Adult Social Care In Crisis Amidst “Unsustainable Financial Pressures”

Millions of pounds more is being spent by councils to prop up adult social care, but with soaring demands, Derby and Derbyshire are only managing to cater for a half of requests, potentially leaving thousands of elderly residents without support.

The pressure facing these authorities, which oversee services such as residential care and home-visits, is by no means a rarity – the same issue is being faced by councils across the UK.

Derby City Council and Derbyshire County Council have written to central government to raise concerns over the lack of funding ahead of the long-awaited adult social care Green Paper – due to be announced in the autumn by the Secretary of State for Health and Social Care, Matt Hancock. They seek “permanent recognition” of the unsustainable financial pressures they are facing to support social care.

In July, the city council revealed that it had a funding “black hole” of £23 million over the next four years and £12.2 million next year. Adult care makes up £4.9 million of next year’s budget shortfall.

Meanwhile, Derbyshire County Council is set to make £5 million in cuts to its adult social care service this year, on the back of £5.3 million last year.

The Local Government Association (LGA) says that councils in the UK face a adult social care funding gap of £3.5 billion by 2025. A report from the city council stated: “The emerging pressures in this service area are not sustainable without a permanent recognition by Government that more funding needs to be aligned to offset the increasing pressures being faced by all local authorities providing social care across the country.”

In the past five years, the county council has gone from catering for just over three quarters of requests for care to just over half. Some of these requests were directed to another service at the council, outside of adult social care, and others to different public bodies; health services; and the independent and voluntary sectors.

Five years ago there was a gap of 5,054 people between those who had requested some level of assistance and the people receiving care from the authority – as of last year that figure now stands at 17,166. The increase in the number of people catered for has increased 2,268 but the number of requests has gone up by 14,379.

The county council’s cabinet member for adult care, councillor Jean Wharmby, said: “We have a very strong commitment to funding social care in Derbyshire and we’re investing in our services.

“But, like all local authorities in the country, we’re facing pressures like never before and as well as the council having less to spend there is also an increase in the demand for services.

“Despite this, Derbyshire is investing in adult care and we’ve restarted our £30 million care programme to provide high quality and affordable residential, nursing and extra care accommodation across the country. We’re currently planning to build a new £15 million care home in Cotmanhay, Ilkeston.

“We proactively support people to help themselves stay healthy and well so they can retain their independence for longer and lead fulfilled and dignified lives.

“We work closely with many community and voluntary organisations, funding them to provide services which help people to stay safe and get out and about.

“This means that although the number of requests for care has increased, we’ve been able to support many more people than those who meet the minimum eligibility threshold as defined by the Care Act.

“We’ve done this by working closely with our partners, making the best use of resources and through the hard work of our social care staff at all levels.”

At the city council, only around half of the people aged 65 and above who requested care from the authority are being provided with it – 2,928 out of 6,121 in 2017. In Derby, these figures have remained relatively the same for the past four years. The city council did not respond to a request for comment.

Financial pressures for adult social care have been largely caused by funding of new Deprivation of Liberty Safeguards responsibilities – brought in as an amendment to the Mental Capacity Act in 2005. DoLS involves a local authority placing an adult either in hospital or in a care home due to their lack of mental capacity to care for themselves. For their safety, it may be necessary to “restrict their liberty”. For example, they may not be able to go out on their own, and carers may need to check on them regularly.

In these incidents, the person in question does not have the capacity to sign-off on this decision, which can often lead to appeals from family members. These appeals could include family members petitioning to keep their relative at home or that they have the suitable level of mental capacity. To ensure that there are no breaches in this area, the council must take out a variety of assessments, which take a lot of time and require specifically-qualified staff.

A decision in 2014 – dubbed Cheshire West – drastically widened the scope for the people who would qualify for a DoLs request. This is what has sparked a huge drain on local authority resources.

This has seen the number of cases which the city council has to process skyrocket from 55 in 2013 to 1,234 in 2016, dropping slightly to 1,079 in 2017 – 19 times as many.

In comparison, the county council saw referrals rise from 162 in 2009 to 2,847 in 2016 – 17 times as many.

This saw spending assessments triple from £316,056 in 2010 to £936,765 in 2016.

Derbyshire County Council wrote in a report earlier this year: “DoLS referrals increased nationally by a factor of fourteen.

“Derbyshire, in common with other local authorities, became unable to meet its statutory duties under DoLS, despite considerable investment (more than tripling the size of its DoLS team).

“Derbyshire, in common with other local authorities, will not be able to meet all its DoLS statutory responsibilities without massive investment (and corresponding divestment from other key services).

“We endeavour to steer a middle path in comparison with other local authorities.”

On July 3, the government launched a new system to assess people who may not have the mental capacity to make their own decisions about their care. The Liberty Protection Safeguards – part of the The Mental Capacity (Amendment) Bill – will soon become law and replace the current DoLS system. The reforms seek to introduce a simpler process that involves families more and gives faster access to assessments; is less burdensome on people, carers, families and local authorities; and allows the NHS, rather than local authorities, to make decisions about their patients, allowing a more efficient and clearly accountable process.

It is thought the reforms could save local authorities more than £200 million a year.

Minister for Care, Caroline Dinenage MP, said: “We know local authorities are under pressure which is why these reforms are so important: to reduce the burden on councils so they can focus their resources where they are needed on the frontline.”

A Government spokesperson said: “We have provided local authorities access to £9.4 billion in dedicated social care funding over the last three years.

“Our green paper due in the autumn will set out our plans to reform the social care system to make it sustainable for the future.

“We know we need to ensure the system is prepared to meet the challenges of an ageing population, which is why we are consulting on options to improve social care and put it on a more secure financial footing.”

She added that £90.7 billion would be handed to councils over the next two years to help meet demand, with an additional £2 billion to relieve short-term pressures across the health and care system.

By Eddie Bisknell – Local Democracy Reporter