LGA response to "People at the heart of care: adult social care reform white paper"

This briefing sets out the LGA's response to different parts of the Government's adult social care white paper chapter by chapter. While we fully support and endorse the positive framing of social care in the white paper, we question whether the funding set out matches the Government’s level of ambition.


Background

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The Government published its adult social care system reform white paper, ‘People at the heart of care’ on 1 December. The white paper sets out a 10-year vision for care and support in England and is based around three key objectives:

  • People have choice, control and support to live independent lives
  • People can access outstanding quality and tailored care and support
  • People find adult social care fair and accessible

The white paper follows the September 2021 publication of ‘Build back better: our plan for health and social care’ (the ‘Plan’), which set out a range of measures, including reforming the way adult social care is paid for and funded. The key elements of the plan’s social care proposals included: a cap on care costs and more generous financial means test thresholds; the ability for self-funders to ask their council to arrange their care; and moving towards a fair rate of care in respect of councils’ fees to providers. The plan announced the creation of a new Health and Social Care Levy to fund the changes. Our briefing on the plan is available here.

The white paper also follows the October Spending Review. This announced new government grant funding of £1.6 billion per year for councils over the next three years but did not provide additional funding to address existing pressures facing adult social care. Our response to the Spending Review is available here.

Headline response to the white paper

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  • We fully support and endorse the positive framing of social care, which mirrors much of the language we have used in recent years to describe the importance and value of care and support.
  • The Government’s ambition for social care, as defined through the various statements about what people can expect from social care and what the sector will do to achieve this, is helpful. It reflects what the LGA and many others have articulated in terms of what social care needs to be in order for people to live their best life and an equal life.
  • The recognition of existing good practice is welcome as is the importance of taking forward reforms from the foundation of the Care Act, which remains a well-supported piece of legislation. The focuses on the workforce, prevention, unpaid carers, innovation and the links between care and housing are also helpful.
  • However, councils will be unable to play their part in delivering the Government’s ambitions if the central issue of funding is not tackled. The table below sets out the main issues that need to be addressed.
      2020/21 2024/25
    Fair price of care (including the cost of self-funders accessing care at the council-commissioned rate) Minimum of £1.5bn for all councils to hit benchmark rates Minimum of £1.8bn for all councils to hit benchmark rates
    Adult social care pay – parity with comparable roles in the NHS Estimates of £1bn (LGA) - £1.8bn (Health Foundation) Estimates of £1bn (LGA) - £1.8bn (Health Foundation)

    Provide care for all older people that need it (based on estimates of unmet need amongst older people by Age UK)1

    £3.2bn £4bn
    Provide care for all people of working age who need it (estimates based on broad assumptions set out below)2 £1.6bn £1.9bn
    TOTAL £7.3bn - £8.1bn

    £8.7bn - £9.5bn

1 Our estimate of the cost uses 2018 Age UK figures as a starting point. We take their figure of 164,217 – the number of older people who receive no support with three or more essential daily activities – and assume support for those people based on the profile of existing support for older people in terms of home care and residential care. We then apply 2018/19 unit costs: for home care we cost 1 hour per day; for residential we cost a year of residential care. 2020/21 and 2024/25 figures uprate the result by demographic/inflation factors. This was last performed in early 2020.
We apply the same method used for estimating the cost of meeting unmet need amongst older people. However, as we do not have a starting number (equivalent to the Age UK figure of 164,217) we link to the number of working age adults currently receiving services. The number of working age adults supported is roughly 40 per cent of the number of older people supported so we apply that percentage to the Age UK figure and apply working age adult unit costs for home and residential care.
  • The figures above do not include core pressures. In our Spending Review submission, we estimated that councils face future demographic and inflationary base annual pressures of £1.1 billion. We estimate that the Spending Review measures will enable these pressures to be met this year but will be insufficient to cover the pressures in full in 2023/24 and 2024/25.
  • We are not convinced that the £5.4 billion allocated for social care through the new Health and Social Care Levy is sufficient to fund the charging reforms set out in the September 2021 Plan. We are also concerned by recent reports that £5 billion of the revenue raised by the Levy may need to be used to fund a permanent Covid booster vaccine programme. While we of course recognise and support the need for vaccination funding (including ongoing funding as necessary), this must not come at the expense of adult social care reforms and we seek assurances from Government on this point.
  • We question whether the funding set out in the white paper for its associated reforms adequately matches the Government’s stated level of ambition. For example, throughout the white paper there is helpful recognition of the crucial role played by unpaid carers and a clear commitment to empower them and provide them with better support. However, the only dedicated funding aligned to this priority is £25 million to kickstart a change in the services provided to support unpaid carers. This is not a significant investment, particularly when set against the estimated value of care provided by unpaid carers since the start of the pandemic (£111 billion).  
  • Through our work on our own green paper for social care and wellbeing in 2018, we called on government to make the case for increases in national taxation to raise additional funding for adult social care. Through the new Health and Social Care Levy, Government has done this, but the clear majority of the funding raised in the first three years has been allocated to the NHS. We therefore call on the Government to immediately redirect a significantly greater share of the Levy to frontline adult social care.

Chapter 1: who cares?

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What the white paper says

The white paper recognises that social care is “at the heart of our communities” and “matters to everybody”. It sets out the scale of social care, is clear that it is about adults of all ages, notes the range of activities and settings underpinning social care and recognises that the care workforce is “our biggest asset”. It also recognises the “crucial contribution” of unpaid carers.

LGA view

We fully support and endorse the positive framing of social care at the start of the white paper. This sets a helpful tone and is something the LGA has sought to embed in all of our work on social care in recent years, particularly since our 2018 green paper, ‘The lives we want to lead’. If we are to build greater public support for investment and change, it is essential that we frame social care as being about all of us and a means to the end of enabling people to live an equal life, rather than an end in itself.

Chapter 2: our 10-year vision for adult social care

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What the white paper says

The white paper unpacks the three key objectives at the heart of the Government’s 10-year vision for adult social care.

  • People have choice, control and support to live independent lives
  • People can access outstanding quality and tailored care and support
  • People find adult social care fair and accessible

The white paper expands on these objectives by considering what they mean from the perspectives of people who draw on social care, the care workforce and the range of organisations involved in care and support, including government, councils, providers and the wider sector.

LGA view

The Government’s ambition for social care, as defined through the various statements about what people can expect from social care and what the sector will do to achieve this, is helpful. It reflects what the LGA and many others have articulated in terms of what social care needs to be in order for people to live their best life and an equal life.

However, this is not a particularly new definition of ambition. White and green papers published by governments of different colours over more than twenty years have set out similar ambitions framed around the promotion of, for example, people’s independence, high quality and personalised services, and the primacy of the person over the system. This is not necessarily a problem; indeed, similar core aspirations over time demonstrate a potentially helpful degree of unanimity on what is needed for the future. What is more problematic is the extent to which there is clear recognition and understanding of why previous similar ambitions and visions have not been fully realised.

This understanding is notable by its absence in the white paper and gives rise to two primary concerns. First, while some of the initiatives are to be welcomed (explored further below), the funding allocated for them is relatively modest, resulting in a mismatch between ambition and deliverability.

Second, and to the point of why previous visions have not been realised, social care’s significant immediate pressures remain unaddressed. Mirroring previous moments of change, this white paper, the Spending Review, and the Build Back Better Plan have done very little to deal with the here and now challenges. Funding to stabilise core services, tackle unmet need, stabilise the provider market and address care worker pay remains absent.

Without this, the white paper is attempting to build a better future from inadequate foundations. Councils will be unable to play their part in delivering the Government’s ambitions if immediate funding shortfalls are not tackled. The scale of the shortfall cannot be overstated; we estimate in the region of £7.3 billion – £8.1 billion is needed now to secure stronger foundations, rising to £8.7 billion - £ 9.5 billion by 2024/25. This includes:

    • £1 – £2 billion to address care worker pay and move towards greater parity with the NHS for comparable roles
    • Nearly £5 billion now to address unmet need, rising to nearly £6 billion in 2024/25
    • £1.5 billion now for councils to pay providers a ‘fair rate of care’, rising to £1.8 billion in 2024/25.

These amounts exclude future demographic and inflationary pressures. We assume that the core spending power increase and council tax flexibilities set out in the Spending Review will fund these annual base pressures, which we estimated at £1.1 billion in our Spending Review submission. We estimate that the Spending Review measures will enable these pressures to be met this year but will be insufficient to cover the pressures in full in 2023/24 and 2024/25.

We therefore call on the Government to immediately redirect a significantly greater share of the new Health and Social Care Levy to frontline adult social care.

Chapter 3: strong foundations to build on

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What the white paper says

The white paper acknowledges that there is “an abundance of good practice, aspiration, and legislation that provides strong foundations for our 10-year vision”. Specific reference is made to the Care Act and its importance as a foundation for reforms, whilst recognising that “the full spirit of the Care Act is not currently being met”. The white paper states that the current Health and Social Care Bill, and the reforms in the white paper itself, will “seek to rectify this”.

The remainder of this chapter sets out a number of key challenges facing the sector and where improvements need to be made. The areas identified are set out below and are introduced ahead of fuller treatment in the remainder of the white paper:

  • Shaping healthy and diverse social care markets: here the white paper identifies the need to address variability in culture and leadership which impacts choice, low fee rates and self-funder cross-subsidisation of care, insufficient encouragement of new innovative, community-based organisations that can give people greater choice, independence and wellbeing. [See chapter 7.]
  • Variation in quality and safety of care: the white paper references the 14.3 per cent of providers rated ‘requires improvement’ by the Care Quality Commission (CQC) and the 1.4 per cent rated ‘inadequate’. Geographic variation is also raised. Action on the care workforce and local authority assurance are highlighted as two particular areas of action that will improve quality. [See chapters 6 and 7.]
  • Supporting our adult social care workforce: the white paper cites staff turnover, vacancy rates, workforce mental health and burnout, and training and career structures as issues that need to be addressed to better support the workforce. [See chapter 6.]
  • Navigating the system and finding the right care and support: this issue is introduced in terms of people’s difficulty in understanding their entitlements, how to access care, overwhelming and poorly tailored information and advice, and a lack of public understanding of how social care operates. [See chapter 5.]
  • Accelerating adoption of technology: the white paper acknowledges the use of digital technologies in transforming the delivery of care during the pandemic but notes that COVID-19 has also “laid bare inequalities in access” to such technologies. [See chapter 4.]
  • Expanding the choice of housing options: the white paper sets out its intention to “support local communities to build the partnerships and plans to embed housing as part of the local care and health system” and both increase the availability of specialised housing and adaptations to people’s own homes. [See chapter 4.]
  • Driving integration of health and care services: the white paper notes the problems associated with a lack of effective join up between social care and health and points towards the upcoming integration white paper for addressing these through new proposals.

LGA view

The recognition of existing good practice is welcome. There are excellent examples of councils across the country working with people who draw on care, and their partners from the provider and voluntary and community sectors, to develop care and support services that are preventative, improve people’s wellbeing and support their independence.

Sharing this learning and thinking about how best to replicate it more widely is essential work. We also welcome the Care Act being seen as the foundation for future reforms as this remains a solid and ambitious piece of legislation which, if fully realised, would improve the experience of, and outcomes for, people who have cause to draw on social care.

However, and as set out above, unless significant new funding is made available for core services and tackling key issues such as care worker pay and unmet need, we question whether the white paper reforms will make sufficient progress. Indeed, as the Secretary of State notes in the foreword to the white paper, this is a “social care reform journey” and “The proposals outlined will not solve all of the problems, but they are a significant step in moving us towards a new vision for social care that the whole of government is committed to.”

It is welcome to read that the whole of government supports social care reform, but unless the Treasury injects new funding into social care, it is highly likely that the journey will take considerably longer to complete and be further beset by barriers that impede progress. The more concerning prospect is the potential possible likelihood that the vision will not be fulfilled at all and may in fact move us backwards as proposals and initiatives that raise expectation go unrealised due to a lack of funding for both their delivery and the core services that support them.

Our views on the specific issues above are set out in full in the corresponding chapters below.

Chapter 4: providing the right care, in the right place at the right time

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Summary of main proposals

  • £300 million over the next 3 years to embed the strategic commitment in all local places to connect housing with health and care and drive the stock of new supported housing.
  • At least £150 million of additional funding over the next three years to drive digitisation across the sector; and unlock the potential of caretech innovation that enables preventative care and independent living.
  • Launch a £30 million Innovative Models of Care Programme to support local systems to build the culture and capability to embed into the mainstream innovative models of care. This will work for a changing population with more options for people that suit their needs and circumstances.
  •  Fund a new service to make minor repairs and changes in peoples’ homes, to help people remain independent and safe. This will happen alongside increasing the upper limit of the Disabled Facilities Grant (DFG). • Continue to invest in the Care and Support Specialised Housing (CASSH) fund with £210 million available for the period 2022–23 to 2024–25.

Making every decision about care a decision about housing

What the white paper says

Invest at least £300 million over the next 3 years to embed the strategic commitment in all local places to connect housing with health and care and drive the stock of new supported housing.

LGA view

It is positive that the Government has confirmed new funding over 3 years to enable local partners to work together to boost the supply of supported housing that is appropriate to people’s needs. For people in vulnerable circumstances, a safe home with personalised support to address practical and care needs, can help people to regain their independence. The additional funding will help some places to address the shortage of older people’s extra care housing, which will improve older people’s housing choices and outcomes. Supported housing also helps to reduce demand on social care and health services by supporting greater levels of independence in the community, preventing admissions to residential care and hospital and aiding discharges.

We look forward to working with Government on the detail of the funding and links to wider reform agendas around planning and welfare. We caution against a competitive bidding process which can divert valuable resources towards an application process. We encourage the Government to adopt a flexible and locally-led approach to the funding that seeks to build upon and strengthen existing local strategic plans, partnerships and practice. It should also enable places to address local people’s housing and support needs and aspirations, and robustly evidence the ability of supported housing to achieve better outcomes for individuals, communities and the economy.

Whilst 3-year funding is a step forward and sends a strong signal to supported housing providers and developers, investing in supported housing is a long-term decision that requires sufficient and stable revenue funding. Therefore, we would like to see a strong emphasis on mainstreaming practice, capturing and sharing learning widely, and building the evidence base that will allow this welcome funding to be built upon and extended in the longer-term. 

We support the emphasis on the importance of integrating local housing into local heath and care strategies and the critical role that Integrated Care Partnerships will play. The LGA has emphasised the need for Integrated Care Systems to build upon existing place-based structures for driving integration. In particular, health and wellbeing boards, which are increasingly embedding housing in their shared evidence base, vision and priorities to improve population health and wellbeing outcomes.

What the white paper says

Commit a further £570 million per year (2022–23 to 2024–25) to provide funding to local areas to deliver the Disabled Facilities Grant (DFG). The Government is also committed to a public consultation in 2022 that will look at options for:

  • increasing the amount that the grant can pay for an individual adaptation
  • the way DFG is allocated to local authorities
  • aligning the means test with the charging reforms.

LGA view

It is positive that the white paper locks in recent increases in DFG for another 3 years. Whilst there is an undersupply of fully accessible homes, with just seven per cent of the stock meeting the four ‘visitable’ criteria, 72 per cent could be adapted. Timely home adaptations support older people and disabled adults and children, their families and carers to manage wellbeing in the home, extending safe and independent living. However, given the increasing number of older people and working age adults, we remain concerned that it will not be sufficient to meet increasing demand for DFG.

We are encouraged that there will be a further consultation in early 2022 about additional steps to ensure the grant can reach more people who will benefit from it. We look forward to contributing and encourage the Government to pay particular attention to making it easier for the increasing number of people living in the private sector to access adaptation grants.

We are pleased that the white paper highlights the need to do more to ensure that new builds are designed to be more accessible in the first place and notes that the Government will publish its response to a DLUHC consultation on the accessibility of new homes in due course. The LGA supports raising the minimum accessibility for new housing. It is essential that accessible and adaptable housing for everyone is a key part of our national ambition to build new homes.

What the white paper says

Fund a new service to make minor repairs and changes in peoples’ homes, to help people remain independent and safe. This will happen alongside increasing the upper limit of the DFG.

LGA view

We support the white paper’s emphasis on making minor repairs and changes to people’s homes to help them stay safe and independent and reduce demand for more substantial adaptations through DFG. Due to funding pressures, many councils have had to stop or reduce funding for home improvement agencies and similar arrangements, which are usually commissioned from the voluntary and community sector.

There is no detail yet about how much funding will be allocated to the new repair service or what service will look like. It is important this is new funding and is in addition to the funding streams announced in the white paper. We are ready to work with the Government and other partners to shape this important commitment, which should be locally-led and through the council connected to local DFG plans and the wider Better Care Fund outcomes.

As part of developing plans for the new service, consideration should be given to how people can access timely, high-quality and impartial advice about minor repairs and changes to their home. It will also be important to consider how people can access the new support, recognising that finance is often a barrier.

What the white paper says

Continue to invest in the Care and Support Specialised Housing (CASSH) fund with £210 million available for the period 2022–23 to 2024–25.

LGA view

We are pleased the Government has listened to our call to continue capital funding for affordable specialist supported housing through the Care and Support Specialised Housing fund. The funding announced in the white paper is broadly in line with previous years and will go some way to providing investors with the certainty they need to bring forward much-need supply. We welcome the commitment to undertake further work to understand the barriers to accessing capital grants in order to increase the supply of supported housing.

However, given the increasing number of older people and working age adults with disabilities or mental health problems and in particular the ambitions of the Building the Right Support Programme for people with learning disabilities and autism, we remain concerned that the continuation of current funding levels will not be sufficient to meet demand for this type of housing in all parts of the country. In addition to capital funding, sufficient and stable revenue is also needed to fund the support that enables people to live independently in specialist housing.

Using the full potential of technology to support people’s lives and aspirations

What the white paper says

Invest at least £150 million of additional funding over the next three years to drive digitisation across the sector; and unlock the potential of caretech innovation that enables preventative care and independent living.

LGA view

We strongly support the specific mention of funding for technology and digitisation and are glad that the government has provided earmarked funding for digital technology as a key enabler to achieve better outcomes for people. There is a significant amount of investment that is required so whilst £150 million across three years is an excellent promise for additional funding, this funding will not in itself be able to resolve the under-investment in digital technology within adult social care over the last decade.

What the white paper says

“I can live in my own home, with the necessary adaptations, technology, and personal support as designed by me, to enable me to be as independent as possible”

LGA view

We support the inclusion of technology alongside the right housing choice as key enablers for people to live the lives that they wish and to enable people to live as independently as possible. Digital technology has an essential role in enabling a wider range of choice and control for people on the lives they lead, where they live and the care and support they utilise. The vital importance of digital technology for people as demonstrated in the quoted 2021 SCIE survey illustrates how much technology is now a priority for people. Intertwining digital technology, adaptations and housing as core elements of social care is essential and we are glad to see this approach being taken by government.

What the white paper says

Building a system that can develop and adopt new ways of providing care and support to people at scale.

LGA view

Local government is often at the heart of innovation for their local communities and a number of good practice examples can be found across English councils. However, to enable innovation, councils must be provided with the right resources, infrastructure and freedoms to allow them to test out new ways of working based on the needs of their local populations.

Supportive but not restrictive national policies are needed to enable councils to work with partners to test new ideas. Top-down imposed innovation or solutions do not work for different local communities and populations and must not be seen as a solution. Standards and guidance can be more useful rather than trying to implement a one sized solution and allow for local areas to co-produce local solutions with local people.

What the white paper says

Although DFG grants can already be used to fund these technologies, we want to raise awareness among people, their families and those providing care of how assistive technology can support people to live independently. More information on this will be shared in the forthcoming DFG guidance and via other web resources.

LGA view

Many of the care technologies are easy to use for both the people living in their home and the people who may be supporting them. They can greatly improve mental and physical wellbeing and health, help to prevent falls or detect early deterioration making them an ideal investment. The encouragement to use DFG grants to fund care technology as well as traditional physical adaptations is welcome as the care technology solutions particularly around smart sensors and remote monitoring technology may require considerable upfront investment for some individuals which can make some of these technologies less accessible to some people.

The use of the DFG grants to fund care technology is not a new solution but as highlighted the awareness and update around this is limited. The forthcoming DFG guidance will be essential in providing detail on how this will work and we would remind government that providing the detailed guidance as soon as possible is essential to allow councils to plan and respond to any changes.

What the white paper says

With this funding, to support people to live independently in their own homes for longer we will launch a new scheme to test ideas, scale those where there is proven benefit, and build the case for change. With local authorities, the voluntary and community sector, people who draw on care and support and their care networks, we will produce a shared roadmap of priorities. This will build on best practice across the country, including the Social Care Digital Innovation Programme delivered by the Local Government Association

LGA view

We are extremely pleased that the positive work undertaken by the LGA in partnership with NHS Digital has been seen as best practice to build upon. This work over a four-year period demonstrated the ability for digital innovation within councils and was a great way for local areas to test ideas and solutions. The SCDIP programme also had a strong focus on service design and co-production ensuring that solutions originated and were developed with local people to meet their needs.

Whilst we strongly support the funding for a new innovation scheme it is essential that we consider how to scale successes from the beginning. Unfortunately, despite excellent work demonstrated through SCDIP the widespread scaling up of these solutions has not yet been realised. Sharing good practice and solutions alone is not enough and any new innovation funding must consider sustainability and wider investment funding for proposed solutions to enable widespread adoption across councils, care providers and the adult social care sector. We ask for the amount dedicated to this fund to be set out clearly as well as how sustainability and scaling solutions will be funded.

What the white paper says

An early priority is to protect the 20 per cent most vulnerable residents in care homes with technologies that prevent falls.

LGA view

We strongly support the need to address falls since the impact can be devastating for the individual and their family, as well as costing both adult social care and health significantly. We would strongly encourage any programme looking at falls prevention to consider this in the widest sense and also seek to address falls prevention within the community and the wider social care sector not just people living in care homes. Around 814,000 people receive home care compared to 490,000 living in care homes. Whilst we agree that falls prevention is essential, we would also strongly encourage flexibility to allow for local solutions and for councils to address their top priorities for their local population and ensure that falls prevention in care homes is not the only focus for the use of care technologies.

What the white paper says

By March 2024 we will ensure that at least 80% of social care providers have a digitised care record in place that can connect to a shared care record, connected to shared care records – a commitment that was set out in the draft Data Saves Lives strategy for health and social care.

LGA view

Digitising social care records is a key step towards achieving an integrated shared care record across both health and social care. This is something we strongly support as outcomes for people are greatly improved if we all have the right information at the right time and can share one version of the truth. The increased support for social care providers to move towards having a digitised care record has been essential and has been a good example of where the right central support and investment from government can have positive impacts for adult social care.

We support the aim of 80 per cent of social care providers having a digitised care record in place and are keen to understand the support and next steps to ensuring that we can get all social care providers on board, understanding that those who are not digitised by March 2024 are more likely to be care providers who may need significant investment in their digital infrastructure and in increasing their digital capability.

What the white paper says

To support care providers in adopting proven technologies which can transform quality of care and safety we will fund implementation support within each integrated care system and invest in the infrastructure and skills required for the future. By rapidly digitising social care we can ensure a more equal partnership with colleagues in the NHS and achieve wider ambitions for joined-up care around the individual.

LGA view

As integrated care systems are not on a statutory footing until 2022 there is still a lot of unknowns within ICS and how they will operate in practice across England. A key concern of using ICS as the structure to invest in infrastructure and skills is whether this will meet the needs of both councils and care providers within the ICS footprint since the ICS is an NHS structure. Ensuring that investment across the 42 integrated care systems does not result in funding just to the NHS and health is vital and funding for digital must be equitable across both social care and health.

What the white paper says

To make the most of these technologies, staff need access to fast, reliable and affordable internet connections. We will therefore deliver fibre broadband upgrades to those care homes still dependent on poor connections.

In addition, we will work in partnership with the Department for Digital Culture, Media and Sport and the telecommunications industry to ensure home care providers have the infrastructure they need to work digitally. We already have work underway to understand the telecare sector’s readiness for the digital switchover, which will switch all analogue phone lines across the country to digital connections by 2025.

As the sector’s integration with NHS systems deepens, good cyber security practices must be in place to safeguard peoples’ information and their interactions with health and care professionals. Building on the Better Security, Better Care programme, we will continue to broaden our data and cyber security support and drive uptake of the Data Security and Protection toolkit (DSPT). This sets out minimum cyber security and information governance requirements for all health and care providers.

LGA view

We support the current focus on infrastructure and cyber security set out in the above statements. In addition, we would emphasise the need to ensure that government work together to ensure that adequate digital infrastructure is in place across all communities.  Care and health needs are closely linked to socioeconomic status therefore those in the most deprived communities may be hit the hardest by higher support needs and insufficient digital infrastructure meaning they are left without access to the full range of care technologies and the benefits this could bring. Government must work collectively to tackle digital exclusion; this is not just an issue for the home care sector in adult social care.

We support the work being undertaken on cyber security through the Better Security, Better Care programme and the use of the DSPT. Ensuring that care providers are supported to uptake the toolkit and are supported to improve their cyber security and information governance is essential and requires continued investment. Ensuring that this work continues in the supportive manner with the care market is vital.

What the white paper says

Our ambitions for a digitally enabled care system cannot be realised without a workforce that is skilled and confident in the use of technology. Building on the findings from the recent digital skills baseline report, we will provide a comprehensive digital learning offer that includes accessible training and online resources to build transferrable digital skills as well as practical guidance on using technology in all care settings. This will include targeted digital leadership support for decision-makers who can drive cultural change at a senior level. It will complement the workforce investment outlined in chapter 6.

LGA view

The need to develop and provide a comprehensive digital learning offer is essential in enabling the roll out of digital technology. We would seek to understand whether this digital learning offer will be funded within the allocated workforce funding or the £150 million for digital technology funding. Funding for the workforce must be made available to the full adult social care workforce including care providers (both organisational and individual) and councils and need to consider informal carers.

What the white paper says

Separately, as announced in the National Disability Strategy, we are investing up to £1 million in 2021/22 to develop a new Centre for Assistive and Accessible Technology, and we will report progress on this by summer 2022. As part of this work, we will assess the assistive and accessible technology needs of disabled people in England, to establish where these are being met and where improvements can and should be made.

LGA view

Investment to understand and assess the assistive and accessible technology needs of disabled people is welcome and it is essential that the technology that is in use and being developed is fully accessible and meets the needs of people with a disability. We would question whether £1 million pounds will provide enough resource to undertake this important work.

What the white paper says

From 2022 to 2025, we will provide £3.6 billion to reform the social care charging system, enable all local authorities to move towards paying providers a fair rate for care and prepare local care markets for implementing reform.

LGA view

Any funding must also be made available to support any implementation costs around new social care systems for local authorities as a result of the changes to the charging system. Clear guidance is also urgently needed to ensure that the sector has the time to build their systems and response to meet the new requirements for the cap and metering.

As set out above, we are not convinced that the funding allocated for social care through the new Health and Social Care Levy is sufficient to fund the charging reforms set out in the September 2021 Plan.

Building a system that can develop and adopt new ways of providing care and support to people at scale

What the white paper says

Government will invest up to £30 million in a new ‘Innovative Models of Care’ programme which will address the key barriers to embedding and ‘mainstreaming innovation in the sector.

There is no ‘one size fits all’ solution, different models will be needed in different places, and local authorities, providers, people who draw on care and support, and their family members, will be best placed to develop and choose models that work for them.

The Programme will provide the vehicle for local areas to come together to trial and embed ambitious new services for addressing key priorities such as prevention, reablement, better support for unpaid carers or key enablers such as local community capacity building or outcomes-based commissioning for improved outcomes.

The programme will support local authorities and partner providers to develop, commission and deliver new models of care for people living in non-residential settings. The programme is being designed in consultation with the sector to ensure it addresses the key barriers to embedding innovation. As part of the programme, innovation partnerships will be convened.

Risk-sharing funding will also be provided to a number of local authorities to mitigate the additional costs arising from system change as well as business development support to care providers to build capacity in the sector. This will be underpinned by evaluation.

LGA view

We welcome the innovation fund and it is helpful that this builds on the white paper’s recognition that there are already great examples of adult social care innovating across the country. It is also helpful to recognise the challenges to innovation and that support will be given to both councils and providers. We look forward to being part of the programme design.

However, it is unclear how these approaches will be scaled up on the back of evaluation. More broadly, and in line with what we have said elsewhere above, the critical issue remains the fact that there is insufficient core funding for adult social care and councils are struggling with additional growing demand and pressures on budgets. The innovation fund is not set up to manage those pressures, but if underlying funding is not addressed, then only some, rather than all, councils will benefit. This also further brings into question the risk of councils being set up to fail under the new assurance framework.

Councils can and do work with people who draw on social care and providers to develop new ways of supporting people. However, if the resources that are needed to then fund this ongoing support for those who would benefit from it are not available, the potential for changing lives will be significantly reduced.

Focusing on prevention and health promotion to support people to live healthier lives for longer

What the white paper says

The Government recognises that more needs to be done on preventing the causes of ill health which can increase demand for adult social care and notes that the new Office for Health Improvement and Disparities will work with a new cross-government ministerial board on prevention.

The white paper makes specific reference to maximising the independence of older people and notes the consequences of increased deconditioning, particularly falls. To tackle this problem, the white paper commits £3 million over three years towards the establishment of a ‘deconditioning inequality innovation fund’.

LGA view

We welcome the focus on prevention, but intent and ambition needs to be matched with proper investment; councils’ public health grant has been cut by 24 per cent on a real-terms per capita basis since 2015/16. In our Spending Review submission, we called for £1 billion of funding in 2022/23 rising to £3 billion in 2024/25 for a new Community Investment Fund, with much of the funding likely to be directed through the voluntary and community sector. In the realm of adult social care, this funding would focus on prevention and innovation.

We support the creation of a cross-government ministerial board on prevention, which should include local government representation.

We recognise the particular problems associated with deconditioning and welcome the focus on work to prevent falls. However, as with other initiatives set out in the white paper, we question whether an investment of £3 million over three years is sufficient to make the level of progress needed. It should also be recognised that the NHS has an important role to play on the deconditioning agenda – both through better support from community health, but also in terms of support for people in hospital, where deconditioning can become a particular problem.

Chapter 5: empowering those who draw on care, unpaid carers and families

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Summary of main proposals

  • Invest at least £5 million to test and evaluate new ways to help people navigate local adult social care systems.

  • A national website providing information and simple explainers about adult social care reform.

  • Invest up to £25 million to work with the sector to kick start a change in the services provided to support unpaid carers.

  • A new obligation for Integrated Care Boards and NHS England to involve carers when commissioning care for the person they care for.

  • DWP will launch Local Supported Employment to identify effective ways local authorities can support autistic people and people with learning difficulties into employment.

  • BEIS will introduce a Carer’s Leave entitlement of 5 days of unpaid leave per year for eligible employees.

Improving information and advice

What the white paper says

Informing the public about social care reform: the Government will create a national website providing information and simple explainers about adult social care reform for the public.

Personalised advice about adult social care: the Government will provide at least £5 million over three years to local organisations to pilot and evaluate new ways to provide personalised advice to help people navigate local adult social care systems.

Improving oversight of local authority information and advice offers: increased oversight of local authority practices will include how local authorities empower people and enable them to make informed decisions.

Providing people with the basic information they need to compare providers: the Government will consider changing CQC regulations to require CQC-registered providers to be more transparent about their fees and will explore how to allow better and more transparent feedback about services and other comparative information. Finally, the Government will keep under review the Care Act provision for introducing a new system to allow the public to appeal certain adult social care decisions made by councils.

LGA view

It would be helpful to understand more about the Government’s new adult social care reform website, including how much it will cost, so as to form a judgement on whether that funding would be better spent bolstering local provision of information and advice.

Where the website addresses funding/charging reform, the Government must be clear that key issues (such as daily living costs not contributing to the care cost cap and who will be able to access council-commissioned care and when) are national Government decisions, not those made by councils. More generally, Government also needs to be realistic in what it sets out as part of its own information offer; a lack of resources locally for core services and reform initiatives runs the risks of national Government over-promising and raising expectations too highly – this must be avoided.

Under the Care Act, councils already have a duty to “establish and maintain a service for providing people in its area with information and advice relating to care and support”. Under the legislation’s statutory guidance, it is clear that councils are also “expected to understand, coordinate and make effective use of other high quality statutory, voluntary and/or private sector information and advice resources available to people within their areas”. To the extent this is another aspect of the legislation that has not been delivered because of funding pressures, we therefore question whether £5 million is an adequate investment and whether a three-year timeframe is commensurate with the urgency of the need.

Linked, if the focus of personalised advice to help people navigate local social care systems is to shift to local organisations (ie not just councils), we need to see more detail about CQC’s role in overseeing councils’ information and advice offer. This is potentially a further area where councils may be set up to fail; without adequate funding, councils will be less able to satisfy increased oversight of whether they are meeting their statutory duties.

We support the general principle of provider fees and service feedback being transparent – such steps could help support people’s understanding of the services they or a loved one are receiving. However, CQC already publish a good deal of information about providers, and we need to guard against people feeling overwhelmed by the volume of information, which could ultimately make such provision counterproductive. Striking the right balance is therefore important.

Should the Government explore the introduction of a new system enabling the public to appeal certain council adult social care decisions, it must engage with local government from the outset to ensure the system is fair, proportionate and not burdensome for councils.

Empowering unpaid carers

What the white paper says

Working with the sector to kick start a change in the services provided for unpaid carers: the Government will invest £25 million to work with the sector to identify and test a range of new and existing interventions, which could include respite and breaks, peer group and wellbeing support, and new ways to combine these to maximise support. On respite, the white paper commits to working with the sector (including councils) to explore different models of respite, how they are accessed and what the barriers to access are.

Identifying, recognising and involving unpaid carers: the white paper sets out proposals for improving data collection and the sharing of data to help better identify unpaid carers. The white paper also sets out a commitment to ensure that the voice of unpaid carers is properly embedded in Integrated Care Systems.

Supporting the social and economic participation of unpaid carers:

  • The white paper states that the Department of Health and Social Care (DHSC) is working with NHS England, the Carers Trust and Carers UK to produce a social prescribing summary document to be disseminated to local carers organisations. It will upskill staff at carers organisations on social prescribing as an intervention for loneliness, and to increase unpaid carer health and wellbeing. The DHSC is also working with these same organisations to evaluate good practice in social prescribing to reduce unpaid carer loneliness, as well as testing loneliness interventions amongst unpaid carers.
  • The white paper also references a Department for Business, Energy and Industrial Strategy consultation on measures to increase the availability and uptake of flexible working, which is considered in this context as part of the drive to provide more choice and control to unpaid carers to help them access and stay in work.
  • The white paper also sets out the Government’s already-stated commitment to introduce carer’s leave.

LGA view

We welcome the money to pilot new approaches but question whether the scale of the investment matches the scale of the ambition.

It is important that local authorities, as the key local commissioners and providers of carer services, are involved in the work to kick start new approaches. Similarly, issues pertaining to unpaid carers need to be addressed through place-level arrangements; ICSs will have a role in supporting this work but will not be the vehicle for delivery.

Any positive outcomes emanating from the pilots must be given sustainable long-term funding. The LGA has already produced a number of case studies that demonstrate how local councils support carers in innovative ways.

On respite, and as the main commissioner of respite services to unpaid carers, it is important that councils are included in this work. Respite can be delivered in a variety of ways, such as a care home placement, home care, day services or direct payments. It is important that there is a choice that meets the individual circumstances of the carer.

We are strongly in favour of the duty to engage with patients, carers and representatives. We have committed to work with the Government, NHS, local government and patient and public voice organisations, to produce clear guidance to support local health and care systems to work in partnership with their communities.

It is important that this work recognises the role of councils in addressing loneliness and isolation. Councils provide or commission a number of services that help alleviate isolation, including social prescribing services.

Supporting autistic people and people with a disability into employment

What the white paper says

DWP will fund a Local Supported Employment scheme, working with 20 local authorities, expected to begin in 2022. The initiative will support approximately 1,200 participants with a learning disability or autistic people who use local authority social services.

A new proof of concept, Access to Work Plus, will test new enhanced support for disabled people with high in-work support needs, such as those receiving social care support. This will include a higher level of personal support and financial support for employers who are willing to do more to flex job roles and create supportive working environments. The proof of concept is expected to start in 2022.

LGA view

Autistic people, people with a learning disability and disabled people with high in-work needs should have the same opportunities as anyone else to have paid work in order to live as independent and valued citizens and earn money regardless of the support they need to secure or maintain this. We are pleased that the White Paper recognises, commits to, and announces new investment to overcoming barriers they face when seeking, entering, retaining and progressing in paid employment.

It is also important for employment support programmes to recognise that some people will be self-employed and that some people will need a flexible approach that allows for changes in their needs, for example, fibromyalgia, arthritis, and anxiety/burnout for autistic people. Autistic people who would benefit from this additional employment support may not use social services, so we encourage a wider eligibility criteria to ensure that autistic people have a fair chance of accessing it.

Councils already work with partners to promote participation and engagement of people who face additional barriers in their communities and to deliver support services. To ensure this investment is maximised, DWP should co-design the Local Supported Employment (LSE) scheme and Access to Work Plus (A2W Plus) with councils and combined authorities, alongside employers and other partners, and people with lived experience. This will help to ensure that these programmes reflect existing good practice, especially the importance of a whole-person approach to sustainable employment and personalised budgets with the potential to braid funding in order to give maximum flexibility to meet a person’s employment support needs.

Prior to roll out a discussion on commissioning and delivery mechanisms would be helpful to ensure this new provision aligns with existing employment support and other local services people rely on, as well as the funding envelope and duration.

Local join up is essential as there are so many national employment and skills schemes with different eligibility, timescales, spatial footprints, agencies and providers. This is why the LGA recently launched an online tool to map this provision by local authority. It highlights how Access to Work is contracted or delivered in several ways which will result in multiple providers and arrangements operating locally. 

Councils are well placed to help Government join up employment and skills provision across a place to support residents and local businesses. Many have trusted and established local employment and skills services which bring together provision - national and local – to support residents and local businesses, some of which will include supported employment. They also directly deliver DfE funded adult and community learning (ACL) in community settings, which is critical to supporting adults with learning disabilities and disabled people get closer to the local labour market. This is missing from the White Paper and we recommend it is factored in, working with LSE and A2W Plus providers.

The design, commissioning and delivery of LSE and A2W Plus should therefore support local collaboration and work with existing provision. While we support the principles underpinning the LSE scheme and A2W Plus, the former will only reach around 1,200 people with a learning disability or autistic people in 2022, and it is not clear how many will be reached in subsequent years, or the timeframe for extending the Access to Work Plus proof of concept, but with the right funding we encourage an ambitious commitment that will make a decisive contribution towards addressing the employment inequalities that autistic people, people with a learning disability and disabled people can face.

To achieve this potential, it is vital that councils and employment support agencies develop plans and targeted support based on their knowledge of local businesses and communities with specific consideration of people who may face additional barriers, recognising that many autistic people may not be identified until they are finding it hard to cope.

Supporting more autistic people into employment is also a priority in the Government’s National Strategy for Autistic Children, Young People and Adults 2021 to 2026 and the Government’s National Disability Strategy commits to making the world of work more inclusive and accessible. We are keen to understand how the Adult Social Care White Paper’s welcome focus on employment will relate to other cross-Government strategies and commitments including the Skills and Post 16 Education Bill, and the upcoming Levelling Up White Paper, which we expect to provide opportunities for councils and combined authorities to put forward new and strengthened existing devolution deals including employment and skills provision.

Chapter 6: our strategy for the social care workforce

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Summary of main proposals

At least £500 million to transform the way the workforce is supported and developed:

  • A Knowledge and Skills Framework (KSF), career pathways and linked investment in learning and development to support progression for care workers and registered managers.
  • Funding for Care Certificates, alongside significant work to create a delivery standard recognised across the sector. This will improve portability, so that care workers do not need to repeat the Care Certificate when moving roles.
  • Continuous Professional Development (CPD) budgets for registered nurses, nursing associates, occupational therapists, and other allied health professionals.
  • Investment in social worker training routes.
  • Initiatives to provide wellbeing and mental health support and to improve access to occupational health.
  • A new digital hub for the workforce to access support, information and advice, and a portable record of learning and development
  • New policies to identify and support best recruitment practices locally.
  • Exploration of new national and local policies to ensure consistent implementation of the above, as well as higher standards of employment and care provided.

Pay

What the white paper says

The white paper acknowledges that people working in social care need to feel recognised, rewarded and equipped with the right skills and knowledge. It notes that the Government is increasing the National Living Wage (NLW) by 6.6 per cent in 2022, with a commitment for it to reach two-thirds of median earnings by 2024 (giving the lowest-paid care workers a real-terms pay rise). The white paper also commits to working with commissioners and providers to make sure care workers are paid for all the hours they work and to improve workers’ terms and conditions.

The white paper also states that funding will be provided to support councils to prepare their local markets for reform, including by moving towards paying providers a fair rate for care which reflects local costs, including workforce.

LGA view

While much of the ambition for the workforce is to be welcomed, it will not hang together cohesively without proper action on pay. Reference to the NLW does not answer the pay question because it will not allow the sector to become competitive with the NHS and other key employers. Indeed, it could exacerbate existing difficulties with recruitment and retention.

We support the commitment to working with commissioners and providers on terms and conditions. Pay must be a central element of this and should take the form of an independent review, as we have long called for.

Without meaningful transformation on pay, many of the ideas put forward in this chapter (such as a Knowledge and Skills Framework to support career structure and progression) will be hard to deliver because people will have no guarantee of increased pay and reward for their increased skills and may continue to use social care as a stepping-stone to the NHS or other opportunities outside of the sector.

A well-trained and developed workforce

What the white paper says

Knowledge and Skills Framework and career structure: the white paper commits to working over the next year with the adult social care sector to co-develop a universal Knowledge and Skills Framework (KSF) and career structure for the workforce. This will include exploring options for embedding the KSF consistently across the sector, so it is a recognised benchmark for all social care roles. The framework will articulate the knowledge and skills required for roles in the sector and set out clear pathways for career progression. The Government will also continue to ensure that high-quality apprenticeships meet the skills needs of employer, including the promotion of more flexible models of apprenticeship delivery.

Care workers – portable care certificates: this is pitched as a key part of the Government’s offer and will involve working with the sector to design new training delivery standards and exploring options for external validation and accreditation to ensure Care Certificate training is high quality and portable. In this way, the care workers will be able to carry their certificate with them throughout their careers.

Care workers – KSF-linked learning and development offer: the new national KSF will be accompanied by a funded learning and development offer, so the workforce can become experts in their field or progress into new roles. The offer will provide hundreds of thousands of training places and qualifications and the funding will be linked to the KSF.

Care workers – skills passport: this is introduced as helping to address the issue of portability of staff training and development. The passport will provide a permanent and verifiable record of skills, behaviours and achievements that can be shared with new or potential employers.

Registered managers and regulated professions: the white paper commits to exploring options for developing new pathways into the registered manager role and will fund accredited Level 5 diplomas for registered managers who do not hold formal qualifications. A bespoke support programme for new registered managers in their first year will also be introduced, offering learning and development opportunities, peer support and mentoring.

Registered managers and regulated professions: registered nurses, nursing associates, occupational therapists and other allied health professionals who work in social care will be supported with a new fund to help meet their continuous professional development objectives. There will also be investment for new training routes for people who want to become social workers. Additionally, work will be done to improve the pre- and post-qualification landscape for social workers.

LGA view

Clarity is needed on whether the funding described in this chapter is allocated for setting up and establishing the various initiatives, or if it is expected to also stretch to cover, for instance, the actual delivery of training for the workforce.

The KSF should be across health and care to enable people to maximise opportunities, retain people within the system rather than necessarily the social care sector and to build knowledge and understanding of different roles. At present the pay differential is a barrier to this happening and there is often a one-way flow of people from social care to health, which again puts social care at a disadvantage within the system.

Maximising the opportunity of apprenticeships is welcomed, however more support is needed to build capacity to enable employers to take up this opportunity. This may be in terms of inducting and training staff to a level where they can add capacity to the employer. Current workforce capacity pressures mean that many employers do not have time to support apprentices, which impacts on the retention of apprenticeships in the sector. It would also be helpful to be clear how much funding will be allocated for this commitment and provide greater clarity on growth targets (ie beyond simply ‘hundreds of thousands’). We also welcome the investment in training routes for people who want to become social workers and would emphasise that we would like this opportunity to be inclusive of all.

The introduction of a portable care certificate is welcome and supports the ambition of career development for care and support workers. We would like to see this co-produced with people with lived experience, care workers and providers. We note that a fund has been set up to support CPD for regulated professions; we would like to see a similar fund made available for care and support workers to recognise that the skills they have are also ‘professional’. We agree with the need to improve training and support for registered managers but would also like to explore what support is needed for other roles in social care and where there may be gaps.

A healthy and supported workforce

What the white paper says

The white paper recognises the immense sacrifice made throughout the pandemic by the social care workforce. It commits to a new wellbeing and occupational health offer, working with councils and providers to reduce mental and physical sickness and develop a more positive experience for people working in social care. The offer includes counselling, peer support, a bespoke support helpline, mental health training, coaching, a workplace wellbeing fund, an occupational health portal, pilots to explore collective purchasing and subsidies of occupational health provision, and a pilot to explore how ‘Freedom to Speak Up Guardians’ can be introduced in the social care sector.

LGA view

It is absolutely right to recognise the outstanding contribution made by the care workforce throughout the entirety of the pandemic and we welcome the focus on enhancing wellbeing and positive mental health of the workforce to aid wellbeing and retention. The proposals will go some way towards completing and consolidating a workforce offer that is equivalent to the NHS.

In taking forward this work, we would draw Government’s attention to the work of the National Wellbeing Steering Group, which comprises national and local partner organisations, providers, the National Coproduction Advisory Group and others, as well as the array of initiatives and approaches that were developed by councils and partners before and during the pandemic to support the workforce. A short-term action should be to make the Wellbeing Hubs, currently accessed by the NHS, more accessible to the social care workforce.

It is helpful that the focus is on embedding ongoing cultural change, rather than just continuing pandemic-related support. This is also an aim of the National Wellbeing Steering Group, which is looking at the potential of introducing the role of Wellbeing Guardians to the sector to help provide assurance that wellbeing is considered at a strategic level in organisations.  It would be helpful to be clear how these will align with the Freedom to Speak Up Guardians and to provide a clear narrative around these roles.

A sustainable and recognised workforce

What the white paper says

A new care workforce hub will be developed as a central digital platform for the workforce, allowing staff to identify themselves as working in care and be signposted to the new support available.

The hub will also embed the skills passport. The hub and passport will be voluntary in the first instance, establishing a foundation for registration of staff in the future in a way that benefits staff and providers alike.

The white paper recognises the challenge (nationally and locally) of recruiting people into the care workforce and commits to providing support to identify best recruitment practice. Work will also continue with the DWP to promote social care careers to jobseekers and support employers through local DWP infrastructure, such as Jobcentres.

The white paper notes the review currently being undertaken by the Migration Advisory Committee on the impact of the UK’s exit from the EU on the social care sector and commits to considering the review’s outcomes.

LGA view

We would welcome more information on the development of a new care workforce hub and can see the value of this becoming a ‘one stop shop’ for information for care workers. While we do not disagree that this will help staff to easily identify themselves as working in care, this will not address the perception of others outside the care sector, which has been an issue during the pandemic.

Recognition that more work is needed on the idea of a mandatory register is welcome. We will need to see more of the Government’s plans for the proposed hub to better understand whether it is likely to build toward something meaningful.

On recruitment, councils, providers and partners have, over the last eighteen months, demonstrated some creative approaches to bringing more people in to the sector. The LGA, ADASS and Skills for Care have been working collaboratively to identify and share good practice in local recruitment for the past few years. We would therefore welcome Government’s view on how this practice can be scaled up to have a more significant impact for the sector.

While the Migration Advisory Committee’s review is helpful, we would welcome early action on this issue as local areas are currently spending significant amounts of time and money in trying to improve capacity by drawing in people from the EU. There is currently confusion over the bureaucratic process and the cost of taking this route is prohibitive for many providers.

This chapter of the white paper sets out a number of potentially helpful proposals and aspirations for the care workforce. However, comprising only 11 pages, we do not consider this a comprehensive workforce strategy, as it is described in the white paper. Purely for comparative purposes, the NHS People Plan is 50+ pages long, builds on the 70+ page interim People Plan, and is accompanied by the NHS People Promise, which was heavily informed by those who work in the NHS. The Government should therefore consider this chapter of the white paper a first step and commit to a more thorough workforce strategy that is shaped by all parts of the sector, particularly the workforce itself and those who have cause to draw on it.

Chapter 7: supporting local authorities to deliver social care reform and our vision

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Summary of main proposals

  • From 2022 to 2025, we will provide £3.6 billion to reform the social care charging system, enable all local authorities to move towards paying providers a fair rate for care and prepare local care markets for implementing reform.
  • We will provide more support to local authorities, including specific support to strengthen their market shaping and commissioning capabilities. In total we will provide an increase in improvement funding of more than £70 million between 2022–23 and 2024–25, to ensure that local authorities are well set up to deliver our vision for reform.
  • We will introduce a duty for the Care Quality Commission (CQC) to independently review and assess local authority performance in delivering their adult social care duties under Part 1 of the Care Act 2014.
  • We are putting in place new legal powers for the Secretary of State for Health and Social Care to intervene in local authorities to secure improvement where there are significant failings in the discharge of their adult social care functions under Part 1 of the Care Act 2014.
  • Establish an adult social care data framework by spring 2022 and improve the quality and availability of data nationally, regionally and locally.

Supporting sustainable care markets and tackling variability in market shaping and commissioning

What the white paper says

£3.6 billion will be provided between 2022 and 2025 to reform the social care charging system and enable all local authorities to move towards paying providers a fair rate of care. Further details to be announced shortly and Government will work closely with the sector to shape the implementation of fair rates for care.

Support will be provided for sustainable care markets and investment in strengthening market shaping capability. This will include investment in commissioning and contract management capability in councils, including a focus on continuous professional development, support for developing a clear career path for commissioners and strengthening leadership.

LGA view

We infer from the September Build Back Better Plan and this white paper that the Government believes providers should be paid more and that this will help address the current situation where self-funders often pay significantly more than people who are fully or partially funded by councils, effectively cross subsidising public services. Through existing legislation that has not yet been turned on (Section 18.3 of the Care Act), the Government will enable self-funders to ask their council to arrange their care at the rate the council pays. To make this change sustainable for providers, rates paid by councils will need to increase.

Our own estimate of the provider market gap (the difference between what providers say is the benchmark cost of providing care and what councils pay) is £1.8 billion by 2024/25. It is unclear – and probably unlikely given the various commitments the £5.4 billion is expected to fund and the high cost of those commitments and other existing pressures – that moving towards a fair rate of care will fully address the cross-subsidy issue. It is even more unlikely that it will give providers additional income with which to, for example, improve the quality of care or care worker pay.

A new assurance framework, improvement support and intervention, and statutory intervention

What the white paper says

CQC assessment of local authorities: CQC will independently review and assess the performance of councils in delivering their adult social care functions, including a focus on identifying what is working well.

The emerging approach to assessment: the ambition is for CQC to use its powers and duties to help improve outcomes. Assessments will look at different issues, such as safeguarding, commissioning and contracting, meeting the needs of unpaid carers, market shaping, assessments of people’s needs, and maintaining oversight of the social care workforce.

Assessments will be flexible and informed by a range of information and data, including from people who draw on social care and unpaid carers.

The Government will work with a wide range of stakeholders to ensure the outcomes of assessments are presented clearly and accessibly, whilst minimising the burden on councils. Assessment will launch no sooner than April 2023.

Government will increase improvement funding to over £70 million over the next three years to step up improvement activity across the sector and will play a more proactive role in ensuring support is targeted where it is needed most. Government will build on DHSC’s regional assurance team that was established during the pandemic to work with councils.

The improvement offer will comprise an expanded universal offer (eg resources, materials and training opportunities) as well as more bespoke support to tackle particular problems (eg additional expert support, workshops, consultancy-type support.

The Government will take a more proactive role in supporting councils to improve where CQC’s assessment (and additional intelligence and data from the department’s regional team) identifies a serious and persistent risk to people’s safety and wellbeing. In the first instance, this will be ‘directed support’, and a request of the council to produce and implement an improvement plan. Directed support will be designed with the sector and will be tapered off where the council demonstrates improvement.

In cases where a council has been unable to tackle sustained problems, the Secretary of State will be given new powers to intervene. The expectation is that these would only be used in exceptional circumstances. Councils will have a legal right to make representations before any decision to use statutory intervention powers is made.

Such powers and measures will be developed through further close working with the sector.

LGA view

We understand Government’s desire for greater transparency in social care. We favour a review-driven approach looking at whole systems, based on a shared agreement of what good looks like – in particular, the importance of person-centred and locally flexible care and support.

Local government has helpfully been an equal partner in the design of national oversight to date, which has recognised the value and importance of building on existing sector-led improvement work and local democratic accountability. It is important that a meaningful voice is given to people who draw on and work in social care.

In considering its own improvement offer, the Department must work closely with local government; the sector’s own improvement offer is respected and valued by councils and it will be important to avoid creating a confusing improvement support landscape.

Any new processes or structures for assurance and oversight need to be accompanied by an updated New Burdens assessment to fairly capture the capacity and resource implications for councils in meeting new regulatory approaches.

Any assurance process has the potential to highlight shortfalls in services and delivery of the intentions of the Care Act due to resource constraints. Any assessment of a council’s adult social care services would need to be contextualised in terms of available resources. As we have set out above, failure to properly invest immediately in core services has the potential to set councils up to fail under the new assurance framework.

We welcome the Government’s expectation that statutory intervention will be by exception and as a last resort and that any council finding itself facing such action will have a legal right to make representations. We look forward to continuing to work with the Department to develop this aspect of the assurance framework.

Data

What the white paper says

Establish an adult social care data framework by spring 2022, setting out what data the sector needs to collect, the purpose of the collections and the standards it is collected to.

Update the Adult Social Care Outcomes Framework for autumn 2022, working with the sector to set out the indicators that will enable councils to benchmark their performance, provide a good national indication of performance to inform or direct CQC assessments, and provide local people with a simple mechanism to hold their council to account.

Agree a core provider data set with partners (including CQC), for the sector, along with a means of collecting it that will minimise collection burdens. Providers will be able to use this data to support more effective and efficient delivery of care.

Develop an easily accessible data sharing solution with local authorities and providers that supports real-time decision making at local, regional and national levels. A new data sharing solution will build on the lessons learned from the pandemic and seek to ensure different actors in the system have access to the same rich data sets over the next three years.

LGA view

We (collectively across government, regulators, health and care) already capture a vast amount of detailed data, but this is not utilised in a way that supports the timely, place-based intelligence needed. Too often information is captured and stored in silos at organisation levels. Whilst there is increasing focus on the aggregated and often published data required by central government, we must not lose sight of the need to review the timeliness and accessibility of shared data at an operational level, particularly at the interface between health and social care.

There is currently a 6+ weeks lag in systems being able to see critical data, due to the insistence on publication controls and the inability to access shared systems. Where information is captured in relation to individuals, characteristics can be linked dynamically to both organisations and locations to get valuable intelligence - for example, information relating to hospital admissions could be mapped back to local health or council geographies to help understand any patterns affecting needs and care pathways.

The insights and analysis that can be drawn from data are vital for local leaders to plan, commission and improve their services to best suit the needs of the populations they serve. Similarly, for national leaders, insights and evidence drawn from data can provide better oversight and understanding of the health and care system to develop improved policy, guidance and national assurance. We are in the privileged position of having access to more data than ever before for health and social care.

However, we need to ensure that what we draw from the data is used appropriately, is transparent and meaningful and fit for purpose. We need to ensure appropriate use of data ensuring a proportionate balance of focus on outcome measures used for performance and assurance, and more detailed intelligence actively used for operational purposes. Any measures used for performance assessment or assurance purposes must be robust, attributable to (i.e. performance measured by the indicator can be influenced or controlled by) those being assessed, and the data shared on a timely basis so that it can make a difference in supporting improvement.

During the COVID-19 response there has been a rapid development of a nationally co-ordinated approach to data collection from care providers at a registered location level across the adult social care market. There are mutual benefits at all levels, and we endorse plans to continue with some degree of national overview and intelligence about the care market. However, individual councils need the ability to continue to manage relationships with their local providers. Any future approach must be driven from the local needs of councils and care providers, but with the adaptability, flexibility but also consistency that supports the ability to ‘focus in’ and ‘scale up’ when appropriate.

We welcome the commitment to build on the lessons learned from the pandemic. Timely access to data in a format that can be readily used by councils, and regional networks and national partners that support them is fundamental if we are to realise the benefits and potential improvements for councils, providers and the outcomes for people who receive care and support.

Access to care

What the white paper says

The white paper acknowledges that there is a lack of data and evidence on the extent to which care needs are not being met and hopes that better quality data, including client level data, will help increase understanding about both who accesses care, how and with what impact, and who does not and what the barriers are.

LGA view

We agree that there is a lack of data on unmet (and under-met) need and that there are various estimates depending on the definition used. We therefore support the intention to build greater understanding of the extent of the problem. However, the white paper says nothing about meeting the costs of unmet need, once the scale of the problem is better understood. Without actual funding to address identified unmet needs, the problems associated with it will persist.

Chapter 8: where do we go from here?

blue banner

What the white paper says

Commits to working in partnership with stakeholders and people who draw on social care to develop and design the implementation of the white paper’s various measures.

Explore with councils and other stakeholders how best to develop the numerous investments set out in the white paper.

Engage with a diverse range of voices to identify success measures for delivery of the reforms.

Set up co-productive forums to ensure the voice of people who draw on social care is involved in the ongoing design and implementation of reform.

Specific actions include:

  • Housing: working with councils, housing providers and others to agree how to target investment in housing and design the ‘Innovative models of care programme’
  • Disabled Facilities Grant: consult on changes to the upper limit for the Disabled Facilities Grant
  • Digital and technology: publish a social care technology blueprint and develop advice on ‘what good looks like’ for social care technology
  • Information and advice: develop and refine further policy proposals on information and advice based on lessons learned from planned research, testing of new ideas and increased oversight of councils’ offers
  • Unpaid carers: set up a series of workshops with stakeholders to inform the development and direction of the funding earmarked to support unpaid carers
  • Workforce: co-develop new career pathways, the new national KSF, investment in training opportunities and policies on wellbeing, occupational health and recruitment
  • Start working across government to encourage people to think ahead about the life they would like to live in older age

LGA view

This chapter very much underlines the fact that the white paper is just a starting point for moving towards the Government’s 10-year vision for social care. As such, there is already a significant amount of work that needs to be taken forward.

However, while various specific actions are outlined, there is no clear timeline for the months and years ahead. It would be helpful if such a timeline could be published – aligned with the separate timeline for the Government’s charging reforms as set out in the Build Back Better Plan – so that councils and their partners have a clearer sense of what will happen when and what the key milestones are. Without this, there is a risk that reform will move forward without a coherent structure.

We welcome the commitment to working with local government on a number of the identified actions and fully support the further commitment to involving people who draw on social care and support in the ongoing development, design and delivery of the various reforms. These voices will be crucial to the successful implementation of the Government’s reforms.