Social Care: Funding

Baroness Jolly Excerpts

Thursday 5th July 2018 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I declare my interests as set out in the register as chair of a charity providing services for adults with learning disabilities, and I thank my noble friend Lady Brinton for securing this important and timely debate.

The social care sector provides invaluable support to some of the most vulnerable adults in society: those who are old, frail and unable to look after themselves; those with a learning or physical disability or suffering from mental health issues or alcohol and substance abuse; and people with severe dementia. Their care is delivered thanks to the recommendation made in the Beveridge report and the subsequent legislation, but more of that in the next debate.

Learning disabilities account for one-third of the adult social care provision in England, and it is also the fastest growing sector. In 2005, only six of the 151 local authorities in England spent more on care for working-age adults than they did on care for the elderly. By 2017, 57 authorities did so. Adults with learning disabilities are living longer, although, sadly, they will still die 28 years younger than non-disabled adults. I would say to the right reverend Prelate that there are also many people with learning disabilities in prison.

In general, people with learning disabilities are leading better lives. They are moving out of institutionalised, health-based settings into supported living settings in the community. Although supported living undoubtedly delivers better life and health outcomes, it is also a more expensive option for providers. This increase in costs is increasingly not being factored into the rates paid by local authorities.

The funding gap in adult social care has been widely reported and debated in your Lordships’ House on several occasions. Several organisations have now agreed that there will be a funding gap of around £2.8 billion by 2019-20 unless we have decisive action from government. As financial pressures—such as costlier methods of support, unfunded increases in the national living wage and the apprenticeship levy and the uncertainty surrounding historical liabilities for sleep-in pay—all continue to plague the sector, a sustainable funding solution becomes increasingly vital.

The learning disability sector would like to see an annual uplift in funding of 5% each year to remain financially viable. According to the IFS, the total amount spent on adult social care in 2015-16 was £16.8 billion. To remain stable, the sector would have needed an additional £840 million for 2016-17. Instead, the IFS reported a cut of £300 million, with total expenditure falling to £16.5 billion in 2016-17. The CQC has already reported that the social care sector is at “a financial tipping point”. Earlier this year, the Government were warned that the proportion of providers in the learning disability sector now reported to be running at a deficit has more than trebled, rising from 11% in 2016-17 to 34% in 2017-18.

The sector was denied a place in the social care Green Paper, being instead part of a so-called parallel body of work that is to encompass all working-age adult social care, while the Green Paper focuses almost exclusively on older people. With the recent announcement that the Green Paper is to be postponed until the autumn and with little public detail on the parallel body of work, local authorities and social care providers alike are becoming more concerned about the financial viability of essential support services for vulnerable adults. In their recent joint report on the future of adult social care, the House of Commons Health and Social Care, and Housing, Communities and Local Government Select Committees called on the Government to widen the scope of the Green Paper to incorporate all of adult social care. When can the sector expect to hear more concrete proposals about the parallel body of work? What are the work streams? Who is on the panel? Who has given evidence and when might it report?

All of this uncertainty is overlaid on the anticipated costs as a result of sleep-in. For the sector as a whole, this should be around £400 million. I appreciate that the Government are now engaged with this situation and the results of a judicial review are awaited, so any way forward is unclear, but I would be grateful if the Minister could give me details of what consultation was done on these regulations, or even an impact assessment. If she does not have the details, I would be grateful if she would write to me and place a copy in the Library.

The funding situation is now so critical and our care and support system is in crisis. This message comes from right across the sector, the CQC and the LGA. Of course, any failure in the social care system impacts directly on the ability of the NHS to function effectively. We also need interim funding to stabilise the system as a whole. Then, new money will be needed until well into the next spending review period in order to be sustainable and to maintain quality. Without funding, we risk implementing Green Paper reforms to a system that is too destabilised by financial pressures.

Do the Government have plans to deal with failing providers, and do they understand that the tipping point is nearer than ever before? How many organisations will need to fail before the Government come out of their corner to defend the most vulnerable people in our society?