Elderly and vulnerable people could be forced to move out of their own homes into institutional care unless the chancellor invests billions of pounds to shore up social services and reform England’s broken care model, The Independent has been told.
In an exclusive interview ahead of Rishi Sunak’s Budget on Wednesday, James Bullion, president of the Association of Directors of Adult Social Services (ADASS), warned the care system risked “catastrophic failure in some areas” without urgent changes to the way vulnerable people, including younger disabled people, are looked after.
He warned the number of people needing care had doubled in some parts of the country since March, as a result of the coronavirus pandemic.
Ministers are planning to bring forward reforms to social care later this year, but Mr Bullion, who leads social services in Norfolk, said the system needed at least £4bn over the next two years “just to keep the show on the road”.
He warned the sector had been rocked by more than 30,000 deaths in care homes from Covid, with a 40 per cent turnover in staff, higher sickness, and more than 100,000 vacancies on top of rising costs.
“We’ve got social care providers who are very much more fragile and at risk than they were a year ago. We were able to pay premiums to providers to keep going, but we've now reached the point where the revenue consequences of the last year will come home to roost. And we're very worried about the impact on the social care market and whether it will still be there for us in a way that it’s been in the past year if we take that support away.”
He said in some areas this could lead to the “catastrophic failure” of providers who could go out of business while others refuse to take more residents.
He warned: “If somebody wants to be supported at home, but we can’t find home-care providers, then we have to start looking at alternatives to make sure their needs are met. You can get situations where, because you can’t be supported at home, you end up being supported in an institutional setting like a care home.
“There are vacancies in care homes at the moment so one of our worries is that if we can’t reshape the way social care works with better wages and recovery, then we might have very limited choices for people.”
He added that rising unmet need in social care would lead to more pressure on hospitals as people’s health worsens.
Age UK has estimated there could be at least 1.4 million people with unmet care needs but Mr Bullion said he believed that had probably increased by at least half a million now.
“If you take March 2020 as a baseline, many people’s health has been made worse as a result of Covid. In some cases, during the peaks, we’ve seen a doubling of the numbers of people we’re dealing with.
“In Norfolk, we normally see 700 people come through our doors in a month, but that’s up to an average of 1,200 now.”
He added: “We need respite from the current situation to stabilise it, we need a recovery model that gets social care on a par with the NHS and gets it functioning properly, and then we need reform.
“If all we get from the chancellor next week is that they’ll be laying out proposals for adult social care later in the year then we will be bitterly disappointed. We think the evidence is there that social care should be part of how you build back better.”
Councils have been given £1bn extra for social care from April along with the option to add a 3 per cent council tax levy. Mr Bullion said this was inadequate to meet the rising costs and not all councils had opted to increase their share of council tax.
“The reality is the settlement left us very short,” he said.
ADASS is calling for a rise in pay for social care workers, with hourly rates of £10.90, equivalent to what an NHS healthcare assistant can earn. Most social care staff are paid the national living wage, which will reach £8.91 from April.
Mr Bullion warned: “The social care workforce needs parity of value with the NHS and that means raising the wages of that workforce. Around 15 to 20 per cent of all care services have got a quality problem. If we want to solve that problem, we’ve got to invest in training and in the workforce. We need half a million new people working in social care over the next 10 years and we won’t get them by keeping wages low.”
MPs on the Health and Social Care Committee have said social care needs at least an annual funding boost of £7bn to begin the process of reform.
Debate has raged over whether care costs could be capped and whether the value of people’s homes should be used to pay for care.
But Mr Bullion said half of the social care budget was spent on looking after younger disabled people who didn’t have any capital of their own.
He said: “Solving the ‘selling your house problem’ will not impact on any of those people, and that's half of our challenge.”
He said the emphasis had to be on “pooling the risk” as much as possible and in exchange the social care sector had to accept tougher regulation and more rights for residents and councils.
“The current arrangements are not working well. People using services have very few rights, they can be evicted just because their needs change, or because they’ve gone into hospital and come out, they can be refused entry. We find people having to move home because companies are collapsing or changing hands. If we’re to ask people to contribute their own resources to social care, people need better protection.
“We can’t just leave the care market to drift, which is I think what's happening at the moment.”
He said the traditional care home model would need to change to one where more people are given help earlier to stay in their own homes or live in their own flats as part of assisted living schemes.
He said: “We have a problem, because our system really rewards very large institutions with high occupancy in order to get to the breakeven point. If you try and fit everything into that one model, you end up dragging in people who could be at home.”
He urged the chancellor and prime minister to summon the bravery of postwar governments.
“In 1948, three things were born, the NHS, the welfare benefits system, and the social care system. All in the same year, under complementary legislation. We have got it right when it comes to health and thinking about that as part of our national infrastructure, but we need to return to the spirit of those times. We need to get social care right, otherwise we are going to be creating poor health.
“I see lots of evidence of local politicians having to make brave decisions with adult social care as a result of funding constraints. What we need is national bravery.
“That will take a long-term view and to see it as an investment; a practical business case for growing the economy and for minimising future costs for future generations.”
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