Written submission to the Select Committee on Charities from VODG (Voluntary Organisations Disability Group)
Key messages
Third sector provider organisations offer a unique contribution to social care which is characterized by:- Service delivery
- Championing the rights of people who experience social inequality
- Developing innovation
- Building social capital, including volunteerism
- Cuts in public sector spending
- Increasing costs associated primarily with the introduction of the national living wage, pensions auto-enrollment, apprenticeships levy and other pressures
- Approaches to public sector commissioning
- Staff recruitment and retention
- Public perceptions of care services
- The sustainability of the social care market
- Joined up working between health and social care
Introduction
- VODG (Voluntary Organisations Disability Group) is a national charity that represents leading not-for-profit organisations who provide services to disabled people in ways that promote independence, choice and control. Our members work with around a million disabled people, employ more than 85,000 staff and have a combined annual turnover in excess of £2.5 billion. Though diverse in terms of their size, history and individual strategies, our members share common values. These are clearly discernible through work that promotes the rights of disabled people, approaches to citizenship, user choice and control and in successfully delivering person-centred services.
- VODG works on behalf of members to influence the development of social care policy, build relationships with government and other key agencies, promote best practice and keep members up to date on matters that affect service delivery. Our overarching aim is to ensure that VODG members, working in partnership with commissioners, people who use services and their families can provide progressive, high quality and sustainable services that reflect Think Local, Act Personal[1] principles, uphold rights and meet the requirements of disabled people.
- VODG welcomes the opportunity to submit this representation to the Select Committee on Charities. We use this submission to draw out those issues most relevant to charities which are disability care and support providers and to the people they support.
Context
- There are 9.9 million disabled people living in England who represents 19 per cent of the overall population[2]. This includes a significant number of working age adults who require support with their mental health, or who have learning and social or behavioural impairments.
- The Centre for Disability Studies[3] estimates the growth in the numbers of adults with physical and learning disabilities:
- Support will be required for an additional 6,000 to 46,000 young adults with physical disabilities over ten years. This equates to a ten-year growth rate of between 32% and 239%.
- Between 37,000 and 52,000 adults with learning disabilities will require support over the next ten-year period, resulting in a growth rate of 26% to 37%.
- Alongside these ‘working age’ trends, the number of older people is rising. The latest Census data demonstrate 9.2 million older people aged 65 years and over, with 52 per cent of people living with a long-term health problem or disability. This includes a far greater proportion of the population aged 85 and over.
The purpose of charities
- Third sector organisations offer a unique contribution to social care which is characterized by:
- Service delivery
- Championing the rights of people who experience social inequality
- Developing innovation
- Building social capital, including volunteerism
- There has been a rapid expansion of the charitable sector’s role in public service delivery over the last 20 years.The aggregate cost of social care services provided by third sector organisations is estimated to be at least £7.2 billion per year. Of all public service areas, social care is thought to have the greatest involvement from the third sector[4].
- Third sector social care and support providers have a long history of championing the rights of those who experience social inequality. Enabling people to maximise their capabilities and exercise control over their lives remains core to their purpose and activity. In the last 20 years the personalisation agenda, now enshrined in the Care Act, has developed from this philosophy.
- This focus on rights and giving people a voice underpins third sector providers’ approach to innovation. For example, VODG member Turning Point[5] has developed an innovative approach to commissioning through community engagement.
- The sector has developed a range of approaches that enable people who may have complex needs to live an ordinary life. These approaches often rely heavily on volunteering and/or connecting people to universal resources in their local community. Examples include peer support networks[6] and circles of support.[7]
- Approaches to volunteering vary considerably among VODG members. For many providers, volunteer input is integral to their approach to service delivery, while others have very little volunteer involvement often due to the complexity of need of the people they support. However, volunteering remains a feature of our member organisations and VODG members are active in enabling disabled people to volunteer both in national roles and in their local communities. For more information on inclusive volunteering see VODG’s Volunteer Management Toolkit[8].
Pressures, opportunities and resource management
- Pressures which are currently impacting on charitable care and support providers are:
- Cuts in public sector spending
- Increasing costs associated primarily with the introduction of the national living wage, pensions auto-enrollment, apprenticeships levy and other pressures
- Approaches to public sector commissioning
- Staff recruitment and retention
- Public perceptions of care services
- Funding to support disabled and older people has been significantly reduced since 2010. In the five years to 2015/16 local authority funding of adult social care reduced by £4.6 billion (a 31% reduction in net budgets). In 2015/16, 82% of directors of adult social services report that the quality of care is compromised as a result of these savings being made.
- The Local Government Association and Association of Directors of Adult Social Services estimate a £4.3 billion funding gap in adult social care by the end of the decade[9]. In this context providers experience the real tension between delivering high quality of care in a sustainable way at a price that is affordable for commissioners. They are increasingly concerned that this will lead to the closure of services which have become financially unviable. Without adequate funding voluntary organisations may exit the market completely causing further market instability and negatively impacting on the lives of the many people who use their services.
- The continued squeeze on fees for services is leading to an ever widening gulf between the real costs of delivering care and that which commissioners are prepared, or able, to pay for. For 2016/17 directors of adult social care report that they plan to make further savings of £941m or 7% of the overall budget. They estimate that a quarter of these savings will come from cutting services or reducing personal budgets for those people who receive care and support[10]. Insufficient funding is resulting in fragmented social care markets, and councils struggling to manage the market.
- The 2015 Autumn Statement enabled local authorities to raise council tax by 2% for adult social care in 2016/17. This has meant a slight rise in the overall budget. However the Association of Directors of Adult Social Services (ADASS) calculates that this raises less than two thirds of the overall costs of implementing the national living wage[11]. Meanwhile not-for-profit providers have received no additional funding to offset increased take up in pensions as a result of pension auto-enrollment.
- Third sector care and support providers are also concerned that public sector procurement is contract or price driven, rather than strategic and focused on best value. This means that much of the value that not-for-profit providers bring to adult social care, in terms of quality, innovation, volunteering and community engagement is not recognized within the commissioning process. Delivering high quality services offers no commercial advantage when decisions to award contracts are based on the lowest possible price.
- Skills for Care (SfC) estimate that 1.2 million people work in direct care roles in England[12], with some 60,000 vacancies at any one time and an overall turnover rate of 25.4%. Providers report many reasons for challenges in the recruitment and retention of staff. A key aspect is the increasing complexity of the needs of people who use services. This means that social care work is becoming more skilled and specialised, in an industry that is still relatively low paid.
- Recruitment and retention issues are compounded by the demographic demands identified earlier. A 2015 report from the Centre for Workforce Intelligence[13] estimates that the workforce will need to increase by 41% over the next 20 years to meet increasing demand from people with disabilities. This increases to 51% for people with a learning disability.
- There is concern amongst providers about the instability that may result from the decision for Britain to leave the EU. There are an estimated 80,000 EU migrants filing 6%[14] of jobs in the social care in England. A VODG report on the impact of Brexit[15] provides a more detailed discussion of the likely implications of this.
- The negative media representations of the care sector are perceived as a further barrier to those seeking employment, particularly with regards to the low status given to it. A report from Bournemouth University[16] suggests that:
“At a national level, more needs to be done to value those who work in the care sector by highlighting the benefits and rewards of care sector employment and not just the negative aspects of this type of work. Raising the status of the care sector through the provision of career progression pathways, clear qualification requirements, and enhanced pay levels would help to inspire future workers to join the sector”.
- Opportunities may often appear elusive at a time when the overall adult social care market is shrinking. However, technological advances offer significant possibilities and there are potential opportunities to develop innovative services for people with learning disabilities and mental health needs.
- Following the scandal of Winterbourne View, the ‘transforming care’[17] agenda represents a huge opportunity to get services right for people with learning disabilities and mental health needs and the not-for-profit sector has providers who are well-equipped to offer long-term, high quality care and support. This is an area of policy that is failing to be implemented properly with significant lost opportunities for the people requiring transfer from long-stay institutions to community-based support, including their own homes.
Innovation
- New technologies are enabling provider organisations to improve the efficiency of their back office functions, but more importantly are making a significant difference to the wellbeing and autonomy of people who use services. VODG members support disabled people to access and use a wide range of personalized technology such as telecare, environmental controls, communication aids and prompting devices.
- However, there is a dilemma around mainstreaming technological developments; innovation requires significant up-front investment, which can generate long-term savings, for instance by reducing a person’s reliance on paid staff. But local authorities rarely commission these technological solutions. VODG has called on local authorities to commission services based on outcomes delivered through the whole life of a contract rather than fixed hourly rates[18]. This would give providers the confidence to invest in technologies that can simultaneously improve quality of life and reduce long-term care costs.
Governance and leadership
- A key characteristic of the governance arrangements of not-for-profit care and support providers is their need to ensure a strong user voice. This means that many providers have user representatives on their boards; this includes board members with physical disabilities, mental health needs, learning disabilities or social or communication needs. Consequently many third sector care providers have developed an expertise in taking an inclusive approach to board meetings and equipping people from a wide range of backgrounds to contribute to effective decision making at board level in a complex business environment. Therefore we are particularly concerned to ensure that any changes to the governance requirements of charities are compatible with the involvement of people who are both trustees and users of services.
Accountability
- Third sector care and support providers are regulated and/or inspected by a wide range of public bodies including local authorities, Clinical Commissioning Groups, the Charity Commission, the Care Quality Commission (CQC), Companies House, HMRC, the Health and Safety Executive, Ofsted, the Homes and Communities Agency, CSSIW in Wales and the Care Commission in Scotland. Consequently there is much that could be done to harmonise the requirements of the various oversight bodies.
- As part of the red tape challenge, CQC has committed to tackling this issue from a quality perspective in England. If successful this would reduce the intrusion and disruption to people who use services that inevitably accompanies an inspection visit. We would welcome further initiatives to harmonise requirements and thereby reduce the administrative burden on charities.
- In order to demonstrate their approach to sustainability, charities are already required to make a statement on their reserves policy in their annual report. In addition, a number of VODG members have recently become subject to CQC’s market oversight regime[19] and are thereby required to evidence in detail their long-term viability by providing data on a quarterly basis. They report that this is administratively burdensome.
- We realise that in the wake of the collapse of Kids Company questions must be asked and answered about how this situation arose. However, it is clear that information about the vulnerability of the charity was in the public domain[20], but was not acted on by funders (i.e. government) or by the Charity Commission itself. We believe that Kids Company was an exception and that existing systems and structures could have been applied sooner and more effectively in order to prevent or mitigate its collapse. Therefore we recommend that there should be no further additional requirements regarding the management of sustainability and risk placed on third sector care and support providers.
Social investment
- An ability to access good quality housing is crucial to ensuring that people with care and support needs have suitable places to live and that social care providers can develop person-centred services. The current pressure on the housing market means that there are lengthy waiting lists for suitable social housing and rents for private rented accommodation are often unaffordable to people on housing benefit. Therefore the sector needs capital investment. A recent approach taken by some third sector care providers has been to launch their own bond scheme in order to raise capital to provide suitable housing for the people they support.[21] [22]
- These schemes have had no difficulty in attracting investment. However, they are relatively modest. We anticipate that providers will continue to exercise a cautious approach to investment while the social care market remains subject to instability, which results from short-term contracts and downward pressure on fees paid by local authorities and other commissioning bodies. Until providers can be assured of the long-term viability of their public sector contracts, their confidence to borrow and to invest in service development will remain severely limited.
The role of government
- Looking forward we propose that government should:
- Retain a focus on domestic agendas in the context of the decision to leave the EU. VODG’s report on the impact of Brexit[23] provides a detailed discussion of the likely implications of this decision.
- Be aware that the social care market could collapse and therefore focus resources on a sustainable deal for providers.
- Facilitate more joined up working between health and social care in order to maximise efficiencies and enable people to experience a seamless service. For more information see VODG’s report on What can the voluntary sector do to encourage greater engagement and collaboration with the health system?[24]
- Finally, we are concerned that the Lobbying Act has made charities more cautious at speaking out on policy implementation issues and done much to inhibit dialogue between charities and government. Charities are often best placed to understand and articulate the interests of people who experience social inequality and this has been a key feature of their contribution to society over centuries. It is also imperative that care providers are free to highlight the current fragility of the sector as this poses a risk to society as a whole, for instance by placing additional pressure on the NHS. Attempts to prevent charities from speaking out or to fracture the relationship between their service delivery and policy work represent a substantial threat to their involvement in the democratic process. Therefore we believe that Lord Hodgson’s review recommendations should be implemented in full.[25]