Social care is there to improve individual wellbeing, and be an enabler for independence and a good quality of life. At some point in our lives, we will all need the transformative support that social care delivers: “To live in the place we call home, with the people and things we love, in communities where we look out for each other, doing the things that matter to us.“
Social care funding is an investment in us all.
Executive summary
- Ensure that minimum fee uplifts for providers cover the cost of the National Living Wage and National Insurance Contribution increases from 1st April 2025.
- Introduce wellbeing outcome measures and provide funding to drive innovation for early action and longer-term reduction in costs.
- Provide emergency funding to immediately support people out of hospital and back into local communities, working with trusted Not-for-Profit providers.
- Review funding models to introduce fee floors which reflect that supported living typically has a higher proportion of pay costs.
Priorities to drive change
Priority 1: Provide stabilising funding to support careers in social care
There are approximately 131,000 vacancies in the adult social care workforce (1) impacting on the consistency of care and support that people receive. The government’s plan to introduce a Fair Pay Agreement for social care, if fully funded, will support better reward and recognition. But in the short term the current budgetary challenges must be addressed.
Non-profit providers welcome and support the rise in the national living wage, support workers are woefully underpaid. We also understand the need to raise tax revenues and create a stable, growing economy. The 6.4% real term increase in spending power for local authorities is a significant amount but the costs of social care have risen high beyond this.
Approximately 85% of our costs are for our workforce, with the remaining going towards running our organisation and maintaining reserves, which provide the CQC Market Oversight assurance that we are sustainable. 90% of our staff are involved in delivering frontline support.
To improve working people’s lives, the government must:
- Ensure that minimum fee uplifts for providers cover the cost of the National Living Wage and National Insurance Contribution increases. Doing so would collectively reduce the cost burden for More Than A Provider organisations from £11.56 million to £3.2 million. This would reduce the risk of service handbacks or closure and enable not for profit providers to deliver digital transformation and service innovation.
Priority 2: Invest in social care to see an economic and social return and longer-term cost reduction
People drawing on social care and carers are more likely to have low wellbeing. It also impacts people’s ability to be economically active. Family members and cares often face disruptions in education, career, and mental health. This can lead to increased mental health challenges, including anxiety and depression, impacting on the NHS. Effective social care reduces this impact, enhancing productivity, as fewer working-age family members need to leave or reduce their jobs to provide care.
Individual wellbeing is the primary tenant of the Care Act 2014, but little has been done to measure or evaluate the economic value that adult social care brings through the delivery of this piece of legislation.
Wellbeing-adjusted Life Year, or WELLBY, is recognised as a way to consistently measure and value improvements in wellbeing. The Treasury’s own guidance (2) defines a WELLBY as a change in life satisfaction of one point on a scale of 0-10 per person per year. It recommends a value of £13,000 per WELLBY.
If social care commissioning focused on outcomes, such as wellbeing, as opposed to outputs, time and task, the government could more effectively measure the economic value of social care.
It could also lead to a more effective evaluation of individual outcomes. To give people drawing on social care and support greater control in a system that is largely determined by the provider’s ability to tender successfully the government must:
- Introduce wellbeing outcome measures and provide funding to drive innovation to support prevention or early action, and longer-term reduction in costs. Pro Bono Economics estimate that halving the number of adults living below the wellbeing poverty line would generate £54 billion in annual economic benefits (3).
Priority 3: Fund the transition out of Assessment and Treatment Units for the 2000 people who are still locked up
It is costing the NHS £534million a year (4) to keep people locked up in hospital. This public money is used for more than 2,000 autistic people and people with a learning disability to be detained in Assessment and Treatment Units. This cost is far higher cost than creating suitable housing and providing specialist support in the community.
People are often detained in ATUs against their will and long distances from home and families are often unaware of what is happening to their loved ones. Of these, approximately 67% are autistic. This is a 116% increase in the number of autistic people without a learning disability detained since March 2015.
To achieve the ambitions in the Care Act 2014, reduce costs to the NHS and stop the trauma and harm caused by long-term institutionalisation the government must:
- Provide emergency funding to immediately support people back into local communities, working with trusted Not-for-Profit providers. Along with the long-term funding to support trauma-informed support so people can thrive and contribute to their local community.
Priority 4: Create fee floors to support provider stability and ensure value for money
Unlike the NHS, there is no recognised or consistent national ‘tariff’ for social care provision that can act as the parameters protecting both viable financial rates for delivering high quality and CQC compliant care whilst at the same time offering value for money for public resources.
The CQC Market Oversight intelligence confirms that specialist providers do not have the financial resilience as seen in older people’s providers. Given the further financial pressures that will be experienced from 1st April 2025, it is essential that the Spending Review provides funding for fees which allow supported living provision to remain viable. To do this the government must:
- Review funding models to reflect that supported living typically has a higher proportion of pay costs – often over 80% of total revenue. Working with the sector to establish fee floors that provide both market stability and the flexibility for commissioners to fund differing local needs and secure value for money. Calculating indicative fee floors for supported living in 25/26 could help protect continuity of provision and generating indicative fee ceilings can offer insight into how value for money is considered for tax funded statutory provision.
[1] Skills for Care, https://www.skillsforcare.org.uk/Adult-Social-Care-Workforce-Data/Workforce-intelligence/documents/State-of-the-adult-social-care-sector/The-State-of-the-Adult-Social-Care-Sector-and-Workforce-2023.pdf
[2] HM Treasury, https://www.gov.uk/government/publications/green-book-supplementary-guidance-wellbeing
[3] Pro Bono Economics, https://www.probonoeconomics.com/news/32-million-uk-adults-living-in-low-wellbeing-new-report
[4] Mencap and ITV, https://www.mencap.org.uk/blog/government-wastes-half-billion-pounds-year-wrong-treatment-people-learning-disability-and