In our initial response to the Social Care White Paper which we issued the day after the White Paper was published, the Rural Services Network welcomed the ambition of the Government in the Social Care White Paper ‘People at the Heart of Care’. In particular we agreed with the Social Care Minister Gillian Keegan who stated in her speech, “We cannot be serious about Levelling Up unless we are also serious about social care”.

However, we expressed concern about whether the Government will be able to deliver on their promises and fix the broken system.

The White Paper is based on 3 core principles,

• Everybody has choice, control and support to live independent lives
• Everyone can access outstanding personalised care and support
• Adult social care is fair and accessible for everyone who needs it

https://www.gov.uk/government/publications/people-at-the-heart-of-care-adult-social-care-reform-white-paper

We commented:

"These are bold promises from the Government and recent research by the Rural Services Network and the County Council Network, The State of Care in County and Rural Areas, highlighted particular challenges for rural and county areas which would need to be specifically addressed in order to achieve these core principles.

These challenges are:

• Resource: Government funded support for adult social care service costs is significantly lower in county and rural areas
• Workforce: The higher average age alongside ageing population projections within county and rural areas places a high burden on these local authorities
• Self-Funders: The balance of adults self-funding their care is higher in rural areas and likely to be more sensitive to reforms made to the funding system
• Care Homes: The proportion of residential care homes situated in rural locations is higher than in metropolitan areas, often encouraging service user inflow to counties
• Sparsity: Geographical challenges in providing adult social care in large and remote rural areas, particularly the time and costs involved in delivering personal care over large distances

Local Authorities in rural areas are suffering from years of historic underfunding compared to urban areas.  They will be looking for financial reform to bridge the funding gap for Social Care budgets to ensure that they can meet growing demands on the service and current levels of unmet need.  During the Social Care Reform Statement in Parliament on 1st December, Jeremy Hunt MP, Chair of the Health and Social Care Committee highlighted his concerns over the lack of solutions to address the funding to local authorities for their core responsibilities and an ‘end to the workforce crisis’.

The announcements in relation to investment in a range of supported housing options, training for the social care workforce, and a practical support service to make changes in people’s homes so that they remain independent are all welcome, but need exploring in more detail to see how they will be rolled out in rural areas”

In this further paper we comment on some of the funding issues for local government. In doing so we draw on some comments from Pixel Financial Management, the RSN’s Local Government Finance Consultants. These comments are general and not rural specific.

1. Criticisms of the white paper mainly focus on whether there is sufficient funding to make the proposals realistic – and  to make social care financially viable.
2. There is absolutely no mention in the White Paper of the formulae used to distribute Government Grant to Local Authorities. Urban areas receive 16% more per head of population in Government support for social care services than rural areas. The gap has increased from 4% in 2017. This is despite the fact that it costs more to provide services across rural areas.
3. The white paper starts to show how the £1.7bn will be used (p.7/8):
   • “At least £300 million to integrate housing into local health and care strategies”
   • “At least £150 million of additional funding to drive greater adoption of technology and achieve widespread digitisation”
   • “At least £500 million for the social care workforce
   • “A new practical support service to make minor repairs and changes in peoples’ homes to help people remain independent and safe in their home, alongside increasing the upper limit of the Disabilities Facilities Grant for home adaptations” (£570m for DFG).
   • “Up to £25 million … to support unpaid carers”
   • “£30 million to help local areas innovate around the support and care they provide in new and different ways”
   • “A new national website to explain the upcoming changes and at least £5 million to pilot new ways to help people understand and access the care and support available”
   • “More than £70 million to increase the support offer across adult social care to improve the delivery of care and support services”
   • “Continue to invest in the Care and Support Specialised Housing (CASSH) funding with £210m available” over the next 3 years.
4. Some of this funding has already been announced, or is for existing grants, and the values are imprecise (the phrases “at least”, “up to” and “more than” are used liberally). It suggests that ministers have yet to decide how to use some of the £1.7bn in detail.
5. The approach taken by DHSC also suggests that there will be new specific grants, possibly with new burdens or strings attached, and possibly with different allocation Authorities might even find that they have to bid for some of these funds. It seems very unlikely that local government will receive any of this funding simply to use as they see fit to support existing financial pressures. As ever, ministers tend to want to attach strings to new funding.