health in care homes, mental health or substance misuse support services.

18.                                                                                                   The second part the survey focussed on the position of adult social care budgets prior to the pandemic and the impact that the Covid-19 response has had subsequently.[7] The key findings included:

• Directors have also estimated that they face a loss in client income of at least £190m for 2020/21.
• Demographic cost pressures, the level of additional funding required to meet the same level of needs compared to the previous year, increased from £484m in 2019/20 to £520m in 2020/21. An increasing proportion of demographic funding (64%) is now focused on services for working age adults, something that national conversations around funding and testing relating to Covid-19 have not reflected.

19.                                                                                                   The full costs of the pandemic to adult social care, both local authorities and providers, is not yet fully quantifiable. However, ADASS and the Local Government Association, working with the Care Providers Alliance, commissioned industry experts LaingBuisson to estimate the additional financial pressures on independent adult social care providers due to COVID-19.[8] This analysis covered all independent providers supporting both younger adults and older people whether in care homes, or supported living or receiving home care.

20.                                                                                                   This analysis found that the adult social care sector faces a £6.6bn funding pressure as a result of Covid-19 until the end of September 2020. This means that the sector, both local authorities and providers, will be left with a significant funding shortfall for the current financial year without further Government intervention. To-date adult social care has had access to just over £2bn of funding through the Emergency Covid-19 Fund and Infection Control Grant (£1.410bn and £600m).[9]

21.                                                                                                   The period since the turn of the decade has been characterised by austerity and the focus on reducing the national deficit. This has led to local government seeing a significant reduction in their resources in real-terms of this period. All the while demand for adult social care services has continued to increase, alongside the complexity of people’s needs and the costs of delivering services.

22.                                                                                                   When planning for any future waves of Covid-19, or pandemics, we must change our approach. We have to think of hospitals, community health services, social care, family carers, housing and communities as one wide set of supports that help us to live the lives we want to lead, as well as keep us alive. Adult social care is at the heart of our social infrastructure.

Our key ‘asks’ of government

23. ADASS has repeatedly warned government that funding reductions to adult social care would lead to fewer people getting care, provider failure, and would impact on the NHS. It is equally the case that much needed investment in prevention, digital technology and wellbeing services is being hindered by ongoing reductions to adult social care and wider council services.  It is clear that adult social care was rendered ill-equipped and under-resourced to deal with the Covid-19 pandemic by the failure of successive governments of all political colours to recognise and understand how essential social care is to the nation. Adult social care has relied upon the skill and compassion of those people that work within the sector to ensure that those people who need care and support could continue access it throughout this period.

24. Without immediate investment in the sector, whose value has been seen by the nation during the pandemic to-date, the consequences will be catastrophic. The likelihood of more providers failing, more essential care staff being lost and that the NHS being not able to successfully navigate the next winter, will be significantly increased – without mentioning the prospect of further turbulence if there is a no-deal EU Exit. Most importantly, the cost of the pandemic will be borne out most by those of us who are older and disabled, or who are caring for family members.

25. We hope, out of adversity, that there might finally be some long overdue recognition and action. This is why we have made the following recommendations to Government:

1. A two-year ringfenced funding settlement for adult social care to cover the additional costs of Covid-19 and to allow reform to be agreed, planned and implemented.
2. A new employment deal with our care staff, including a workforce strategy, adult social care minimum wage, enhanced training, development and career progression, recognition and regulation.
3. Reform of the care provider market based on sustainable new business models, economic growth, and commitment to improved quality – supported through regulation, a national market statement and local economic plans. The future shape of care and support will look very different, with a likely shift towards a greater emphasis on care and support in people’s homes and communities.
4. A consultation programme over the next two years that is cross-government, includes extensive public and cross-party engagement, that works nationally, regionally and locally to build the care and support that people want now and over the next 10 – 20 years.

About Us

The Association of Directors of Adult Social Services 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

Our members are current and former directors of adult care or social services and their senior staff, including principal social workers.

June 2020