This autumn has brought its usual crop of studies on the state of the social care sector. They contain some important insights for councils as they step up their preparation for the Care Act 2014.
The Care Quality Commission’s 2013-14 report on the state of health care and adult social care confirms the continuing reduction in adults receiving local authority care since the high point in 2008-09.
Over that period 500,000 fewer people are getting services, with the biggest proportionate drop being in learning disability services. This sits in stark contrast with the ambition to be more preventative.
Directors report a 26% reduction in budgets for adult social care over the past four years; some £3.5bn. This is set against demographic pressures running at £400m per year.
According to the National Audit Office, auditors are increasingly concerned about local authorities’ capacity to make further savings, with 52% of single tier and county councils not being well-placed to deliver their medium-term financial plans. Together with the uncertainties around the NHS’s future funding, this suggests real issues about the affordability of the Care Act.
By contrast, Skills for Care reports that the sector is growing and adapting to changing needs. Numbers employed in care have grown from 1.32 million in 2009 to 1.52 million in 2013. It projects this trend, together with increasing demand, could see some 2.2 million jobs by 2025. Over that period, jobs where the employer is a direct payment recipient have grown to 145,000, almost a 50% increase.
Concern continues about the viability of some corporately owned residential and nursing home providers, now representing 39% of the market, an increase of 2% over the past year.
The Care Quality Commission estimates there are some 50 to 60 providers, dominant in parts of the country or market, whose collapse would represent a serious challenge to councils. From April 2015, the act gives a new duty to CQC to assess their financial sustainability and to give councils early warning of possible business failure.
The Institute of Public Care has advised CQC of the main factors affecting stability in the market. These are the availability, training and pay of a skilled workforce; a rise in property values; low fees paid by councils; and increasing regulatory demands. The greatest risk is a provider that does not own the properties it operates in and has a concentration of homes in poorer areas.
Perhaps the most striking figure this autumn is the newly revised estimate that some two million people will become carers every year. They will have new rights to assessment and support under the Care Act. While they are unlikely to march on town halls collectively, it is vital that councils develop services and contingency plans that sustain them.
Andrew Cozens is an independent social care and health specialist