NAO attacks DHSC over lack of workforce plans

The Department of Health and Social Care (DHSC) has not published a workforce strategy for the past nine years and cannot demonstrate that the sector is sustainability funded, according to a National Audit Office (NAO) report published today.

The Adult Social Care Workforce in England also criticises local and regional bodies for not taking the lead on workforce planning in the absence of a national strategy.

This has led to high staff turnover rates (27.6%) and vacancy levels (6.6% rising to 9% for nursing staff), the growth in the number of jobs falling behind demand for care and public perception of care roles as low skilled and offering limited opportunities for career progression.

NAO head  Sir Amyas Morse said: ‘Social care cannot continue as a Cinderella service – without a valued and rewarded workforce, adult social care cannot fulfil its crucial role of supporting elderly and vulnerable people in society.

‘Pressures and demands on the health and social care systems are increasing, so the Department needs to respond quickly to this challenge by giving the sector the attention it deserves and needs, instead of falling short and not delivering value for money.’

An investigation by the Government spending watchdog found that the DHSC’s last strategic document (Working to put people first: the strategy for the adult social care workforce in England) was published in 2009, can only be found on the National Archive website, refers to roles and bodies that no longer exist.

Furthermore, Health Education England’s draft workforce strategy for health and care to 2027, published in December, was ‘short and lacking detail’ when it came to adult social care. However, the DHSC is working with Skills for Care on a consultation exercise to inform future strategies. Any future strategy ‘will require the roles of the various bodies involved in delivering care to be more clearly defined and agreed across the sector’, NAO said.

It continued saying uncertainty over sustainable funding was making workforce planning difficult, with council spending on social care falling by 5.3% in real terms between 2010-11 and 2016-17. A further 0.2% drop is expected by 2019-20 despite rising demand for services and the increased cost of the National Living Wage.

The report states: ‘The sector remains concerned that there is no certainty about whether the extra £2bn in government funding for social care between 2017-18 and 2019-20 is a permanent increase. Uncertainty over the sustainability of funding makes it difficult for local authorities to plan how much care, and at what price, they will be able to purchase. This affects providers’ ability to undertake workforce planning.

‘The Department should establish how much funding the sector will need over the long term and make the consequences of any funding gap clear. The Department should consider sharing its modelling of cost and demand pressures on the care sector to help commissioners set appropriate fees for providers; this includes the costs arising from future changes to the National Living Wage.’

In addition, the DHSC should encourage local authorities and CCGs to produce workforce strategies that complement national plans, including liaising with other statutory bodies such as Jobcentre Plus offices.

Current initiatives, both national and local, to support recruitment, retention and development need to have a bigger impact, with successful ones increased in scale, concludes NAO.

Chair of the Housing of Commons Public Accounts Committee Meg Hillier said the report showed the social care workforce is in a precarious state. ‘The Department of Health and Social Care needs to address these issues urgently’, she said. ‘To date it has done little to help councils and providers prevent a looming workforce crisis.

Colin Angel, policy director at the United Kingdom Homecare Association, responded to the findings saying: ‘The National Audit Office rightly calls time on the Department of Health and Social Care’s consistently “hands-off” approach to the social care market and its workforce.

‘The absence of a published strategy for the social care workforce highlighted by NAO should be an embarrassment to Government, but a strategy is only useful if it leads to decisive action.

‘Government has given increasing responsibilities to councils to shape their local care markets, while councils argue that they have insufficient funds to do so.  UKHCA continues to urge Government to ensure that social care is properly funded and that there is independent oversight of councils’ commissioning practices and their effects on the social care workforce.  Government must finally tackle the growing crisis in social care head-on.’

Chief executive of Care England, Professor Martin Green, said the report showed ‘yet more evidence that the social care system is fit to burst and that the Government is not doing enough to support the social care workforce’. He said: ‘Workforce is the most valuable asset to care providers and they need to be able to support, develop and pay them appropriately’.

‘No more reviews, no more consultations; let Government press ahead with all the necessary partners, to provide some much needed direction to a sector that is struggling.’

Cllr Izzi Seccombe, chairman of the Local Government Association’s Community Wellbeing Board, added: ‘Councils can’t plan for the future due to uncertainty over funding and an annual £2.3bn shortfall that adult social care will face by 2020.’

A Department of Health and Social Care spokesperson told CM: 'We recognise there are challenges in the social care workforce - that’s why we’ve launched a consultation on the adult social care workforce and committed to publishing a health and care workforce strategy in the summer. At the Spring Budget we provided an extra £2 billion funding to the sector and we have just announced a further £150 million for 2018-19. We will publish plans this summer to reform social care to ensure it is sustainable for the future.'

Care Markets: March 2018


Hunt says Green Paper to make system less 'random'

Secretary of State for Health and Social Care Jeremy Hunt has indicated that the Green Paper on older people will propose reforms to make the social care system less ‘random’.

In evidence to the House of Commons Health Committee at the end of last month, Hunt said he would be taking on responsibility for this Summer’s Green Paper which he described as ‘a very important piece of cross-Government work’.

He explained further saying: ‘Part of that work is looking at all of the financial issues around social care, so the strategic reforms that I think we all accept on all sides of the political spectrum that need to be made to the social care system to make it sustainable going forwards to deal with pressures, that is now my department’s responsibility to think through.

‘The truth is there are two sets of forms we need to consider. The first is the longer-term funding changes which is, put very simply, is the fact that most people save for their pension but they don’t tend to save for the social care provision they need and it’s very hard to find a way to do that but we need to address that because its random and many people have no social care costs while others will have hugely expensive social care costs when they are old.

‘And then there are the short-term pressures in this sector after having its budget cut after the financial crisis of 2008. That budget has now started to rise but it’s still not at the levels that it was at before. It’s under very, very sustained pressure and I think we have to find a solution to those short term pressures as well as part of this process.’

‘I think we will continue to have a mixed economy [with state and self-funding] but I don’t think the risk pooling part of the social care sector works at the moment. It is very random. If you get dementia, for example, you could end up losing absolutely everything because there is a reasonably high chance that you will end up in a care home and end up being cleaned out which wouldn’t happen if you had a different illness. So that’s why we need to have this review as there is an unfairness as to how the system has evolved over the years.’

He said that, despite the Conservative Party having ‘setbacks’ in the election which may have been linked to attempts to reform social care, Theresa May ‘cares about the issue deeply’ and had tried to address it during her time as Prime Minister.

He said he would want long-term plans for the NHS and social care to be considered together as they are interrelated but would not go as far as joining them both together in the Green Paper.

Hunt also said that Government would be looking at funding models from all over the world as part of the review process.

Meanwhile, The House of Commons Communities and Local Government and Health Committees have launched a joint inquiry into the long-term funding and provision of care which will feed into this summer’s Green Paper.

The inquiry seeks to ‘identify funding reforms that will command broad consensus to allow progress ensuring the long-term sustainability of both the health and social care systems’.
Written evidence on how to fund social care sustainably post 2020, bearing in mind the interdependence of the health and social care systems, and a mechanism for reaching political and public consensus on a solution, should be submitted by 7 March.

The committees are expected to report their findings in May.

Councillor Izzi Seccombe, chairman f the Local Government Association’s community wellbeing board, said: ‘The Committees are absolutely right to focus on long-term funding solutions and how to build political and public support for them. We do not need a major overhaul of our care and support system; the Care Act provided that and the vision it sets out in legislative terms enjoys widespread support. What we need is consensus on funding solutions so the Care Act vision can be realised.

‘We will be submitting evidence to this inquiry which we urge is acted upon to fully inform this summer’s Green Paper and possible subsequent legislation.’

At the beginning of the year the Department of Health was renamed the Department of Health and Social Care, following a cabinet reshuffle.

Jeremy Hunt was renamed Secretary of State for Health and Social Care, with the reclassified department taking on responsibility for the upcoming Green Paper which will set out the government’s proposals to improve care and support for older people.

Hunt said: ‘Changing the name of the department doesn’t address the issues of social care funding and integration on the ground. But symbolism does matter in politics and this is the first time in this country that we have secretary of state who has social care in their job title and their job description and I think that is important. And I think it indicates that the Prime Minister, because these decisions are made by the Prime Minister, that she attaches a lot of importance to addressing the pressures in social care.’

The decision was welcomed by the Association for the Directors of Adult Social Services. Vice president Glen Garrod said: ‘This is a welcome recognition of the importance of social care … we hope the Secretary of State will see social care as crucial in its own right, and not just viewed through the prism of what it can do for healthcare.’

LaingBuisson founder William Laing added:‘The Department of Health has always had strategic responsibility for social care, so nothing of substance has changed. However, it is good to see Jeremy Hunt sending a message, in his new title as Secretary of State for Health and Social Care, that he takes the social care part of his brief very seriously.’

Care Markets: February 2018


Care cap scrapped says Doyle-Price

After four years of delays, Care Minister Jackie Doyle-Price has announced the care cap has been scrapped. She said the Government had abandoned the plans to set a limit of £72,500 for care costs ahead of next summer’s Green Paper on the reform of care for older people. Speaking in the House of Commons yesterday, the Minister said: ‘To allow for fuller engagement and the development of the approach, and so that reforms to the care system and how it is paid for are considered in the round, we will not take forward the previous Government’s plans to implement a cap on care costs in 2020.’

She added, however, that Prime Minister Theresa May had ‘made it clear that the consultation will include proposals to place a limit on the care costs that individuals face’.

Amid suggestions that the Green Paper would include plans to means-test older people and a new form of social care insurance, Doyle-Price also announced that Andrew Dilnot and Kate Barker, both advocates of these two solutions, would be among the independent experts the Government has asked to provide their views.

Dilnot was the instigator of the care cap, which he said should be set at the far lower level of £35,000. The Coalition Government announced in 2013 that it was to adopt a revised version of the Dilnot Commission’s recommendations, including raising the eligibility criteria from £23,500 to £123,000. This was due to be implemented in 2016 but has been put back by successive Conservative Governments.

In addition, ahead of the publication of the Green Paper, a number of roundtables will be held to hear a range of perspectives from those representing different constituencies, including carers, service recipients, providers, health services, financial services providers, local government and working-age adults, Doyle-Price said.

Care Markets: December 2017


Government announces plans for 'sheltered rent'

Following Prime Minister Theresa May’s announcement last week that the Government is to drop a proposed cap on housing benefit, it has set out proposals for a ‘sheltered rent’ for sheltered and extra care housing.

The Department for Communities and Local Government (DCLG) said this proposal would keep rent and service charge ‘at an appropriate level, protecting the housing needs of older and vulnerable people’ and, crucially for many providers and their tenants, within the welfare system.

Social housing regulator the Homes and Community Agency will use existing powers to regulate gross eligible rent (rent inclusive of eligible service charges) for sheltered and extra care housing under a new Rent Standard, in the way it does for Affordable Rent.

DCLG said in the consultation document: ‘The Sheltered Rent approach means that we will set an overall cap on the amount that providers can charge in gross eligible rent on each unit of sheltered or extra care provision. It will also, as we currently do for net rents, cap annual increases. It will be determined in accordance with the following model:

‘Sheltered Rent = ((Formula rent +/- 10% flexibility for supported housing) + (£X for eligible service charge) up to a level of £Y).

‘We have committed to bring existing supply into the system at their existing level. New supply will be subject to the cap.’

This will apply from April 2020 but, where relevant, providers will need to continue to comply with the rent reduction requirements to the end of their 2019-20 rent year.

Furthermore, the Government has already announced its intention to reinstate the previous CPI+1% limit on annual rent increases for five years after the end of the rent reduction period and it will consider how this will apply to sheltered rent, through the consultation. It will also further consult with the sector to agree an exact definition of ‘sheltered’ and ‘extra care’ for the purposes of this new funding model.

DCLG said this model offers long-term funding sustainability, and important but proportionate new cost control and oversight measures.

There will also be a ring-fenced grant to local authorities by April 2020 to provide short-term and emergency housing.

Minister for Family Support, Housing and Child Maintenance Caroline Dinenage said: ‘We value the important role supported housing plays and that’s why we have worked closely with providers and listened to their feedback to come up with solutions that will safeguard its future and improve support for those that need a home that is safe and secure.

‘The new flexible funding model and reforms will give housing providers certainty over future funding and drive up quality and provide value for money. The supported housing sector support provides homes from older renters. It also provides a home for other vulnerable groups such as people with learning disabilities, mental ill health, homeless people and victims of domestic abuse.’

Chief executive of Associated Retirement Community Operators, Michael Voges, said: ‘This is an important step forward, and we are pleased to see that the government’s plans to localise rental revenue have been shelved. As a result, we should see new development of extra care pick up again but we will need to see what the fine print of the consultation has to offer.’

The move was also welcomed by Ashley House, which has seen its financial performance hindered by uncertainty about the cap.  Antony Walters, chief executive said: ‘The threat of the LHA cap on supported housing has stifled development and investment in the sector and put many of our important pipeline schemes on hold.’

Walter said the business is now able to push forward on these schemes enabling hundreds of vulnerable people, particularly the elderly, to receive suitable housing with care provision. He added: ‘As we said in our statement last month, the company continues to look to extend and widen its financing options to enable it to invest in the pipeline as it accelerates.’

Care markets: November 2017


Law Commission delivers its event fees verdict

Following a two-year investigation, the Law Commission has concluded that there is real potential for abuse when extra care providers charge event fees. In order to prevent this, the government should regulate the sector and bring in a new code of practice, the Commission concluded.

Its inquiry found that, in some cases, owners of extra care properties not always being told about the charges, which can be up to 30% of the property price, while others are charged when the occupant of the property changes.

The Law Commission proposes that event fees can only be charged when the property is sold or, in limited circumstances, when it is sub-let, when the resident has died or the property is no longer their primary home. However, if a resident’s partner or carer moves in as their principle home, an event fee could not be charged.

It is also recommending a cap on the fees charged for sub-letting or change of occupancy of no more than 10% each year of the total event fee for the sale.

This, and the Law Commission’s other reforms, would only apply to new leases after the reforms are implemented and, in some cases, would take effect on the next sale of an existing lease.

Law Commissioner Stephen Lewis said: ‘For many, event fees are a good way to enable the purchase of a quality retirement property now, by deferring payment of some of the running costs until they come to sell their home later.

‘But, in the worst cases, a few unscrupulous landlords are getting away with very high hidden fees buried deep in the small print of a long and complicated lease.

‘We’d urge the government to crack down on rogue landlords by regulating the sector and making sure that before consumers sign on the dotted line, they have already been told exactly what’s being provided for their money.’

Standardised and transparent information should be provided to prospective buyers at an early stage in the purchase process, including how much the fee is likely to be, how it is calculated, who receives the fee and what the home owner gets in return.

The Law Commission wants to see changes to the Consumer Rights Act 2015 so that if landlords breach the code of practice, event fee terms would likely be unenforceable. Furthermore, guidance and an online database for estate agents and consumers should be created to ensure event fee information is included in all advertisements.

Executive director of Associated Retirement Community Operators (ARCO) Michael Voges said: 'ARCO has been saying for years that we need more regulation on event fees, not less, so we are very supportive of the proposals to add statutory requirements for the disclosure of event fees. It’s been long overdue, and we believe that an event fee that has not been transparently disclosed should not be charged.

‘In other countries, event fees are a well-established mechanism that can enable older people to use their housing equity to ‘enjoy now and pay later’, for example by reducing their service charge or deferring some of the costs of building communal facilities. We believe that the Law Commission’s reforms will lead to increased supply of specialist housing that addresses the housing and care needs of our ageing population.

‘ARCO already runs a Consumer Code scheme, which we assess our members against, and this includes clarity up front about event fees. However, this is only applicable to our members and thus not compulsory for organisations outside of ARCO. Therefore, we support the Law Commission’s proposals to make disclosure compulsory, as we believe this will increase consumer protection and thus confidence in the sector.

‘As an additional step, we would like to encourage the Government and Law Commission to introduce additional regulation in the form of a Retirement Communities Act or similar, like we see in other countries.’

Care Markets: April 2017