Councils warn against ‘knee-jerk’ centralisation of care

The County Councils Network has said that the government should set out its plans to reform social care this year but warned against a ‘knee jerk’ centralisation of the system in the aftermath of coronavirus.

Attention has turned back to reform of social care in recent weeks, following concerns over the handling of the pandemic in the care sector and speculation that social care could be brought under control of the NHS, with commissioning and budgets controlled by the health service rather than councils. The CCN is warning against overly simplistic arguments for a centralisation of the care system, potentially removing it from democratically elected councils.

Councils say this is the wrong solution to the right question and want a re-invigorated role in social care reform, working with local NHS organisations to enhance community-based care as part of reforms in the long-awaited social care white paper.

Analysis of councils’ care support plans shows the extent to which councils stepped up during the pandemic – with all 36 councils within the network’s membership moving quickly to increase fees to care providers by the end of May. Many went above and beyond, such as one council sourcing 160,000 pieces of personal protective equipment (PPE) for its care providers, several others re-purposing their staff to care and support roles, one setting up a 24 hours a day emergency support line, and another announcing it will pay invoices within five days rather than the usual 30.

Leaders of the CCN’s 36 local authorities argue that the sector would have been even more vulnerable during the pandemic had it been overseen from the centre. They say issues with the distribution of PPE to care homes and the national testing programme illustrate drawbacks of a centralised care service. They have estimated that they will spend an additional £837 million this year for coronavirus-related costs to support providers. They stepped in to supply PPE to their local care homes, setting aside £120 million to protect staff and residents. Other councils also piloted infection control schemes in the first weeks of the virus.

Councils have the local commissioning expertise and were able to shift substantial sums of money in a matter of weeks to prevent providers from going bankrupt as the virus hit, setting aside £335 million. They project a £285 million spend to meet the increase in people receiving care packages throughout this year. CCN’s member councils have been provided with £1.16 billion of additional resources to help meet these costs. However, it has been insufficient as they face £841 million of additional costs in other council services and a further £1.55 billion in lost income pressures.

Councils warn that this is why reform needs to come forward this year – but suggestions that social care should be centrally run is not the answer. They say that it is a misconception that adult social care is purely for those in old age and say the system is hugely complex but embedded in local communities. Adult social care services comprise of support for people not just in old age, but extensive care for working-age individuals with severe learning disabilities and those with chronic health conditions too. These services require local knowledge which councils have.

David Fothergill, CCN spokesperson for health and social care, and leader of Somerset County Council, said: “The harrowing scenes that we have witnessed in our care sector deserve scrutiny, but we should be wary of a knee-jerk reaction that removes democratic oversight from adult social care and places it in a centralised system that coronavirus has shown contains huge drawbacks. Many of the people supported by councils require their care more embedded in their community, not provided by a one-size fits all, system which cannot make the best use of localised knowledge and networks.

“The coronavirus has exposed the fragility of the adult social care system due to years of underinvestment and no reform. It is only right that the dialogue turns to how we can re-shape the system so that individuals receive a world-class care service, but in order to provide this councils must be part of the solution.”