Joy looks at 'what is social care in the 21st Century and why it is important?' including the current state of the social care market and taking a look at the future.

1. Elderly care conference 2017
The state of social care:
the commissioning landscape
Joy Hollister, Strategic Director, Adult Social Care,
Derbyshire County Council

2. The State of Social Care: the commissioning
landscape
Joy Hollister,
Strategic Director, Adult Social Care,
Derbyshire County Council

3. What is social care in the 21st century and why
is it important?
• ‘Social care provides care, support, and
safeguards for those people in our
communities who have the highest level
of need and for their carers. Good care
and support transforms lives, helping
people to live good lives, or the best they
can, in a variety of circumstances. It
enhances health and wellbeing,
increasing independence, choice and
control. It is distinctive, valued, and
personal.
Distinctive, Valued, Personal: Why
Social Care Matters even more in 2017 and into
the long term future, March 2017

4. Why social care matters
 Social care responds to a wide range of needs - from an
18 year old with autism who needs support to leave
home to an 80 year old with dementia who needs
protection as well as personal care
 It helps people to live as independently as possible,
protects people from harm in vulnerable situations,
balances risks with rights and offers essential help at
times of crisis
 Social care touches the lives of millions of people –
almost one fifth of the adult population of England has
experience of social
 Social care relies heavily on over 5.5 million unpaid
carers – usually family members

5. Why social care matters (cont’d)
 Social care involves both public money and private spending. Local authorities spend £13.82 billion -
35% of their total spending and the biggest single budget that councils control
 Individuals spend at least £10 billion of their own money on care services. Nearly half of care home
fees are met by individuals with their own money.
 Social care is a vital ‘connector’ to other public services, especially the NHS but also local housing
and community services
 Councils have important legal responsibilities to protect people’s interests and rights in vulnerable
situations - for example where people are being abused, where they lack the capacity to make
decisions for themselves or where doctors are considering compulsory assessment or treatment of
people in acute mental crisis
 Social care contributes to economic growth as well as meeting social needs. Most care providers
are small businesses that form a sizeable chunk of local economies. It contributes as much as £43
billion to the national economy and supports 1.5 million full time equivalent jobs

6. The current state of social care
• Demographic pressures – 57% increase in people aged 85+ and 21% increase in number of people with
learning disabilities by 2030
• Numerous recent reports highlighting the perilous funding situation of adult social care. This funding
gap is due to increase from £1.9bn to £2.3bn by 2021.
• ADASS budget survey 2016 - only 36% of Directors could say they were fully confident of being able to
deliver all their statutory duties in 2016/17, falling rapidly to just 8% who are sure they could do so in
2017/18
• National response - Social Care Precept, March 2017 budget statement allocated an extra £2bn for adult
social care from 2017/18 to 2019/20
• Better Care Fund 2017/18 will be £5.128 billion and £5.617 billion in 2018-19 – including the local
authority social care grant funding
• Government intends to produce a Green Paper on future funding of adult social care by autumn 2017

7. What does the future hold?
• Changes in who pays?
– Care Act (Part 2) - changes to the means test due to come into
effect in April 2016 delayed until April 2020 (£23,250 upper limit
will be raised to £118,000 and lower limit to £17,000)
– Green Paper – will look broadly at what social care for older
people should do as well as who should pay
• Dilnot commission on funding of care and support recommended a tax
to provide lifelong adult social care that is not means-tested
• The average person will need social care worth about £20,000 during
their lifetime, with slightly more than a fifth of the population dying
before they require any support. 10% of the population will have social
care costs over £100,000

8. There has been no shortage of attention to adult
social care - a reminder of social care White
Papers, Green Papers & other consultations since
1998. The 13th is on its way.

9. Local government and health integration and
Sustainability and Transformation Plans
• Key part of the Spending Review 2015 – goal of integration by
2020
• Financial position of local authorities and health – ‘two financially
leaky buckets’
• NHS Five Year Forward View - new shared future vision based
around new models of care
• More than saving money - need system transformation
• Changing models of care require greater levels of collaboration
between health organisations as well as between health and
social care
• Risk that integration is seen as an end in itself - lack of evidence
that it saves money
• STPs – to further develop Five Year Forward View. 44 footprints
more closely linked to acute pathways than place
• STP leadership through senior managers from health
commissioning and provider organisations – only 4 with local
authority background
• STP based around analysis of health and wellbeing gap, care
and quality gap and financial gap

10. The Social Care Market
• Older people and younger adults (18-65)
– Personal Budgets and Direct Payments
– domiciliary care at home
– day services
– Supported Living
– respite care
– Shared Lives
– residential/nursing home care
• ‘There is profit in care; it is coming from the self-funders who are the forgotten victims
of our collective failure to address how we are to pay for care.’ (Peter Hay)
• In 96% of cases self-funders paid more than state funded residents in the same
home for the same room and the same level of care
• Self-funders pay 43% more than people who have services arranged by the state

11. Some key issues in the care market
• Availability and capacity of the care market – 80 councils (62%) had experienced
residential and nursing home closures in the last 6 months. 74 councils (57%) had
contracts handed back by home care providers
• Quality of care provision - nationally 28% of care services still need to improve
• Requirements of the Care Act – requirement for councils to produce a Market Position
Statement; need to understand and take account of costs of care required to pay for a
sustainable market
• Integration with the Health Service
– Plans for integration by 2017 and 2020 through BCF policy and planning guidance
– Most integration plans will have integrated commissioning as a priority
• Sustainability of the workforce

12. The workforce
• £40.4 billion per annum to the economy
• Over 900 people leaving their jobs in social care every day
• However 1000 people taking up a role in social care every day
• So a net gain of around 100
• But 90,000 live vacancies on any given day
• Need to recruit another 275,000 people by 2025
• Average age of a worker was 43 years old years old
• 160,000 to 220,000 care workers paid below the
national minimum wage
• 49% of home care workers are on zero hour contracts, compared with 2.9% of the
workforce nationally
• 27% of care workers received no dementia training and 24% of those who administer
medication were not trained to do so
• Between 2010–11 and 2013–14, the number of unpaid carers increased by 16.5%,
while the general population grew by 6.2%
• One in five unpaid carers providing 50 hours or more of care each week

13. What can we do?
• What do social care commissioners and providers need
to do?
 Continue to provide evidence to the Government of
need for a strong, sustainable social care offer
 Commissioners and providers to work together to
understand actual costs of care – cost effective
commissioning and provision
 Move as far as possible to outcomes
 Work as part of Sustainability and Transformation
Plans and BCF to integrate where it brings benefits
 Make stronger connections between health, care
and housing
 Joint strategies and approaches on workforce
recruitment, retention and development
 Ensure we are promoting prevention and
independence to cope with demand and improve
outcomes