Social Care in the UK
Katie Mitchell, Marketing Manager at Autism Plus asked Philip Bartey Group Chief Executive if he would be happy to be interviewed by her as she was aware that the organisation, along with many other organisations have been placed under pressure for some time as a consequence of funding cuts to local authorities and CCGs (Clinical Commissioning Groups).
Which bodies hold the funding for social care in the UK?
Social care budgets form a large part of a local authority’s budget set by national government.
Where do CCG’s fit into this?
Their budgets are set separately from local authorities and they are currently empowered by NHS England to fund care directly and they sometimes enter into joint funding arrangements with local authorities. However, there is much talk from government about merging health and social care to achieve joined up funding which I support.
The media talk about social care in crisis, what do they mean?
I want to set out the facts in relation to the state of the social care sector in the UK and the immense difficulties encountered by charities and private companies both of whom manage most of the social care provision in the UK. You will be aware that social care has been in crisis now for some years. Funding for our sector has never been set at adequate levels by government for many years. The situation deteriorated further from 2010 when the coalition government introduced austerity measures resulting in local authorities and health facing immense year on year cuts to their budgets. Consequently, private sector and charity sector providers have faced cuts and reduction in fees as commissioners have refused to meet the full cost of care. This situation has led to 95 local authorities across the UK reporting contracts being under funded and handed back by providers who can’t afford to run them below cost. Many more tenders have been disregarded by providers who simply cannot afford to run them at a loss.
Who is responsible for ensuring vulnerable people requiring care are properly supported and funded?
Local Authorities have a statutory duty to ensure vulnerable people are properly supported and they achieve this by undertaking an assessment to determine the level of support required and providers are asked to either bid for this work (increasingly with the work being given to the cheapest provider) or if it is a single spot contract we state our required price and the authority will either look to beat the price down or select another provider who will accept a lower price. The price they accept is based around the assessment of support required.
Do you complain to local authority commissioners and try to negotiate better terms?
Yes, it’s a big part of my job now as we complain every time new budgets are set, and we are simply told they do not have the resources to meet our request. It’s the same story across the UK as I network with other provider leaders and through the CEO union. I have also met with Ministers and set out our case. Last year I wrote to Theresa May about the state of social care. I work with large lobbying groups both charity and private sector, who like me write regularly to the PM and Ministers and MPs on our collective behalf and they received similar responses. Our trade associations work with me and others in intense lobbying over these issues and they have done so since 2010. The organisations include ACEVO which is the sector CEO union and support network, The NCVO (National Association of Voluntary Organisations) and VODG (Voluntary Organisations working with Disabled People). I am a member of all these groups and I am also a member of the Institute of Directors all of whom are supportive of our position and lobby on our behalf concerning the crisis in social care. All providers are in the same boat I’m afraid, so this crisis affects the whole of the UK not just Autism Plus.
Is it possible to subsidise social care contracts with fundraising money?
Absolutely not. Fundraising grant bodies and companies only want to fund capital projects, equipment and where they can add value. They refuse, quite rightly to subsidise state funding because they do not have the legal responsibility to pay for social care as that responsibility sits entirely with government. Grant making bodies like to give one off donations where they feel they can make a difference. They will simply exclude applications designed to support state funded work.
So, what is the government doing about this crisis in funding?
That’s a good question Katie. They have so far given sticking plaster money to the NHS and ignored social care completely. If you listen to Ministers when they are asked about social care they mainly talk about care for the elderly and dementia. In 2010 David Cameron announced £2 Billion for social care which was paid to councils. Providers of social care for people with autism and LD did not see any of this because local authorities were not mandated to pass it on. The money largely went to providers for the elderly. I, and others wrote to Cameron pointing out we had not received a single penny from this fund. Furthermore, I pointed out to him that the elderly are sometimes self- funded whereas most of the autism and LD users are totally dependent on state funding, are more vulnerable, and increasingly come with challenging and complex conditions. I did not receive a reply. They released a further £2bn recently and I wrote asking to consider paying this direct to front line providers. No response was received and we did not see a single penny from this fund. Again, it was used for elderly patient providers and remote rural locations..
The government promised, following lobbying from the sector, to produce a Green Paper addressing the social care crisis that should have been released last summer. Jeremy Hunt (Minister) deferred it until November then he was quickly re shuffled to the foreign office. The government did not produce it in November and we are still waiting.
Can you explain the sleep- in issue?
A sleep in is when a care worker sleeps in the home of someone they support so they are on hand in case of an emergency or any other problem that may occur during the night.
This situation is also in a mess politically. When the National Minimum Wage (NMW) was introduced in 1999, the Low Pay Commission advice and the associated regulations at that time said that sleep-ins do not count as ‘work time’ for the purposes of the new law because people were asleep and not working. Local authorities therefore decided to pay providers a flat rate on call allowance currently and typically at between £28 and £35 per night. This flat rate was as far as local authorities were prepared to go and the sector was funded on this basis for decades prior to the new law.
Since then there has been several tribunal cases challenging this position and in October 2016, the government issued new guidance saying that time spent asleep did qualify for NMW payments. This was followed by aggressive HMRC enforcement action demanding providers paid six years back pay. This would cost the sector and local authorities £400 million in back pay alone.
Local authorities refused to pay this or recognise it and the HMRC followed up with enforcement action demanding providers paid six years back pay estimated to cost £400 million.
If providers paid this money with six years back pay without the money coming from government (whose fault it was because they set the flat rate then changed the rules) it would have left many providers going bust, laying off staff affecting thousands of vulnerable disabled people who would be left with no support. The money to fund this is not available to local authorities or providers so enforcement action would lead to many service closures and job losses.
Because local authorities could not afford to pay providers the back pay and instead continued to pay only the flat rate, Mencap, on behalf of the sector appealed against the decision at the Court of Appeal. Unison took Mencap to court and then Mencap appealed against the verdict.
If the government agreed to provide the resources for the six years back pay then providers, including Autism Plus would be happy to pay this over to staff. This is the same approach adopted by all providers-charities and companies. Mencap won its case and Unison were refused right of appeal. Unison are currently requesting the right of appeal to be granted and the case is expected to be heard next March 2019. The current ruling in force means that six years back pay is not now enforceable.
Local authorities are continuing to fund providers at the basic flat rate level. Where the local authority pay us the allowance for sleep- ins we pass it on to the relevant staff.
Unison in a recent press release stated that this sleep-in issue and responsibility for it lies squarely at the door of this government. I agree with them for all the above reasons.
Finally, can I ask what sort of Christmas do you enjoy?
Well I enjoy a traditional family Christmas at home sat around the log fire eating nuts, watching the kids putting up the tree and decorations and getting excited, I love listening to and singing carols, going to mass, letting our Great Dane sleep on the bed, a traditional turkey dinner, going for walks, I love watching Scrooge on TV- the old films and the new Disney, old clips of Morecambe and Wise, listening to the Queens speech and relaxing.
Thank you Philip, that was very helpful.
If you are an Autism Plus employee and have questions regarding sleep ins or anything else you can contact Philip by emailing firstname.lastname@example.org