Written submission to the Select Committee on the Sustainability of the NHS from VODG (Voluntary Organisations Disability Group)

Key messages

The future of the NHS and that of social care are inextricably linked. A sustainable NHS is predicated on a sustainable social care system.

People are using care services at a time of unprecedented demographic changes and financial austerity. Fewer and fewer disabled people are eligible for services and unmet need is on the rise. A return to investment in preventative services is necessary to stem this trend.

The continued squeeze on fees has led to social care markets, worth over £43 billion per year, being fragmented and unstable. Without adequate funding providers will exit the market, increasing pressure on the NHS as demand for emergency and hospital services rises.

Sustainable funding for the social care sector will enable disability organisations to invest in their people – to further build careers in the sector, to recruit and retain the right staff and to pay the workforce at a rate which recognises the value of the work they do in society.

Not-for-profit social care providers should be engaged in the development of Sustainability and Transformation Plans (STPs). They need clear routes for engaging with Clinical Commissioning Groups (CCGs).

There is further scope for supporting people with complex needs in social care, rather than NHS settings, assuming this provision attracts realistic funding.

Significant up-front investment is needed in order to mainstream technological developments in social care which can generate long-term savings, but local authorities rarely commission these solutions.

 

Introduction

  1. 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.
  1. 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.
  1.  VODG welcomes the opportunity to submit this representation to the Select Committee on the sustainability of the NHS. We use this submission to draw out those issues most relevant to voluntary disability care and support providers and to the people they support.

Context

  1. 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, physical disability, or who have learning and social or behavioural impairments.
  1. 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%.
  1. 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 future healthcare system

  1. The future of the NHS and that of social care are inextricably linked. A sustainable NHS is predicated on a sustainable social care system. A social care system that is working well:
  • Prevents hospital admissions by helping people to live healthy lives
  • Responds quickly and supports people to access health services appropriately if they become unwell
  • Enables people to leave hospital as soon as they are ready
  1. Therefore we believe that the following steps will contribute to enabling the NHS to respond effectively to demographic changes described above:
  • Delivering a fair and sustainable deal for social care providers
  • Enabling more people to be treated at home by:
    • Better integration of services
    • Better equipping social care staff to support people with complex health conditions
    • Increased take up of technology to support people to maintain their independence and stay well at home
  • Continuing to recruit both qualified and unqualified staff from within the EU[4]

Resources issues

  1. 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, regulation and red tape and other pressures
  • Approaches to public sector commissioning
  • Staff recruitment and retention
  • Public perceptions of care services
  1. 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.
  1. 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[5]. Insufficient funding is resulting in fragmented social care markets, and councils struggling to manage the market.
  1. 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[6]. Meanwhile not-for-profit providers have received no additional funding to offset increased take up in pensions as a result of pension auto-enrollment.
  1. 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[7]. 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, negatively impacting on the lives of the many people who use their services and increasing pressure on the NHS. This is not inevitable, but the situation is urgent.

Workforce

  1. Skills for Care (SfC) estimate that 1.2 million people work in direct care roles in England[8], 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.
  1. Recruitment and retention issues are compounded by the demographic demands identified earlier. A 2015 report from the Centre for Workforce Intelligence[9] 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.
  1. 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%[10] of jobs in the social care in England. A VODG report on the impact of Brexit[11] provides a more detailed discussion of the likely implications of this.
  1. 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[12] 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”.

Models of service delivery and integration

  1. As social care providers we share many of the same concerns as our NHS partners, including improving health and wellbeing and the outcomes of care services. We are concerned that STPs are being developed without the involvement of the voluntary sector, although not-for-profit providers will be integral to delivering them.[13]
  1. Over the last few years there has been much discussion about developing more out-of-hospital services, but we have seen little progress in this area. Social care providers regularly express extreme difficulty to us in engaging with CCGs and need clear routes for doing so. For more information see VODG’s report on What can the voluntary sector do to encourage greater engagement and collaboration with the health system?[14]

Prevention

  1. New technologies are enabling provider organisations to improve the efficiency of their back office functions and 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.
  1. 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[15]. This would give providers the confidence to invest in technologies that can simultaneously improve quality of life and reduce long-term care costs.

 

VODG is happy to prepare further briefing, address questions and attend witness sessions.

VODG (Voluntary Organisations Disability Group)

www.vodg.org.uk | info@vodg.org.uk | @VODGmembership

 

[1] Think Local, Act Personal www.thinklocalactpersonal.org.uk/
[2] Department for Work and Pensions (2015) Family resources survey. Accessed: www.gov.uk/government/uploads/system/uploads/attachment_data/file/437481/family-resources-survey-2013-14.pdf
[3] Centre for Disability Studies (2012) Estimating the need for social care services for adults with disabilities in England 2012-2030. Lancaster: University of Lancaster.
[5] Association of Directors of Adult Services (ADASS 2016) ADASS budget survey 2016. Accessed www.adass.org.uk/budget-survey-2016/
[6] Association of Directors of Adult Services (ADASS 2016) ADASS budget survey 2016. Accessed www.adass.org.uk/budget-survey-2016/
[7] Local Government Association and Association of Directors of Adult Social Services (2014) Adult social care funding: 2014 state of the nation report. Accessed: www.local.gov.uk/documents/10180/5854661/Adult+social+care+funding+2014+state+of+the+nation+report/e32866fa-d512-4e77-9961-8861d2d93238
[8] Skills for Care (SfC 2016) The size and structure of the adult social care sector and workforce in England, 2016. Accessed: www.nmds-sc-online.org.uk/Get.aspx?id=971293
[9] Centre for Workforce Intelligence (CfWI 2015) Forecasting the adult social care workforce to 2035. Accessed: www.cfwi.org.uk/publications/forecasting-the-adult-social-care-workforce-to-2035-workforce-intelligence-report/@@publication-detail
[10] NMDS-SC data. Accessed: www.nmds-sc-online.org.uk/reportengine/GuestDashboard.aspx?type=AgeBand
[11]  VODG (2016) Post-Brexit: What next for voluntary sector disability organisations? Accessed: www.vodg.org.uk/news/476/111/A-focus-on-the-future-new-VODG-report-on-the-impact-of-Brexit.html
[12] Bournemouth University (2015) Pathways to recruitment: perceptions of employment in the health and social care sector. Accessed: www.ncpqsw.com/publications/pathways-to-recruitment/
[13] Kings Fund (2016) Separating the noise of contract negotiations from the signal of STPs. Accessed:  http://www.kingsfund.org.uk/blog/2016/04/contract-negotiations-stps
[14] VODG (2016) What can the voluntary sector do to encourage greater engagement and collaboration with the health system? Accessed: https://www.vodg.org.uk/uploads/pdfs/2016%20What%20can%20the%20voluntary%20sector%20do%20to%20encourage%20greater%20engagement….pdf
[15] VODG (2016) Technology is changing the way we live. Can it also transform the way we deliver adult social care? Accessed www.vodg.org.uk/uploads/pdfs/2016%20VODG%20technology.pdf