Social care: the forgotten front line


By Dr Eleanor Roy, CIPFA Health and Social Care Policy Manager

The fact that social care has been in crisis for years is widely recognised, with the sector facing mounting levels of demand and unmet need, workforce shortages, an increasingly fragile provider market and significant levels of under-funding. The COVID-19 pandemic has revealed clear weaknesses in the sector’s resilience, and will exacerbate them.

Recent figures on the number of COVID-19 related deaths in care homes, and the comparative death figures for the same time last year, clearly demonstrates that social care is the forgotten front line in this pandemic.

COVID-19 is creating additional demand and cost pressures in social care, including additional staffing, costs of infection control and PPE, purchase of services from providers in expectation of demand, and providing services for vulnerable people relying on care from friends or family who have had to self-isolate or can no longer provide care.

Like the NHS, social care will not only have to deal with the immediate crisis, but will also face increasing demand and pressures in its aftermath. There will be a need for support for those recovering, not only in care homes, but also in home and community settings. There will also be a backlog to deal with, including all the areas of ‘business as usual’ which have been paused due to social distancing.

The enhanced discharge arrangements and the removal of the need for assessments, together with councils purchasing services in expectation of demand and moving to payment on the basis of planned services has indeed sped up the provision of social care. However, whilst this has been critical in freeing up NHS capacity, it has not come without associated problems. 

The removal of financial assessment means that those who may normally be classed as self-funders, or would financially contribute to their care, may now be in receipt of publicly funded care. This will impact on social care provider income, as the rates paid by self-funders are generally higher than those in receipt of publicly funded care.

The relevant assessments will need to be conducted at some point. This risks not only creating a backlog after the crisis has passed, but perhaps also a situation where individuals receiving publicly funded care may have it retracted after an assessment.

Whereas some providers may be experiencing increased demand, others are experiencing losses due to under-occupancy of facilities, as a result of deaths and individuals delaying uptake of services due to fears that it is unsafe. 

Despite the severe financial difficulties they are facing, councils are recognising the need to support the fragile social care provider market, and taking action to support providers in meeting the additional costs they face. Many are also providing additional sustainability payments to providers to ensure they stay afloat. 

Having providers fail during this time of critical need would be disastrous, and would place further burdens on local authorities to identify alternative provision. There is an urgent need for this to be recognised. While the government have provided £600m for providers via the Infection Control Fund, there are strict limits on how this can be used, thus it cannot compensate for lost income.

Compared with the sums already announced to support businesses and the NHS, the critical support needed to enable local government to continue to deliver essential services could be secured by a relatively smaller sum in comparison. 

While the £3.2bn allocated from the emergency response fund is welcome, this has to cover the wide range of services councils are providing in response to the outbreak, not only social care. A sum nearer to the £4bn identified recently by the LGA to properly fund social care alone would be a good start.

Given the longstanding pressures on local government funding, and the fact that social services were already over-stretched, the sector entered the current crisis on the back foot.

Moving forward, it is essential that:

  • sufficient funding is provided to cover additional costs of social care and wider council services as a result of COVID-19
  • the weaknesses revealed in the social care sector’s resilience should act as a catalyst to drive the long awaited reform of social care funding
  • such reform should be strategically informed, financially sustainable, equitable and underpinned by a clear understanding of the challenges of funding social care
  • until a long-term solution to the issue of social care funding can be implemented, adequate funding must be provided to put the sector on a sustainable footing and enable it to withstand future shocks.

This article first appeared in Public Finance.

Further reading

If you are looking for further comment, insight, support and resources relating to social care, our Building Sustainable Social Care page provides information on overall context and how CIPFA can help. You can also find our reports, publications and help for the very considerable challenges, even pre-COVID-19, that professionals face.

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