The government has launched an action plan to safeguard telecare users from the switching off of the UK’s analogue phone network.

Its replacement by a fully digital network will mean that existing services connected to the copper-based system, including many telecare devices, will need to be switched over by January 2027.

The switchover was initiated by the telecommunications industry, independently of government, with companies migrating customers to a digital service against an initial deadline of the end of 2025.

However, in December 2023, the then government said there had been a number of “serious incidents” in which telecare users’ devices had failed following migration, putting them at significant risk.

‘Telecare users must be protected’

“There is a risk that the process of migrating telecare users to digital landlines will disrupt their telecare services,” said minister for care Stephen Kinnock, in a statement launching the telecare action plan.

Stephen Kinnock (photo: Richard Townshend Photography)

“Telecare users must be protected during the digital phone switchover and every effort must be taken to avoid these risks.”

The telecare national action plan, which is targeted at councils, telecare providers, telecoms companies and housing providers, has four objectives:

1. That no telecare user will be migrated to digital landline services without the communication provider, the user or the telecare service provider confirming that the user has a compatible and functioning telecare solution in place.
2. That use of analogue telecare devices is phased out to ensure that only digital devices are being used by a deadline that the Department of Health and Social Care (DHSC) will set following talks with stakeholders.
3. That telecare users, their support networks and their service providers should understand what actions they need to take to ensure a safe migration to digital phone lines.
4. That stakeholders identified within the plan collaborate to safeguard telecare users through the digital phone switchover.

Councils sharing data with telecoms sector

The DHSC and Department for Science, Innovation and Technology (DSIT), which are jointly responsible for the action plan, said a key priority under objective 1 was that councils and telecare providers shared data about service users with telecoms providers, so they could put additional safeguards in place for them.

The Local Government Association (LGA) and London Office of Technology and Innovation (LOTI) have drawn up a data sharing template to streamline the process of councils and telecoms providers reaching agreements.

This stated that the lawful basis for councils sharing the data was “substantial public interest”, based on it being in the best interests of people with care and support needs using social care for them to do so.

The DSIT and DHSC said they would engage with local authorities who had not signed data sharing agreements to understand the barriers to doing so.

Continued use of analogue devices

The departments said objective 2 required action to stop the manufacture, sales and purchase of new analogue telecare devices. Ministers wrote to telecare suppliers in September 2024, requesting that they do not sell analogue-only devices, while the departments are also working with consumer groups to highlight the risk of people purchasing such equipment.

However, they added that, while their long-term ambitions were for telecare users to have fully digital devices that were resilient to power cuts, interim solutions that enabled the use of analogue devices on digital phone lines were permissible in the medium-term, so long as there was adequate risk assessment, testing and ongoing monitoring.

The action plan said testing had shown that the reliability of such devices was dependent on the model, the telephone line type and provider and equipment used by the alarm receiving centre, meaning telecare providers needed to “ensure the reliability of the specific combination of equipment and services they use”.

Raising awareness among telecare users

It added that a national awareness raising campaign on the switchover, to be launched by the telecoms industry in early 2025, would be “tailored to the unique characteristics of telecare users and their support networks”.

The action plan also highlighted the risks of criminals exploiting the switchover to target people with scams, by tricking them into sharing personal information.

It pointed to LGA guidance on the issue, which advised councils to ensure that frontline staff were aware of the switchover and reported potential scams to trading standards while also raising them as safeguarding concerns.

The LGA guidance also urged co-ordination between children’s and adults’ social services teams and trading standards to identify which residents may be vulnerable to scams and to proactively safeguard them, for example, through setting up call blocking services.

The new commission on social care reform should deliver final proposals by the end of this year, not by 2028, as planned, according to the author of the last major review of the sector.

Andrew Dilnot told MPs that a host of challenges facing people who need care, families, care staff, councils, providers and the NHS had gotten worse because of a failure to reform the system since his commission reported in 2011.

The economist was speaking to the House of Commons’ health and social care select committee in the wake of the government’s announcement of a commission – headed by Baroness (Louise) Casey – to draw up proposals for adult social care reform.

Casey, a former senior civil servant who has led several other public service reviews in recent years, is due to issue an initial report next year and her final conclusions by 2028, a timeframe heavily criticised by sector leaders.

Casey ‘should report by end of 2025’

Dilnot, who led the last social care commission, in 2010-11, said Casey should be able to deliver her recommendations by the end of this year, and would only be prevented from doing so by a lack of political will from government.

“I think Louise Casey will very quickly work out what needs to be done,” said Dilnot. “And I think she should say what needs to be done as quickly as possible…I think it would be perfectly feasible for the government to expect by the end of 2025, [to be able to say] ‘actually, we know what needs to be done’.”

He added: “It really is a matter of political courage and political decision-making. We know things can happy very quickly once a government, a House of Commons, decides to get something done.”

What Dilnot recommended

Dilnot’s 2011 report made two key recommendations:

• Increasing funding for the existing means-tested system, to address unmet and under-met need.
• Extending the means-test to enable more people to take advantage of state-funded care and capping people’s total costs for their personal care, to insure the population against catastrophic care costs.

The first recommendation fell foul of the austerity policies of the 2010s, but the coalition government legislated to enact the second through the Care Act 2014. However, its implementation, due in 2016, was first delayed and then ditched altogether by the Theresa May government.

It was then revived in modified form, in 2021, under Boris Johnson, but its implementation was delayed again before the plan was scrapped by the current Labour government on attaining power last year.

Dilnot’s list of costs of failing to reform social care

Dilnot said the priorities for reform remained the same but the need to take action had become more urgent since his report, listing several costs arising from a failure to act:

1. The potentially large and unknowable costs faced by individuals. “I’ve often likened needing social care to being in a shop with no prices,” said Dilnot. “Because you know how much it will cost each week or month for your partner, your mum or your grandma to be looked after, but you don’t know how long it’s going to go on for.”
2. Self-funders paying more for their care than local authorities.
3. People having to build up savings in case they need a lot of care. “80% of 65-year-olds will need social care before they die, but the amount they will need is unknowable and most of them actually won’t need very much and a small number will need an awful lot,” Dilnot said. “But in the current system all of them are faced by needing to set aside a lot of money in case they are one of the unlucky ones. So, a significant cost of inaction is that many people, not with especially large amounts of income and wealth, are setting aside money that they won’t actually need because there is no pooling of the risk.” 
4. Premature loss of function and loss of life arising from unmet need.
5. The difficult decisions families face about, for example, making home adaptations now or saving money should a loved-one need care in future.
6. The impact of informal care on people’s ability to work and function.
7. The direct effects on the NHS of inadequate social care. “If you are an elderly person with significant social care needs, you’re very likely to have some continence challenges,” Dilnot said. “That’s quite likely to lead, if you don’t have a downstairs loo, to you falling down the stairs and ending up in hospital unnecessarily.”
8. The indirect impact on the NHS. “Because there isn’t good social care that we can get people into when they need to leave the NHS, we have NHS hospitals that have many people in them who don’t need to be there,” said Dilnot. “The frustration that causes to clinicians is extraordinary.”
9. The impact on providers. “The lack of a functioning market means that there are very low returns to innovation and investment and so not much innovation and investment going on,” said Dilnot. “[Providers] are squeezed – we have endless stories of providers handing their contracts back to local authorities because they simply can’t make things work…This could be an area where we could see economic growth if we had a sensible model. We don’t so we can’t.”
10. The impact on care staff. “Staff are under really intense pressure and are not paid enough and have every few opportunities for career progression,” Dilnot added. “All of that is a function of the model we have.”
11. The impact on local authorities. “The inadequate funding of social care means all other services that local authorities provide are being squeezed and the decisions that local authority staff are asked to make would try the wisdom of Solomon,” he told MPs. “If any of you wants to experience a really stressful period, go and sit alongside somebody who is making decisions in a local authority about how to allocate resources to people who desperately need care.”

Asked by MPs why his reforms had not been implemented, Dilnot said: “Somehow, for reasons I don’t quite understand, not enough people make enough noise about [social care], so it feels like an easy thing to pull back on.”

He added that, while there had been consensus on what needed to change in social care, there had not been sufficient agreement on how this would be paid for.

‘Tiny amounts of money’ required to reform care

This is despite spending on adult social care – roughly £30bn a year currently – amounting to just 2% of total public spending – and the reforms that Labour scrapped last year being due to add a further £5bn a year to costs over the long-term. This compares with a £22.6bn increase in annual NHS funding, from 2023-24 to 2025-26, announced by Labour last year.

“So these are tiny amounts of money compared to overall levels of public spending and very small amounts of money compared to the amounts of money that have been added, with enormous support, to the health service budget,” he added.

Dilnot said that, while improvements to the current means-tested system should be funded through general taxation, there was a case for exploring a different way of resourcing an expansion of people’s entitlements to social care.

He said the health and social care levy – a 1.25 percentage point supplement to national insurance, introduced by the Boris Johnson government, in part to fund social care reform, but then scrapped under Liz Truss – was “quite an interesting idea”.

“I think that one of the things that Baroness Casey will undoubtedly want to look at is whether there’s an argument for something like that,” Dilnot added.

The government will set up an independent commission to recommend long-term reform to adult social care, it announced today.

The body, which will be led by former senior civil servant Baroness (Louise) Casey, will examine the key issues facing the sector today before recommending changes designed to help achieve the government’s ambition of creating a ‘national care service’ and based on a cross-party consensus.

Care minister Stephen Kinnock said the Casey Commission would “tackle both the immediate issues and the fundamental challenges that must be addressed if we are to get our adult social care system back on its feet and fit for the future”, with a view to ensuring “everyone is able to live with the dignity, independence and quality of life that they deserve”.

Casey review due to report in 2028

However, the commission is not due to issue its final report until 2028, sparking concerns that the challenges facing the sector will deepen in the meantime.

Alongside the announcement, the Department of Health and Social Care (DHSC) pledged a series of other changes to adult social care, including:

• Increasing the 2024-25 budget for the disabled facilities grant (DFG) by £86m, to £711m, to fund more home adaptations for disabled and older people to enable them to remain independent for longer.
• Skilling up social care staff to carry out more health tasks, such as blood pressure checks, to reduce the need for people to travel to NHS settings.
• Developing a shared digital platform for health and social care to enable staff to share information in a timely fashion.
• Creating national standards and guidance on the use of technology in social care to enable people needing care, families and providers to choose the most effective and safe tools.
• Reforming the Better Care Fund – which pools a portion of NHS and local authority budgets – to focus it on tackling emergency admissions, delayed discharges and admissions to long-term residential care.

Third commission on social care reform in three decades

The Casey Commission is the third independent commission on social care reform in England to be created over the past three decades.

It follows the Royal Commission on Long Term Care for the Elderly, set up by the New Labour government to examine the short and long-term options for developing a sustainable funding system. While some of its recommendations, delivered in 1999, were accepted, ministers rejected its key proposal of introducing free personal care for those aged 65 and over.

Eleven years later, the coalition government established the Dilnot Commission, to examine how to deliver a fair, affordable and sustainable funding system for social care in England.

Its proposals – chief among them a cap on people’s lifetime liabilities for personal care – were accepted and enacted through the Care Act 2014. However, despite successive governments promising to introduce versions of the commission’s proposals, such plans have all been dropped, most recently by the current Labour administration.

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‘Political point-scoring’

“Previous attempts to reform adult social care have failed due to a destructive combination of party political point-scoring and short-term thinking,” said Kinnock. “Baroness Casey’s commission will build cross-party consensus, and will lay the foundations for a national care service that’s rooted in fairness and equality.”

The commission will begin work in April this year, delivering an initial report in mid-2026, setting out the key issues facing the sector and recommendations for medium-term reform.

The second phase, reporting by 2028, will recommend long-term reforms, which the DHSC said would “look at the model of care needed to address our ageing population, how services should be organised to deliver this, and how to best create a fair and affordable adult social care system for all”.

Commission welcomed but concerns over timescales

Sector bodies welcomed the announcement of the commission, but raised concerns about the length of the timescales it was working to.

Association of Directors of Adult Social Services (ADASS) president Melanie Williams said it looked forward to working with Casey on the project, but warned: “Unfortunately, the timescales announced are too long and mean there won’t be tangible changes until 2028.

“We already know much of the evidence and options on how to reform adult social care…and worry that continuing to tread water until a Royal Commission concludes will be at the detriment of people’s health and wellbeing.”

For Age UK, charity director Caroline Abrahams described the announcement as “unequivocally good news”, but raised concerns about the government’s willingness to implement the commission’s recommendations, as well as the timeframes involved.

“Even if all goes well the reality is that it will be the early 2030s before older people and their families get substantial benefit from a transformed approach to social care – fully thirty years after Japan and Germany modernised their social care systems,” she added. “That’s a source of profound regret and it leaves today’s older people and their families to make the best of a system that is widely agreed to be letting many down.”

King’s Fund chief executive said that the commissioned offered the opportunity “to break the cycle of failure to reform social care”.

She added: “We believe the first phase of the commission should focus on funding and on measures the government could quickly get on with implementing, such as work to improve the use of data and technology in the social care sector, better integration with the NHS and making adult social care a more attractive career. Work on many of these issues is already underway but should be sped up.

“But we urge the government to accelerate the timing of the second phase of the commission which focuses on creating a fair and affordable social care system. The current timetable to report by 2028 is far too long to wait for people who need social care, and their families.”

By Simon Bottery, King’s Fund

On the day before the Budget, I held a round table with social care leaders on the government’s ambition for a ‘fair pay agreement’ to raise care worker pay.

This would involve creating a negotiating body, bringing together care providers and unions, to agree higher wages and better terms and conditions for care staff.

“Will the plans happen?”, I asked. The sector leaders were largely positive that they would.

The next day, the Budget loaded care providers with big new national insurance bills. I quickly got a text from one of round-table participants, who wrote: “I wonder what the responses would be if you re-ran that question now?”

From caution to alarm about government social care plans

Fair to say that much of that positivity might have evaporated. Some at the event – mainly social care providers – had already been very cautious, fearing they would be expected to bear the costs of a future increase in pay rather than – as they hoped – having the cost met in full by the Treasury.

So the way in which the Treasury loaded those same care providers with extra staffing cost from increased national insurance contributions (NICs), which, in the worst cases, will make their businesses uneconomic, will have turned up the dial from ‘caution’ to ‘real alarm’.

One large voluntary sector provider, employing 6,000 staff, said the increase in NICs would add £5m to its costs, against a budgeted surplus for the year of just £2.7m.

The owner of a small group of care homes told BBC Radio 4’s Today programme that the measure would increase their costs by £200,000 a year, with the rise in the national minimum wage adding another £500,000.

Chancellor ‘confident’ care services can bear tax rise

The chancellor, Rachel Reeves, was unrepentant. Though “not immune to criticism”, she told the BBC’s Laura Kuenssberg that, despite the costs increases, she was “confident” that care services would continue to operate properly.

She pointed to the Budget providing councils with a 3.2% real-terms increase in available resource in 2025-26, including a £600m grant for children’s and adult social care, as the route through which cost pressures could be met.

It is true that the 3.2% increase in spending power is better than it might have been, even if it doesn’t quite rise to the heights of the “significant rise” called for by the Local Government Association.

Councils ‘staring at a financial precipice’ 

However it still leaves many local authorities staring at a financial precipice and in no position to give care providers the sorts of increases they need to cover increasing costs.

Four in five councils are expect to overspend their adult social care budgets this year and directors fear the financial situation will be worse next year.  The 3.2% increase is also some way short of the 4% average annual funding increase for NHS England over the next two years.

That has left the sector – providers, local authorities, and people who draw on services – with a sense of dismay at the prospects of real change in social care.

Does the government ‘get’ social care?

The Budget has added to a strong sense that the government doesn’t ‘get’ social care – or, if it does, that it doesn’t see it as in any sense a priority.

They remember that virtually the first thing the new government did was to cancel the introduction of a ‘cap’ on a lifetime care costs and wider charging reforms that were due to be introduced in 2025, in the process saving £1.1bn – more than the £600m promised at the Budget.

Though this was part of a broad package of cutbacks and the cap was by no means universally popular – some councils had already argued publicly for it to be postponed – it was not replaced with an alternative vision for the future of social care.

The best the government could muster was a rumoured royal commission on social care, to report some time in the future.

Benefits of fair pay agreement come at a cost

The one concrete measure that government has promised is the fair pay agreement for care workers. It is a bold proposal and one that would meet an undoubted need – an increase in care worker pay so that the sector could compete for staff with other industries.

That would potentially allow social care to offer more and better support to people, an ambition that is widely shared by government, providers, local authorities and, of course, people who draw on care and support.

But it will come at a cost and, after the Budget, the government now has an even bigger job on its hands to convince the social care sector that they will not be expected to bear it.

Simon Bottery is senior fellow, social care, at the King’s Fund 

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The £600m for social care announced in today’s Budget risks being swallowed up by wage and employer tax increases, leaving little or nothing to address spending pressures, sector leaders have warned.

Both council and adult care provider bodies sounded the alarm over the impact of next year’s 6.7% rise in the national living wage (NLW) – which will benefit many thousands of care workers – and increase in employer national insurance contributions (NICs).

Chancellor Rachel Reeves announced the measures today, alongside news that councils would receive at least an extra £600m in grant funding for social care in 2025-26. This was part of a wider grant package worth £1.3bn which, along with other revenue increases, would give local government a real-terms rise in resource of about 3.2% next year.

How £600m for social care measures up

The Treasury did not confirm whether the £600m was for adults’ services, children’s services or both, or how much extra resource councils will have available to spend on social care next year, notably through increases in council tax and the adult social care precept. These details will be set out in the draft local government finance settlement, due later in the year.

The extra £600m is worth about 1.5% of the £38.6bn councils have budgeted to spend on adults’ and children’s social care in 2024-25.

It also falls far short of the £3.4bn in additional pressures that the Local Government Association (LGA) has calculated councils will face in adults’ and children’s social care in 2025-26, compared with 2024-25.

Extra costs to sector from wage and tax rises

However, the Budget also brought significant additional costs for social care services, in the shape of the NLW rise, which will benefit many thousands of care workers, and the increase in employer NICs, both of which come into force in April 2025.

Under the latter – the biggest tax-raising measure announced by Reeves today – the rate employers pay will rise from 13.8% to 15% and the threshold of employee earnings at which firms start paying the tax will decrease from £9,100 to £5,000 a year.

The government has also set aside about £5bn a year to compensate public sector employers, such as councils, for the impact of the rise in employers’ national insurance contributions that comes into force next April.

However, the impact on councils specifically has not been set out explicitly by the Treasury, nor has any funding been announced to cover the measure’s affect on voluntary and private sector employers, including care providers, though the smallest businesses will be protected.

Extra adult social care costs ‘will almost certainly absorb £600m’

The LGA said that the NLW and employer NICs increases “will almost certainly absorb all of the [£600m] grant increase for many councils even if it is spent wholly on adult social care”.

This would leave “little or nothing to address immediate challenges in adult social care, such as long waiting times for an assessment of a person’s care needs or the commencement of care packages”.

Its chair, Louise Gittens, also questioned whether councils, in their role as employers, were being compensated for the rise in NICs.

“The government needs to give explicit clarity on whether councils will be protected from extra cost pressures from the increases to employer national insurance contributions,” she added.

‘Vital government fully funds wage rise for sector’

Though the Association of Directors of Adult Social Services (ADASS) welcomed the additional £600m, it delivered a similar message, with president Melanie Williams saying the extra funding “may end up getting used to cover employers’ national insurance increases and wage increases amongst providers”.

“Our last survey showed that councils overspent on adult social care last year by £586m, therefore it’s vital that government fully funds the increases in national living wage or it risks escalating financial pressures on adult social care further,” she added.

For not-for-profit provider body the National Care Forum, chief executive Vic Rayner said: “Even if all the £600m were to be dedicated to meeting the cumulative additional costs that social care employers will now face, it is unlikely to cover the required uplifts. This is before envisaging how hard this will hit people who pay for their own care, in a system desperate for reform.”

Budget ‘risks sending providers over the edge’

The Homecare Association, which represents domiciliary care providers, was also clear that the £600m was “nowhere near enough” and raised very significant concerns about the impact of the increased costs on providers’ ability to stay in business.

“The chancellor has increased costs for providers without providing enough funds to cover them,” said its chief executive, Jane Townson.

“Many small providers are already close to the brink, running on wafer-thin margins. These decisions risk sending many over the edge.”

She added that the association’s research had found that there was a £1.08bn deficit between commissioner fees in England and the amount home care providers needed to pay the existing NLW of £11.44, cover costs and turn a 5% profit.

Social care ‘struggling to cover basic costs’

Care England, which represents independent adult care providers, similarly warned that providers were already underfunded and that the £600m – which it presumed would also cover children’s services – was a “drop in the ocean”.

“We needed a bold step forward, a signal that adult social care matters to the fabric of our society,” said Care England chief executive Martin Green

“Instead, today’s announcement leaves the sector struggling to cover basic costs, pushing it further toward a point where both capacity and access will inevitably decline.”

The Voluntary Organisations Disability Group, which represents charitable providers, said the Budget “falls far short of the commitment needed to put social care on a surer footing”, while also increasing costs for the sector.

Impact of fair pay agreement for adult social care

Alongside the increase in the NLW and employer NICs, its chief executive, Rhidian Hughes, pointed to the increased costs to the sector from the government’s proposed introduction of a fair pay agreement for adult social care, through its Employment Rights Bill.

‘While the commitments to raise the national living wage and improve workers’ rights are of course welcome, the fact that plans, including a rise in employer national insurance contributions, remain unfunded, disregards the significant pressures already facing providers,” he said.

“Seventy per cent of charities are already under-funded for the services they are commissioned to deliver, with the vast majority of costs being staff costs.”

Strain on carers and organisations that support them

A similar message was delivered by the Carers Trust, in relation to the network of local carer support organisations it oversees.

“The [social care] system is broken, piling pressure on carers while the local carer organisations who support them are struggling to meet demand,” said its chief executive, Kirsty McHugh.

“The hike to employer national insurance contributions will see the operating costs of those carer organisations soar while local government remains squeezed, driving some to the brink.”

The British Association of Social Workers said the £600m for social care was “only scratching the surface of what’s needed”.

No mention of long-term social care reform

In one of its first acts in government, the party scrapped its Conservative predecessor’s plan to reform the adult social care charging system, including by imposing a cap on people’s liabilities for personal care, on the grounds that it was unfunded.

However, despite pledging to create “a national care service” – a term it is yet to define – the Budget included no reference to long-term reform of adult social care, a point that drew criticism from sector bodies.

Age UK charity director Caroline Abrahams said that “the seemingly endless wait for the far-reaching, fundamental reform and refinancing of social care that is so badly needed goes on”, adding that this was “heartbreaking for all the older and disabled people who need social care, and their families”.

For think-tank the Nuffield Trust, director of research and policy Becks Fisher said: “It is disappointing that today’s Budget does little to stabilise the beleaguered social care sector in the immediate term, and that the supporting rhetoric made no mention at all of the future reform it so desperately needs.”

The planned fair pay agreement for adult social care is likely to increase costs to councils, as well as those funding their own care, the government has said.

Providers have limited scope to absorb the expected boosts to staff pay and conditions by improving productivity, narrowing salary differentials or squeezing profits, according to an impact assessment of the proposal contained in the government’s Employment Rights Bill.

As a result, the pay increases are likely to have to be reflected in increases to the fees paid to providers by self-funders and councils, with the latter potentially translating into increased costs for central government, said the Department for Business and Trade (DBT) assessment.

However, the assessment did not put a figure on the overall costs of the measure or the amount that would fall on councils.

It was published as MPs backed the Employment Rights Bill by 386 votes to 105, following its second reading in the House of Commons on 21 October 2024.

Body to set pay and conditions for adult care staff

The bill would allow the government to make regulations creating an Adult Social Care Negotiating Body, with a remit to make agreements about the pay, terms and conditions of adult social care workers in England.

The body would have to have representation from unions representing social care staff and sector employers, though may have other members, while the government would determine how it would operate and reach decisions.

Under the bill, the government would also be able to ask the negotiating body to reconsider proposed agreements.

Enforcing social care pay agreements

Where ministers were in agreement with the body’s proposals, the bill provides for them to make further regulations ratifying them, meaning the agreements would be binding on adult social care employers in England and would need to be reflected in workers’ contracts.

This would be enforceable in the same way as minimum wage legislation is, with such enforcement being the function of a new Fair Work Agency.

The objective of the agreements would be to raise pay, terms and conditions in the sector.

Poor pay and terms and conditions

As of December 2023, median pay for care workers in the independent sector was £11 per hour, against a then national living wage of £10.42, according to Skills for Care’s annual report on the workforce for 2023-24.

The sector continues to lag behind most parts of the economy, with 80% of workers in the UK earning at least £11.54 as of November 2023, according to Office for National Statistics (ONS) figures.

Besides receiving low pay, care workers’ terms and conditions tended to be the minimum required by law, said the impact assessment.

At the same time, the vacancy rate in adult social care in England (8.3%) is three times that of the wider economy (2.7%). While the turnover rate in the independent and local authority sectors fell from 29.1% in 2022-23 to 24.8% in 2023-24, this was substantially driven by international staff, the supply of whom has fallen due to immigration restrictions brought in this year.

Also, Skills for Care analysis has found that staff paid more are less likely to leave their roles.

Low pay ‘affecting domestic recruitment and retention’

In its impact assessment, the DBT said that the evidence it had accumulated showed that “that low pay and poor terms and conditions are key factors affecting domestic recruitment and retention, alongside factors such as limited career progression and limited access to learning and development”.

However, while in a normally functioning market, wages would rise in response to labour shortages, provider pay was “highly constrained” by local authority fee rates, in a context where 77% of community care users and 63% of care home residents received state-funded care as of 2022-23.

The assessment said this could not be addressed simply by raising funding for local authorities as councils may not pass these rises on to providers and, if they did, employers may not pass the increased fees on to staff.

It said creating a fair pay agreement for adult social care “provides a means to negotiate for better pay and conditions”, along with “levers to ensure the negotiated outcome is honoured”.

Positive impact for workers, negative impact for providers

The assessment said the agreement would improve the living standards, health and wellbeing of care workers. However, the impact on providers would be negative, due to increased labour costs, which would be partially offset by cost savings from improved retention.

The DBT said that providers had limited scope to raise productivity in order to absorb these costs because of the labour intensiveness of social care. If they were unable to raise their fees to compensate, due to local authority budget constraints, this would squeeze profits, threatening the viability of some providers, particularly smaller businesses.

The department said it would expect the costs of the fair pay agreement would “likely lead to higher costs for local authorities’ commissioning services and for self-funders”, with the higher council costs potentially requiring more funding from central government.

However, it was not able to quantify the costs because these would be dependent on negotiations between employers and unions through the Adult Social Care Negotiating Body.

Mixed impact on people needing care and carers

The impact on people needing care and unpaid carers was mixed, based on the impact assessment.

It added that people with care and support needs may benefit “both from the additional supply [of workers] to meet demand and from more productive carers who are retained for longer, with greater experience and skills, and more motivation and effort in their work”. This may reduce the burden on unpaid carers by reducing unmet need.

However, it said the increased costs faced by self-funders may increase unmet need and pressures on unpaid carers as a result of people buying less care.

After passing its second reading in the Commons, the bill will now be scrutinised by a committee of MPs, whose deliberations will conclude on 21 January 2025.

The government has no plans to scrap single-word judgments of local authority adults’ services, despite the decision to ditch the approach for children’s social care.

The Local Government Association today urged ministers to end overall ratings of council adult social care performance by the Care Quality Commission (CQC).

The LGA made the call in the light of last week’s decision to ditch single-word ratings for all services inspected by Ofsted, including in children’s social care.

Ending single-word ratings for children’s services

Though there is no date set for the reform, in future, council children’s services and regulated services, such as children’s homes and independent fostering agencies, will not be rated as outstanding, good, requires improvement or inadequate following full inspections.

Instead, they will be assessed using a report card-style tool, which will likely involve evaluating performance across a range of areas.

The decision was made in response to the Big Listen, Ofsted’s biggest ever consultation, carried out in the light of a coroner’s verdict that its  2022 inspection of Caversham Primary School, Reading, contributed to headteacher Ruth Perry’s decision to take her own life.

Social care providers more supportive than not of ratings system

The consultation, responded to by over 20,000 people, including 4,325 children, revealed strong opposition to single-word judgments. Ofsted said these were “heavily criticised for oversimplifying the complexities of providers and not providing a full picture of their performance”.

However, separate research with 3,496 providers and 3,831 professionals from across the sectors Ofsted regulates found those in social care were more supportive than not of single-word judgments.

While the CQC has rated regulated adult social care services on a similar basis to Ofsted since 2014, it only started assessing councils last year, following the reintroduction of performance checks of local authority adults’ services.

Return of adults’ services assessments

In the face of opposition from council leaders, the Department of Health and Social Care (DHSC) determined that authorities would receive a single-word judgment.

Of the first nine authorities to be rated, six were judged to be good and three requires improvement, with the judgment being accompanied by a narrative report and a score, based on the council’s performance against nine statements.

The LGA said councils valued the CQC’s narrative reports but added that single-word judgments of adults’ services did not do justice to the complexity of social care, particularly in the context of funding constraints.

Single words ‘cannot capture complexity of adult social care’

“Local government fully supports transparency and accountability,” said David Fothergill, chair of the LGA’s community wellbeing board.

“But while assessment and regulation are both important and helpful in driving improvements to services, single word or phrase judgements cannot ever adequately capture the complexity of adult social care and the work councils do to meet their legal obligations.

“The government must ensure that the assurance process is, and remains, productive and supportive for councils. Sufficient time must be given to learn the lessons from councils’ experiences as more go through the assessment process.”

CQC deemed ‘not fit for purpose’

The LGA’s call comes with the CQC under intense scrutiny, after health and social care secretary Wes Streeting declared the regulator “not fit for purpose” in the wake of a damning report.

In the interim report of her government-commissioned review, Dr Penny Dash found that inspection levels were still well below pre-Covid levels, a lack of expertise among inspectors, inconsistency in assessments and problems with the CQC’s IT system.

In response to the LGA’s call to end single-word judgments, a CQC spokesperson said: “Our assessments were developed alongside the sector to help drive improvement by highlighting good practice and areas for further development.

“Local authorities have told us of the value of sharing findings to help make immediate improvements, by identifying their strengths and where gaps may exist. The narrative assessments and conversations they spark are central to this.

‘No plans’ to end single-word judgments

“The precise methodology for our local authority assessments, including if assessments result in a rating, is subject to ministerial approval. Any changes to this methodology would be a matter for the Department of Health and Social Care.”

A DHSC spokesperson said: “We are thoroughly reviewing the Care Quality Commission (CQC) and as part of that work we have asked the CQC to improve the transparency of their ratings. We are not currently considering a change to the single-word ratings system.”

Social care practice leaders have offered their “expertise and support” to the new Labour government in a bid to shape policy on the sector.

The offer has been made by a new grouping – the Social Care Professional Leads Collective – consisting of the Approved Mental Health Professional (AMHP) Leads Network, the Adult Principal Social Worker (PSW) Network and the Principal Occupational Therapists (POT) Network.

The co-chairs of the networks have written to health and social care secretary Wes Streeting and care minister Stephen Kinnock seeking a meeting on how they can help Labour deliver on its social care objectives.

“Together, across our networks we can bring extensive expertise and experience of social care delivery to ministers and policy makers to support their strategic objectives and achievement of manifesto commitments,” they told Streeting and Kinnock.

They said they were particularly well-placed to support the government through their direct connections to frontline social work, AMHP and OT practice, alongside their role as sector leaders.

Influencing Mental Health Act reform

The collective is particularly looking to influence the government’s approach to reforming the Mental Health Act 1983 (MHA), which was included in last month’s King’s Speech, and to make the case for investment in social care, including as a way of preventing needs for healthcare.

In relation to MHA reform, the networks will argue that there is much that could be done to achieve the objectives of the reform – including reducing the number of people detained in hospital – by improving practice under the law as it stands, including by bolstering AMHPs’ role in preventing detention.

This was an argument made last month by the AMHP Leads Network, which said that this would allow time for the government to “take a more radical approach” to MHA reform than was put forward by its Conservative predecessor.

The collective is also keen to work with Streeting and Kinnock on their long-term plan to develop a national care service, a key Labour manifesto commitment though an idea that has not been fleshed out by the party.

Scrapping of cap on care costs and training fund

The networks’ intervention follows the new government’s decision to scrap two social care initiatives developed by its predecessor: the adult social care charging reforms, including the cap on care costs, and a planned increase in funding for staff training.

Both decisions were taken in order to save money, in the context of what Labour claimed was a “£22bn hole in the public finances” left by its predecessor, though this includes £9.4bn attributable to the new government’s decision to implement independent bodies’ recommendations for public sector pay.

However, the decisions have been heavily criticised by sector bodies, with a group of social care leaders issuing an open letter to Streeting last week urging him to “change course on social care”.

Besides influencing policy, the networks said they wanted to work together to promote innovation and good practice in social care, to improve the quality and efficiency of services, and “champion professional development opportunities for social care lead practitioners”.

The government must delay “unfunded” adult social care charging reforms by at least a year as most local authorities are not prepared to deliver them by the target date of October 2025, county council leaders warned today.

Authorities would need an additional 4,443 social work staff to deliver the reforms, which include an £86,000 cap on people’s lifetime personal care costs. This is up from a 2022 estimate of 4,300 additional staff, found updated analysis by consultancy Newton for the County Councils Network (CCN).

Separately, a CCN survey of 35 of the 37 county authorities found 86% were “not well prepared” to deliver on the reforms, which would make many more people eligible for state-funded care, by next October.

Two-year delay to reforms

That date was set by the previous Conservative government in November 2022, when it delayed its previous implementation target by two years following calls to do so by CCN and other council bodies, who said they were not ready.

In doing so, it recycled £3.14bn of the £3.6bn it had allocated for implementing the reforms into grant funding to help councils shore up their day-to-day social care services for adults and children from 2023-25. The rest of the money is being used to help councils work towards paying providers a ‘fair cost of care’, an element of the reforms (see below).

During the election campaign, the Conservatives and Labour both committed to implementing the reforms in 2025 if elected. However, think-tank the Institute for Fiscal Studies pointed out there was no funding allocated to do so.

£30bn cost over nine years 

Newton’s analysis for the CCN found that the total cost of the reforms over nine years was £30bn, up from its 2022 estimate of £25.5bn. This comprises:

• £18.6bn (up from £13.9bn) to fund care for people made eligible for support through the more generous means-test and the cap.
• £9.2bn (down from £9.7bn) to fund a fair cost of care for residential care providers.
• £2.2bn in operational costs (up from £1.9bn).

The latter is driven by the increase in the number of needs assessments, financial assessments, reviews and care and support plans required for self-funders who become eligible for funded care or to have their placements arranged by their local authority, or who want to take advantage of the cap in future.

More social work staff needed

Newton’s original analysis said councils would need an additional 4,300 social work staff, along with 700 financial assessors, to cope with the additional workload.

It has now increased the social work requirement to 4,443, though, as with the previous analysis, this is based on operational processes remaining as they are, without more efficient ways being delivered. This figure compares with a current adults’ social worker workforce of 18,500.

In response to CCN’s survey, 86% of councils said they were not well prepared to implement the reforms and 92% backed a delay of a year or more.

Almost all respondents (97%) said they were “very concerned” about the shortfall in funding and 80% said they predicted that they would not be able to fulfil their Care Act duties if existing social care resource was repurposed to fund the charging reforms.

‘Impossible to implement reforms by target date’

“To put it bluntly, it will be impossible to implement these reforms next autumn in the current timescales and with no funding committed to the reforms,” said the CCN’s adult social care spokesperson Martin Tett.

“Equally, the government cannot take money currently being spent on day-to-day adult social care services for these reforms, with our survey showing it will have devastating consequences for councils and the thousands of people who rely on local authority care.

“We have always supported the principles of the reforms, as they will make the system fairer. But if the government is to proceed with the reforms, then it must delay them by at least a year – but likely more – to reassess the real costs and set out a way to fully-fund them.”

Labour’s post-election social care actions

Since Labour won power, health and social care secretary Wes Streeting has asked his officials to provide a progress update on implementation of the charging reforms (source: Channel 4 News).

The new government has also included plans for a fair pay agreement for adult social care staff in an Employment Rights Bill announced in this week’s King’s Speech.

However, this will cost money – as yet unallocated by the government – because it will require councils to increase fee rates to providers to enable them to pay their staff more and invest more in training.

This casts doubt on its ability to fund the charging reforms as well, particularly given its commitment not to raise income tax rates, national insurance, VAT or corporation tax, fiscal rules limiting public borrowing and several other calls on public spending, such as NHS and defence.

Also, the Times has reported (behind paywall) that Labour is considering setting up a cross-party Royal Commission on the future of social care which, should it happen, may also prompt it to pause the charging reforms.

History of delayed reforms

The reforms were themselves the result of an independent commission – led by economist Andrew Dilnot – which reported in 2011, with its proposals enacted in the Care Act 2014.

The then government had planned to implement the changes in 2016, but this was then put back to 2020, before the idea was scrapped in 2017 under Theresa May’s premiership before being revived by Boris Johnson in 2021.

Responding to CCN’s call to delay the reforms, a Department of Health and Social Care spokesperson said: “We know that people are suffering without the care they need, and we are committed to ensuring everyone lives an independent, dignified life.

“We are going to grip the social care crisis, starting with the workforce by delivering a new deal for care workers. We will also take steps to create a national care service underpinned by national standards, delivering consistency of care across the country.”

Adult social care faces its “worst financial outlook” for at least seven years on the back of rising levels and complexity of need and costs being shifted from the NHS, a survey of directors has revealed.

Despite receiving what the previous government described as the “biggest funding increase in history” for 2023-25, councils overspent their adult care budgets by £586m (2.9%) in 2023-24, found the Association of Directors of Adult Social Services’ (ADASS) annual spring survey.

This was the highest overspend in at least a decade, while councils also reported having to budget for £903m in savings in 2024-25 (4.4%), the highest annual level recorded by the association since 2016-17.

Just one in ten directors said they were fully confident they had the money to meet their statutory duties for adult social care in 2024-25, down from 35% for 2019-20 and 12% for 2023-24.

And directors reported cutting back investment in preventive services, from £1.55bn in 2023-24 to £1.43bn in 2024-25, despite their potential to reduce or delay needs for care and support

‘Worst financial outlook in years’

“This is easily the worst financial outlook for adult social care budgets that I’ve seen in the seven years of leading the survey,” commented ADASS’s director of policy and analysis, Michael Chard, in a post on LinkedIn.

On the back of the findings, the association called on the new Labour government to shift resource from hospitals to social care and community health to prevent people reaching crisis point, as well as committing to a “long-term, fully funded solution” for the sector.

In its general election manifesto, Labour offered no funded commitments on adult social care, though said it wanted to raise staff pay, improve consistency of care and enhance partnership working across health and social care to tackle delayed discharges and promoting care at home.

It also set a 10-year vision to create a “national care service” but did not define what this would mean.

In response to the ADASS report, a Department of Health and Social Care spokesperson said: “We are determined to tackle head-on the significant challenges social care faces. We will undertake a deep-rooted programme of reform to create a national care service and make sure everyone gets the care they need.”

‘Biggest funding increase in history’

In November 2022, amid significant pressures on the sector, the then government announced what it called the “biggest funding increase in history”, which involved new money and recycling resource earmarked to implement the cap on care costs and related charging reforms.

In 2023-24, this amounted to almost £2bn in extra government grant for councils to spend on adult social care plus up to an estimated £550m from raising council tax by 3% and the adult social care precept – which is ring-fenced for the sector – by 2%.

The impact of this was seen in government figures on council budgets for adult social care for 2023-24, which showed that net expenditure on adult social care was £2bn (10%) higher in real terms than in 2022-23, at £22.3bn.

ADASS’s survey, carried out from April to June this year, was answered by 145 of the 153 authorities, with the association scaling responses up to represent the whole country.

Its figures for total spending are different from the government’s but also showed a significant increase in budgeted spend, from £17.7bn in 2022-23 to £19.2bn in 2023-24 (these figures are not adjusted for inflation).

Overspend driven by mounting need

But despite this, councils collectively breached their budgets by £586m (2.9%) in 2023-24, the largest overspend recorded by ADASS in at least a decade, with 72% of authorities breaching their budgets.

Within this group, 92% of directors indicated that a cause of the overspend was the average cost of care packages outpacing their assumptions, while 89% attributed it, at least in part, to the numbers requiring long-term care exceeding their expectations.

As evidence of the increasing complexity of need that councils were meeting, ADASS found that the average number of home care hours a week councils delivered per person rose from 13 hours 40 minutes in 2021-22 to 14 hours 43 minutes in 2023-24.

In relation to the number of people in need, 22% of councils said they had seen a more than 10% rise in the number of people referred from the community, with a further 46% seeing a rise of less than 10%. Most people (about 80%) are referred to local authorities from the community.

There was an even sharper rise in referrals from people discharged from hospital, whose numbers grew by more than 10% in 45% of areas and by less than 10% in a further 37% of areas.

Cost shunting from the NHS

However, pressures also came from the NHS, with 36% of directors reporting an at least 10% increase in referrals from people who would previously have been, or were formerly, eligible for continuing healthcare (CHC), with another 37% seeing a rise of less than 10% in this group.

The NHS funds social care for people eligible for CHC on the grounds that they have a primary health need. If someone is found to be ineligible, either they or their council must fund their social care.

As of the first quarter of 2024, 51.95 people per 50,000 population were eligible for CHC in England, down from 54.65 per 50,000 two years earlier, according to NHS England data.

Almost all directors (94%) agreed that tightening eligibility for CHC was leading to councils or individuals picking up the bill for more care home placements for people with complex needs.

A similar proportion agreed that there had been a trend of NHS integrated care boards reviewing people who qualified for CHC to find they no longer qualified, leading to an increase in
people requiring council-funded social care.

Meanwhile, 84% of directors reported that frontline adult social care staff were increasingly undertaking tasks that were previously delivered by NHS staff on an unfunded basis, up from 70% in its 2023 autumn survey.

Pressures continuing into 2024-25

Directors said the pressures they faced in 2023-24 were continuing into 2024-25. While they planned to increase budgeted spend from £19.2bn to £20.5bn, authorities reported having to make £903m in savings from their adult social care budgets.

Sixteen per cent of directors said they were not at all confident they had enough money to meet their statutory duties, while a further 74% were partially confident that they would do so.

More positively, ADASS found that waiting lists for assessments, reviews and care packages had fallen, from 470,576 at the end of August 2023 to 418,029 as of the end of March 2024.

“This is welcome progress in difficult circumstances,” said the association. “Nevertheless, it is important to remain sensitive to the difficult human stories behind these numbers. These figures
are still historically high and should command the same concern as hospital waiting times.”