Care and support provision ‘extremely volatile’, say council directors

Stephen Chandler, ADASS president

More than half of local authorities in England are rationing care and support, a survey of council directors has found.

Despite an increase in the hours of homecare being delivered to older people, councils said they were unable to keep up with the numbers requiring care as the Omicron variant of Covid forces staff to take sick leave or isolate.

A survey by the Association of Directors of Adult Social Services (ADASS) found more than one in two directors who responded said in at least some cases they were having to take decisions temporarily to limit the care normally provided, leave people without their usual social contact, or ask families to step in to help.

‘It is clear from discussions with ADASS’s regional chairs that the position is serious across the country but also extremely volatile,’ the survey said.

The member survey, which took place between 24 December and 5 January, received 94 responses.

‘We warned before Christmas that we were heading into a national emergency for social care. The sobering reality of that is now becoming starkly clear,’ said Stephen Chandler, ADASS president. ‘Every council is taking extraordinary steps and a majority say they are having to prioritise the most basic and essential care in at least some areas for some of the time.’

A previous survey by ADASS suggested councils had increased the amount of homecare being provided by 15% in just three months last year. But more than 400,000 people were waiting for assessment or review of their care needs or for packages of support to be provided.

In December, an extra £60m was provided to local authorities to support the adult social care response to Covid-19 this month. The money was on top of the £388m infection control and testing fund announced in October (pre-Omicron) to prevent infections and provide testing in the care sector.

The Omicron wave and pay rises in other sectors have worsened the picture, ADASS said. On top of more than 100,000 vacancies for care staff, agencies that employ them said an average 14% of their team members were off sick or isolating.

Of the councils that responded, 49 were taking at least one exceptional measure to prioritise care and assess risk. These measures are regarded as least acceptable, including prioritising life sustaining care such as supporting someone to eat and remain hydrated over helping a person to get out of bed or complete other activities; or leaving people with dementia, learning disabilities or poor mental health isolated or alone for longer periods than usual.

‘These are decisions that no-one wants to take, and many are unacceptable. They are drastic measures and must not become the norm,’ Chandler said. ‘The roots of this lie in the failure to fund adult social care sustainably over the past decade and to recognise and reward properly the committed, courageous and compassionate people who work in it.

‘Opportunities were repeatedly missed to ensure that adult social care would be robust enough to withstand the challenges posed by Omicron. Any money that has been forthcoming, though welcome, has been too little, too late.’

Last month, the government said £1.4bn would be made available over three years to help increase the fee rates local authorities pay to providers. The money is part of the £5.4bn health and social care levy.

However, ADASS wants at least £7bn extra a year, rising to £9bn by 2024-25, and a social care minimum wage equal to what the NHS pays for similar work. In the first instance, it is calling for a larger share for social care from the levy due to be added to national insurance payments from April.