The Prime Minister has confirmed that there will be a General Election this year. This brings an opportunity to offer the sector the attention and reform it so desperately needs and deserves. With a disappointing year for adult social care in 2023, what can we expect to see this year, and what are the challenges? Apologies in advance for the doom and gloom.
Finances
The Government published its White Paper, ‘People at the heart of care’ on 1 December 2021. This vision for adult social care reform was 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.
This was widely supported and endorsed by the sector but there were a lot of concerns about whether the level of funding would match the ambition.
Fast forward two years and the Local Government Association anticipates that for the financial year 2024/25, the costs of providing social care, and the increased demand on services, will add £15 billion (28.6 per cent) to the cost of delivering council services. The Office of National Statistics’ data [published January 2023 and due for refresh this month] has projected a 1.3 million increase in the population of over-65s by 2028. This comes with a prospective significant increase in the demand for adult social care services and unless this is matched with a significant injection of funding, we face a concerning picture for the future of adult social care in 2024 and beyond.
We have kept you updated on local authorities’ position in relation to overspending and budgets over the last few months. In the last year, both Nottingham City and Birmingham City Councils have issued section 114 (bankruptcy) notices and there is huge concern that this is the start of a trend that we will see in 2024. Once upon a time a council issuing a section 114 notice would be as a result of financial mismanagement, but it is becoming increasingly likely that they will be issued due to dramatic changes in funding [we talked about absolute duties, the type that local authorities could be bankrupted by due to demand, in our Podcasts on Principles series, episode three Distinguishing powers and discretions from duties]. Senior local government experts and council chief executives have warned that every council in England will be effectively bankrupt within the next three years unless major structural reform or additional funding is forthcoming.
Unfortunately, however, as we approach a general election and the associated campaigning, it is likely that policy makers will prioritise funding for the NHS, as it garners more public interest, and social care will be the poor relation, as ever. With a particularly disappointing 2023 for the sector, one must ask, can adult social care continue to withstand this lack of political attention?
Workforce challenges
Skills for Care’s The State of the Adult Social Care Sector and Workforce 2023 report highlighted that if the workforce grows in line with proposed demographic changes and demand, an extra 440,000 roles will be needed by 2035. It further highlighted that presently there are 440,000 posts filled by people who will reach retirement age in the next 10 years. Therefore, there needs to be a big push on not only recruiting younger people into the sector but also focusing on retaining this workforce.
We reported in the last Round-Up that 18–24-year-olds make up only 8% of the social care workforce. The reasons for this could be that there is little positive portrayal of care careers, and a lack of clear career progression opportunities [the Government has recently published its Care workforce pathway for adult social care which aims to address this, see article below]. Knowing this, and that in 2023 the UK’s unemployment rate was 4.2%, compared with 3.7% in 2022, and predicted to be 4.6% in 2024, there is an opportunity for the Government to do something here, but whether they will or not remains to be seen.
It seems that this may have been a factor in the recent decision [described by many in the sector as damaging and incredibly unhelpful and discussed in our 07 December Round-Up] to remove the right of care workers to bring their dependants to the UK. This is only going to make a move less palatable, and this is clearly the intention with the government using what they perceive as populist decision-making. The emphasis seems to be solely on a misguided belief that the UK population opposes further overseas labour. Yet, if the consequences of this choice were transparent to everyone, it is likely that the majority would prefer the government to enhance the management of the immigration system, rather than risk the collapse of our social care system. Victoria Atkins, Secretary of State for Health and Social Care, has said she wishes to recruit more British people into social care, but the fact is that almost one-in-five care workers in the UK are of non-British origin. In the year-ending September 2023, almost 100,000 work visas were granted to people entering direct employment in care.
Liberty Protection Safeguards
On 5 April 2023, the Government announced that it would be delaying “beyond the life of this Parliament” the implementation of the Liberty Protection Safeguards (LPS) to replace the Deprivation of Liberty Safeguards (DoLS).
If the Conservatives win the next election, it is uncertain how much of a priority the implementation of LPS would be for them; it being shelved last year does not indicate it is high on their agenda. Even if they did prioritise LPS, the timescale to revive the policy, deal with the outstanding controversies, and re-establish the relevant civil service departments [they were moved very quickly onto other policy areas] to design and implement the road map this would take us well into 2026 or 2027.
Labour voted against the Mental Capacity (Amendment) Act 2019 which was the basis for the LPS. It therefore seems unlikely that if they come into power, they will pick this up for implementation.
We were awaiting LPS implementation to inform a new Code of Practice for the MCA which is now massively outdated due to changes in case law. The draft Code can be viewed here, ignoring chapters 13-20 which relate to LPS. Whilst we wait for the revised Code, 39 Essex Chambers have produced an unofficial update highlighting the passages that are dangerous in the current Code.
Mental health reforms
The Mental Health Act reforms were included in the 2017 and 2019 Conservative manifestos and are long overdue. Yet the decision to drop the draft Mental Health Bill from the King’s Speech meant that reform would not happen before the next general election. This was despite evidence that the current system has unacceptably high rates of detention, racial disparities in the use of the Act, and the inappropriate sectioning of autistic people and those with learning disabilities.
Since the Conservatives have not implemented something which was in two previous manifestos, it looks unlikely that it would be a priority if they formed a new government.
Labour has pledged to reform the Mental Health Act 1983 if elected to power at the next general election, with Shadow health and social care secretary Wes Streeting committing to introduce a bill to overhaul the Act as part of its first legislative programme, but this is very much a wait and see scenario.
The future – what is needed?
The foremost agenda for the upcoming government should be the implementation of a comprehensive, long-term reform plan for adult social care. Initially, the focus should be on national policy changes to provide immediate support to the existing sector. However, the primary objective should be to establish a robust funding settlement accompanied by a well-defined and strategic plan for the long run. Additionally, there is a pressing need to shift from a crisis-centric, deficit-oriented approach to one that capitalises on individuals’ strengths, fosters positive relationships, and enhances community connections.
The resilience of the social care workforce stands as a significant asset. The departure of people from the sector is not attributed to the nature of the work being distasteful or unpleasant but rather stems from the longstanding feelings of disrespect and being undervalued experienced by social care professionals. Despite prevailing public and government perceptions, those who persist in this field do so recognising the critical significance and necessity of their roles. Addressing the workforce issues in the sector will mean that more people may actively choose a career in social care.
The financial structure of local government is fundamentally flawed, putting the entire sector’s sustainability in jeopardy. A convergence of factors, including escalating demand and costs, depleted reserves, and a substantial decline in income, has created a dire situation. The mathematical outcome appears inevitable: unless swift and radical reforms are implemented, more council effective bankruptcy looms on the horizon. Regardless of the colour of the next government, now is the time for all parties to prioritise social care and build a more coherent and sustainable plan for its future.
In our fortnightly Round-Up we will be bringing you the information and analysis of how all of this plays out over the next 12 months, including our opinion on what this actually means in practice.