Public Accounts Committee publishes report into Adult social care in England, HC 518 as Sixth Report of Session 2014-15.
The Rt Hon Margaret Hodge MP, Chair of the Committee of Public Accounts, today said:
'We are facing a great adult social care squeeze, with need for care growing while public funding is falling.
The Government’s agenda to change and improve adult social care, most notably through the Care Act, is rightly ambitious. However, it simply does not know whether the care system has the capacity to become more efficient and spend less while continuing to absorb this increasing need for care.
There has been an 8% real terms cut in spending on adult social care between 2010/11 and 2012/13, despite the growth in the number of elderly and disabled people, the groups most likely to be reliant on care. Care and support has been cut, as with less money to spend local authorities have had to focus on those with the most severe needs.
We are particularly concerned that local authorities have cut costs, partly by paying lower fees to providers of care, which has led to very low pay for care workers, low skill levels within the workforce, and inevitably poorer levels of service for users. Safeguarding referrals recorded by local authorities have risen 13% in the two years from 2011.
It is appalling that up to 220,000 people working in the care system earn less than the minimum wage. In some areas, whilst local authorities might pay private providers £13 an hour, the worker only earns the minimum wage of around £6 per hour. It is also unacceptable that around one third of the workforce are on zero-hours contracts.
At the same time 2.2 million people have had to give up work to care for family members, at extra cost to the Government through the benefits bill.
Whilst we welcome the commitment to this agenda of the Departments involved, we are concerned that they do not fully understand the scale of the challenges facing local authorities, or the costs associated with implementing the Care Act.
The Act introduces new burdens on local authorities and requires unprecedented levels of coordinated working between central and local government and across local authorities and health bodies.
The Departments recognise the complexities and risks involved but we are not convinced that the responsible bodies will deliver on these ambitions and are concerned that they are raising expectations too high.
The Departments should quantify the new burdens the Care Act will introduce for local authorities, establish a realistic timetable for implementation given the financial constraints, and acknowledge the limits on the sector’s capacity to absorb the growing need for care with falling public funding.'
The challenge posed to society by the changing and growing need for adult social care is considerable. The need for such care is increasing while public funding is falling. The Government’s agenda to change and improve adult social care is rightly ambitious but achieving these ambitions will require unprecedented levels of coordinated working between government departments, between central and local government and across local authorities and health bodies. The Departments recognise the complexities and risks but we are not convinced that the responsible bodies will deliver on these ambitions and are concerned that they are raising expectations too high. We do welcome the determination of the Department for Communities and Local Government and the Department of Health to get a grip, and their recognition of their ultimate responsibility for the adult social care system as a whole. In this report we set out our concerns and make recommendations in three areas: for collaboration across all bodies involved in the care system; for better understanding of the capacity of the system to cope and for whether money really reaches the frontline services on which people depend; and for the Government’s oversight arrangements to reflect the overriding importance of quality of care in a sector where up to 220,000 workers earn less than the minimum wage and around one third of the workforce are on zero-hour contracts.
Conclusions and recommendations
Adult social care is personal care and practical support for adults with physical disabilities, learning disabilities, or physical or mental illnesses, together with support for their carers. The Government’s objectives are to enhance people’s quality of life, delay and reduce the need for care, ensure positive care experiences and safeguard adults from harm. In 2012-13, local authorities provided or commissioned £19 billion worth of individual packages of care and universal care services. In addition, the NHS spent an estimated £2.8 billion in 2011-12 on social care, while the Department for Work and Pensions’ spending on incapacity, disability and injury benefits totalled £28.2 billion in 2012-13. However, publicly funded care makes up only a minority of the total value of care, and this proportion is decreasing. Most care is provided informally by unpaid family, friends and neighbours. In 2012, the Department of Health announced new legislation, the Care Bill, designed to rationalise local authorities’ obligations and to introduce new duties based on individual wellbeing.
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