Demands on service, budget cuts and the pandemic
Demands on service
Demands on social care have been increasing year on year - and this has only been amplified by the pandemic. The number and rate of requests for social care has increased from both working age adults, and people aged over 65. According to the Kings Fund, in 2018/19, there were 1.9 million new requests for social care support, this is 3.8% more than 2017/18.
These increases are driven by several factors: an ageing population, an increase in the number of working age adults, and an increase in need due to more people living with long term conditions, including complex medical conditions and mental health needs.
The 2020 ADASS (Association of Directors of Adults Social Services) Coronavirus Survey has shown an overall increase in the number of people with a social care need presenting to local authorities. This report outlines the temporary closure of services, the rapid discharge of inpatients and the reduction in hospital admissions, the increase in carer breakdown attributed to self isolation requirements and the lack of testing for care staff, the increase in rough sleepers alongside the government’s directive to find emergency accommodation for all, and the downward trend in the number of providers of social care - all a direct result of the pandemic and all have placed immense demand on an already stretched sector.
The Institute for Government says that these demands are reflected in the huge £1.6 billion of additional spending of local authorities in England during March and August 2020, and the forecasted additional £2.3 billion for adult social care over 2020/21.
The pandemic has placed immense pressure on all public services, particularly in social care where longstanding financial pressures have been intensified as local authorities have taken a huge financial hit. Budget cuts, along with staff shortages, can prevent the most vulnerable from receiving the help that they need.
Despite increasing demand, years of cuts and austerity measures means funding for social care has been gradually reduced, resulting in many resources being stripped back. The 2019 Performance Tracker produced by the Institute for Government and CIPFA, has shown a clear decline in the quality of services as a direct result of cost-cutting measures. Public spending on adult social care has fallen by 2.1% over the past decade, with real-terms local authority spending on social care being £700 million below what it was in 2010/11.
Since the start of the pandemic local authorities income from social care has fallen - the ADASS forecast estimates that the loss of client contributions cost £190m in 2020, with the IFG highlighting how loss of revenue from council tax, business rates, sales fees and other charges - all lost due to the pandemic and only partly covered by central government - means that their ability to spend on social care is severely limited.
Despite efficiencies being achieved, it is not sustainable in the long term. This is not just a problem affecting adult social care, children’s services are facing similar pressures.
On top of the issues of budget and demand, the pandemic has brought new and difficult challenges to the social care sector.
The size and task of managing infection control in a de-centralised and underfunded sector, was greatly under-appreciated. The sector was left with no clear PPE guidance specific to social care and many front-line care staff felt they were inadequately protected. The National Audit Office report into the supply of PPE during the pandemic has shown that the adult social care sector only received 10% of its estimated need of PPE from central government, with individual private and voluntary providers having no choice but to source their remaining requirements from wholesalers or local resilience forums - often at a grossly inflated cost. These difficulties put onto social care undoubtedly caused additional uncertainty, stress and anxiety for the sector and its staff.
The pandemic also exposed the social care sectors fragile workforce. A heavy reliance on bank and agency workers, zero-hours contracts, as well as a major staffing shortages, plus general poor conditions of low pay and poor benefits e.g. no sick pay, and a high staff turnover - all of which have been contributed to the scale of the impact of COVID-19 seen in care settings amongst service users and staff.