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True costs: Why we cannot ignore the failure in social care funding

There are 11 million disabled people living in England. Voluntary and not-for profit organisations provide one fifth of the services supporting disabled people. Provision of these support services is a statutory obligation.

The additional funding made available for adult social care through the Improved Better Care Fund and the Adult Social Care Precept is welcome, but fails to meet rising demand, increasing costs and to secure a reliable workforce.

The number of disabled people in England is projected to continue to grow, increasing from 11m in 2017 to 11.7m by 2025. Within this group will be increasing numbers of people who require support with their mental health, physical disability, or learning and social needs.

The unit cost of care provision is increasing and the average hourly rate paid by local authorities to providers does not cover these costs. In 2016/17 this left a shortfall of £1.3 billion in local authority fees for residential care. Increases in the average hourly rate in 2017/18 have not closed the gap. The retrospective requirement to provide national minimum/living wage (NLW) back-pay to sleep-in shift workers for up to six years would be financially disastrous for many providers as well which would be forced to stop trading. It would also adversely impact the many individual disabled people who employ personal assistants (PAs) directly through personal budgets.

Workforce retention and recruitment rates are low and getting worse. This is linked to the complex nature of the work and the comparatively low rate of pay. Brexit threatens further instability in the labour supply for adult social care.

This funding shortfall is undermining the choice, quality and personalisation that is required by the Care Act 2014. Disabled people are receiving less care, and sometimes poorer care.

There is a knock-on impact on other services. Local governments are unable to meet statutory obligations within adult social care budgets. The NHS is struggling to cope, with an increasing proportion of delayed transfers of care due to adult social care.