Agenda item

Purpose: To consider the impacts of the Government's adult social care reforms and what they mean for West Berkshire.

Paul Coe gave a presentation on adult social care reforms (Agenda Item 9). Key points from the presentation were as follows:

·         The Government’s proposals were initially set out in ‘Build Back Better’ with further detail added in the White Paper ‘People at the Heart of Care’ and the Policy Paper ‘Market Sustainability and Fair Cost of Care Fund: purpose and conditions 2022 to 2023’

·         The Dilnot report had looked at charging for care costs, while the Care Act 2014 set out the legal foundations for changes, but this was not progressed in 2015 when the rest of the Care Act was implemented.

·         The focus was on ensuring that arrangements would be affordable and sustainable in the long-term.

·         Specific areas had been identified for investment.

·         The White Papers identified best practice around choice, control, independence, accessibility, timeliness, etc.

·         Key changes included:

o   New Health and Social Care Levy based on National Insurance contributions

o   A cap on care costs of £86,000 from October 2023 for new people

o   New capital limits (upper limit of £100,000 and a lower limit of £20,000)

o   An intent to shrink the gap between private funder fees and local authority fees

·         Priorities for investment included:

o   Support for staff (training, occupational health, recruitment, etc)

o   Better health and care integration

o   Investment to integrate housing into local health and care strategies, with a focus on supported housing

o   Greater adoption of technology and digitisation in social care

o   Support the social care workforce to access training and to feel recognised and valued, with a focus on workforce wellbeing

o   Digital tools to support independent living/improved quality of care

o   New practical support service to help people remain independent and safe in their homes, and an increased upper limit on the Disabled Facilities Grant for home adaptations

o   Improved services to support unpaid carers

o   Funding to help local areas innovate and provide more options that suit people’s needs and individual circumstances

·         Key issues and risks were:

o   The cap on care and proposed changes to thresholds would result in a loss of income for the Council and lead to a substantial funding shortfall

o   West Berkshire had a large number of self-funders who currently organised their own care, either with or without advice

o   Everyone who might need care would require assessment from the local authority in order to arrive at an Independent Personal Budget and to ensure best value

o   Because the cap only applied to ‘new people’, individuals may wait and put their own health at risk

o   There would be an additional burden on providers to account for the different elements of their costs.

The Chairman asked if the cap related to the care costs rather than ‘hotel services’.

Paul Coe agreed, but indicated that details were still emerging. Also, there were some other grey areas where clarification was required. For example, where an unpaid carers had previously received support, but the person they cared for had not received support, it was unclear if the person being cared for would be classed as ‘new’.

Councillor Martha Vickers asked what additional support and funding officers required and how messages would be communicated to the public. The emphasis on staffing, support and recruitment was welcomed.

It was noted that initial announcements had focused on solving the challenges by providing more funding, which the public would have taken at face value. However, the details suggested a more complex situation and there was a lot still to work through. West Berkshire Council would be given an opportunity to feed its concerns back to the Department for Health and Social Care, particularly in relation to forecasts for funding shortfall.

Dr Abid Irfan asked if local authorities would get a percentage of the new Health and Care Levy. He understood that priority would be given to tackling waiting lists for elective care, which were forecast to rise until 2025.

Paul Coe confirmed that health would be prioritised initially.

Councillor Steve Masters noted that many local residents who arranged their own care would soon be engaging with the Council, which would create a significant administrative burden. He asked if this was something that needed to be highlighted to Central Government.

Paul Coe explained that previous efforts had focused on developing a light-touch approach, with information, advice, guidance and practical support to allow residents to make their own arrangements, but the proposed changes could potentially undermine these efforts. However, it was noted that technology would be key to supporting care in future, and an online product was being developed. The challenge had been quantified and costed and fed back to Central Government and efforts would focus on making things quick and straightforward for the Council and service users.

Councillor Masters asked about the ratio of self-funders to supported users.

Paul Coe indicated that it was hard to quantify, but indicated that just 6% of those who approached the Council for care in a community setting were benefitting from a long-term service commissioned by the Council.

Andrew Sharp expressed concern about the additional administrative burdens that would be imposed on residents. He asked if there would be impacts for getting people out of hospital. He suggested Q&A sessions with carers would be helpful to help people understand the changes.

Paul Coe agreed, but stressed that this should only take place when there was more certainty around the details of the changes.

Councillor Jo Stewart stressed that the changes would make positive differences to people who relied upon adult social care. She stated that the Council had experienced officers who were working through the available information. The Council had been invited to work with Central Government and the Local Government Association to highlight concerns and potential challenges arising from the proposed changes. She also noted that there were regular meetings around potential digital solutions that would help the Council to manage and monitor data. She suggested that officers could provide regular updates to the Health and Wellbeing Board as details were confirmed.