PAC slams government plans for adult social care

The Public Accounts Committee (PAC) published their report into adult social care on 9 May 2018. Based on evidence from Skills for Care, ADASS, DH, and DCLG, this Commons Select Committee concludes that Government lacks a credible plan to sustain a sector badly under-funded.

In particular the newly renamed DHSC does not know whether local government contributes to sector problems by the way it commissions social care locally and the price it pays for care. We would say that this a contributory factor; in a market driven sector, you get what you pay for, especially when the crucial resource – staff – is in short supply.

Add to that the all pervading Brexit uncertainty, not just in social care, but now throughout most of the economy, and particularly in areas and roles where we are more reliant on our colleagues from overseas, and we have clear reasons why the sector is struggling.

So what’s the solution? PAC concludes with concerns that the DHSC sees the Green Paper as a “cure all”, when actually it is mainly going to look at older people’s services. PAC also states that DHSC has no credible plans for how care could be sustainably funded. There is a view that most local councils with the responsibility of commissioning ASC, with the notable exception of Northamptonshire County Council, appear to be at least fulfilling their minimum statutory duties under the Care Act 2014, and the “sector is funded adequately at the moment”. However, it acknowledges that the sector faces significant financial pressure and requires future investment. The evidence ignores the recent concerns at councils’ questionable use of funding panels to hold down costs – Wiltshire Council was ticked off by the Health & Care Ombudsman.

However, in contradiction to satisfaction about current funding levels, PAC states concerns about short term funding fixes aimed at adult social care, which are not sustainable. DHSC claims that the July Green Paper will address this. But they note the signs of significant financial stress in the sector now with levels of unmet need high and rising; only 27% of councils apparently have arrangements in place to monitor unmet need. Unmet need is a drifting ice-berg. Most of it unseen and liable to break up on partner agency shores – police, hospitals and communities.

Four-fifths of councils are paying lower than the Department’s Care Act guidance advising on a benchmark cost for commissioning homecare. Whilst in Oxfordshire, we have one of the highest rates in the country, in an attempt to get close to the very high cost of living and extremely competitive employment market, local providers are impacted by others working in neighbouring counties or large providers working across the country. When a provider the size of Allied Healthcare requests a CVA, you know that the resulting ripples will end up on all shores.

The Department has no way of knowing whether local authorities, either individually or collectively, are paying enough for homecare. People who pay for their own care home placements are subsidising placements for people who receive local authority-funded care. The Department accepts that local authorities have cut services to people with low to moderate care needs, but does not know whether these reductions will result in more people requiring statutory care services in the future. The Ministry of Housing, Communities and Local Government has apparently given local authorities access to an extra £9.4 billion of funding, but this is coming from various sources including council tax rises and the social care precept introduced by local authorities themselves (at the behest of central government). And with the downturn in high street sales, is one of these revenue streams at risk?

In short, the funding and commissioning of adult social care is a dog’s breakfast. Many providers are choosing not to eat this and instead developing their own business model that relies less, or not at all, on public funding.  Nothing emanating from DHSC gives us any hope of a sea-change anytime soon.

Muddley ideas and short term fixes served up on a Brexit plate. Not very appetising. No wonder the sector has indigestion.

[More at Credible plan to sustain underfunded care sector needed this year]