NCA whitepaper outlines ‘critical’ challenges facing adult social care
By Integrated Care Journal
The adult social care system’s funding shortfall could reach £18.4bn within a decade, according to a new whitepaper from the National Care Association and HCR Law.
The adult social care sector in the UK is facing a critical financial crisis, as outlined in a recent whitepaper that examines key challenges through the lenses of funding, workforce, and regulation. The whitepaper, Adult social care: Steering through change, was published by the National Care Association (NCA) in partnership with HCR Law. It paints a stark picture of a sector struggling to stay afloat, with urgent reforms needed to prevent widespread collapse.
The whitepaper explores three critical areas – funding, workforce and regulation – proposing immediate and long-term strategies to address the challenges and to create and thriving, robust sector. Emphasising the intricate web of the adult social care landscape, the report underscores the need for a unified, cross-party approach to implement meaningful changes, and welcomes the recent announcement of the independent commission led by Baroness Louise Casey.
Nadra Ahmed, CBE, Executive Co-Chairman of the NCA, said: “Despite the challenges we face, we have the appetite to ensure that we start to consider and put forward solutions. The paper considers how to overcome the challenges and create a thriving, robust sector which is fit for purpose. It reconfirms the sector’s commitment to playing our part in overcoming the challenges and delivering the rewards.”
Funding crisis threatening sector’s viability
At the heart of the sector’s instability is a glaring funding gap. The Health Foundation estimates an annual shortfall of £8.4 billion, leaving care providers unable to cover basic operational costs, let alone invest in improvements or expansions. This financial strain has already led to bankruptcies and a reduction in available care placements.
Citing the Nuffield Trust, the report argues that the 2024 Budget exacerbated the problem, adding an estimated £2.8 billion in costs to independent care providers. While the planned National Living Wage increase from April 2025 is a positive step for worker compensation, it adds further pressure to an already fragile financial ecosystem. Projections indicate that without significant intervention, the funding gap could grow to £18.4 billion by 2032/33.
Workforce shortages hitting care quality
The sector employs 1.6 million people, representing 5.8 per cent of the UK workforce. The report stresses that years of low pay and worsening working conditions have led to the sector’s high turnover and difficulty recruiting and retaining workers. The Budget, it argues, has worsened these issues, increasing the risk of safeguarding issues that local authorities must manage.
The report stresses that passion alone cannot sustain the workforce; substantial government investment is required to implement the Skills for Care workforce strategy, which aims to elevate social care as a respected and viable career. Alongside this, the report also calls for development of robust career paths, creation of coaching and networking opportunities – and the empowerment of experienced staff while developing the next generation of care workers.
Looking further ahead, the paper supports the notion of a National Care Service. It argues that although the care industry is already interconnected, a fully integrated system incorporating local care services could provide significant, long-term benefits. The proposal aims to create a cohesive and efficient care system which can better serve the UK.
Regulatory inconsistencies erode public trust
Regulation, critical for maintaining care standards, is another area of concern cited in the whitepaper. It criticises the CQC for inconsistent inspection quality and a lack of public confidence in its ability to enforce high standards. Variations in local government oversight further complicate the regulatory landscape, undermining efforts to safeguard service users. The report suggests that comprehensive reform of the CQC, or even the creation of a new regulatory body, may be necessary to restore trust and accountability.
Rebecca Leask, Partner and Head of Healthcare at HCR Law, commented: “In our work, we see the challenges and opportunities faced by all stakeholders in social care and support, from local government and public sector bodies to private and public care providers. We see firsthand their dedication and passion for their work. We take great responsibility knowing the work we do in advising our clients in this sector helps them navigate these challenges and seize opportunities, enabling them to continue delivering for service users and taxpayers alike.”
The whitepaper is available to download from HCR Law.
Report details perilous state of UK adult social care
By Gabriel Blaazer
Latest Sector Pulse Check report calls for a multi-year funding settlement when the government’s Spending Review concludes in summer 2025, alongside a fully funded roadmap towards parity between care workers and NHS counterparts.
An annual review of adult social care services in the UK has warned that thousands of vulnerable adults are at risk of eviction due to mounting and far-reaching cost pressures.
The Sector Pulse Check 2024, produced by Care England and the learning disability charity Hft, is the culmination of a survey of more than 200 independent and charitable providers of adult social care. It says that social providers are operating in “survival mode… sprinting to stay afloat”, arguing that spiralling cost and workforce pressures have put “the entire sector…in a state of acute precarity”.
Financial pressures mounting
The report finds that the financial pressures on social care providers are far-reaching and having a tangible effect on the sector’s ability to provide quality services. In their responses to the survey, 90.9 per cent of providers said that workforce related costs were among the top financial pressures, with 38.8 per cent citing the cost of utilities, and 29.1 per cent unpaid or delayed bills by local authorities. Of these workforce related costs, increases to the national living wage were identified by 95.8 of providers as one of the biggest challenges. Critically, 85 per cent of providers did not experience increases in fees paid by local authorities to cover the national living wage rise
To cope with financial pressures, three in ten providers closed parts of their organisation or handed back care contracts to local authorities in 2024, often evicting some residents in the process. One third of all providers have curbed inward investment in the last year to offset rising costs, rising to two fifths of providers of care for older people, a move likely to impact care capacity and quality over the long-term.
Although the share of providers in deficit fell for the third consecutive year (down to 29 per cent from 40 per cent the year before), 60 per cent of those in deficit reported an increase in the size of deficit from the year before. It is estimated that seven in ten providers currently operating with a decreasing surplus will be in deficit within three years. This is expected to increase if the government does not add exemptions for social care from the rise in Employer National Insurance Contributions (NICS) announced in the 2024 Autumn Budget. Social care providers have been pushing the government for exemption, but the government has yet to announce any policy to mitigate the increased costs for the sector.
“Severe” workforce shortages
The report identifies workforce concerns as an ongoing and “severe problem” for the social care sector, pointing to its 8.3 per cent vacancy rate. The whole UK economy’s vacancy rate is 2.6 per cent, indicating the unique difficulties facing social care. 33 per cent of providers reported a fall in job applications in 2024, compared to 2023. This is partly attributed in the report to changes to legal migration rules introduced in March 2024, which include a ban on foreign care workers bringing dependants on their visa, along with an increase to the minimum baseline salary to be sponsored as a Skilled Worker (rising from £26,200 to £38,700).
While 40 per cent of providers (particularly smaller organisations) reported relying on international recruitment to fill posts, providers reported a decline in international applications following the new immigration restrictions, and expect to see yet further impact with time. Hft and Care England argue that the government should lift the ban on dependents for international social care staff to help protect the sector’s supply of workers.
Due to staff shortages, 29 per cent of providers reported refusing new admissions, while 40 per cent have increased their use of agency workers to fill gaps. Agency workers are typically more expensive and considered “less prepared to deliver quality care compared with their full-time equivalents”.
The sector’s future
The Sector Pulse Check report concludes that “there can be no expansion in the capacity of the social care sector without both more funding and more workers”. Lord Darzi’s recent revelation that the equivalent of 13 per cent of NHS beds are occupied by people waiting for social care support or care emphasises that the NHS cannot thrive without a functioning social care sector. The sector’s high turnover rate of nearly 26 per cent demonstrate social care’s challenge in attracting and retaining skilled workers.
While the government has recently announced the launch of an independent commission to reform adult social care, led by crossbench peer Baroness Louise Casey, some in the sector have voiced concerns over the commission’s three-year scope. Martin Green, Chief Executive of Care England, commented that “waiting until 2025 is not an option,” and voiced concerns that this will be “yet another report that gathers dust while the sector crumbles”. Regarding immediate action, the report highlights Skills for Care’s Workforce Strategy for 2024, which offers a series of policy recommendations to “attract, retain, train and transform the social care workforce”.
The report makes two major policy recommendations:
Commit to a credible, multi-year funding settlement for the adult social care sector when the Spending Review concludes in Summer 2025. Funding increases must cover future increases in the national living wage, and any changes to Employers National Insurance, and inflation, to avoid real-term pay cuts and the large-scale market exit of care providers.
Create a fully funded roadmap toward parity between care workers and workers in the NHS. Pay and conditions are central to this, yet the significance of status and respect must not be ignored. This should include adopting the recommendations of the Skills for Care Workforce Strategy to address the high vacancy and turnover rate in the sector.
Alongside these, it calls on the government to either exempt care providers from the increase in Employer NICS contributions, or to fully fund the rise itself. It also urges the government to ensure that the NHS and local authorities are sufficiently funded to reimburse care providers through the Local Government and NHS funding settlement.
The full Sector Pulse Check 2024 report can be accessed here.
Landmark ruling sets critical precedent for adult social care funding and local authorities
By Integrated Care Journal
The landmark judgement on social care finance was handed down on 17th December in Julie Richardson Ltd & Banbury Heights Ltd v Oxfordshire County Council, increasing pressure on local councils to meet adult social care funding obligations.
In late December, Her Honour Judge Walden-Smith handed down a landmark ruling with potentially far-reaching implications for local authorities and their obligations to fund adult social care for eligible residents.
The case, Julie Richardson Limited & Banbury Heights Limited v Oxfordshire County Council, was brought by two family-owned care homes – The Julie Richardson and Banbury Heights Nursing Homes.
Represented by Paul Ridout, Healthcare Regulatory Partner at HCR Law, the claim was filed against Oxfordshire County Council (Oxfordshire CC) on 13 August 2021. The dispute centred on unpaid care costs exceeding £195,000 for two adult social care residents. Both individuals had been assessed by Oxfordshire CC as meeting the care eligibility criteria under the Care Act 2014 and were placed in the respective care homes.
While the care homes provided essential services, the financial resources of the residents fell below the statutory threshold, triggering an obligation for Oxfordshire CC to begin funding their care.
However, as essential care and accommodation continued to be delivered, the bills were being left unpaid. This placed the care homes in the difficult position of delivering unfunded care or discharging residents with nowhere else to go, an outcome no care home would ever willingly choose.
A spokesperson from the nursing homes said, “We are pleased that the court has, so far, ruled in our favour regarding the injustice we faced at the hands of Oxfordshire County Council. We refused to evict vulnerable elderly residents from our nursing homes simply because they had exhausted their funds. The council suggested we should have done so but failed to provide any indication of where these individuals could go to receive the care they needed. When faced with a crisis in the lives of these residents, the council shirked its legal obligation to fund their care, instead expecting a small, family-owned nursing home to bear the financial burden of hundreds of thousands of pounds for their upkeep and care.”
During the legal proceedings, Oxfordshire CC sought to strike out the claim. In response, the claimants filed an application to amend the particulars of their claim, alleging unjust enrichment on the part of the council.
On 17 December, the court ruled in favour of the care homes, granting permission to amend the claim and rejecting Oxfordshire CC’s application to strike it out. The judgment marks the first positive ruling under key provisions of the Care Act 2014 (Sections 8, 13, and 18) and underscores the statutory duty of local authorities to provide care funding for eligible individuals.
Paul Ridout commented: “This is a landmark ruling and the first positive judgment under the Care Act. It serves as a powerful reminder to local authorities across the country of their legal obligations.”
The court reaffirmed that once a resident’s care needs are established, local authorities must ensure those needs are met at a reasonable cost. This ruling sets a significant precedent, highlighting that councils cannot neglect their legal obligations. Paul Ridout added, “I am certain care homes nationwide will take note of this decision and review any outstanding payments owed by local authorities for the essential care they have provided.”
This ruling adds to the strong headwinds surrounding adult social care funding and the financial pressures on local authorities. Care England has recently reported a £2.2bn shortfall in residential care provision, while the 2024 State of Local Government Finance in England report revealed that 16 per cent of councils are planning to cut adult social care services. This judgement could lead to significant national policy implications for the government, who ultimately may need to support local authorities in meeting their obligations, reinforced by the ruling.
The nursing home spokesperson concluded, “This case involved two individuals whom the Council knew required a high level of care and for whom they were responsible under the Care Act. Instead of meeting these obligations and paying the fees for this care the Council decided to use their power within the market to force the costs onto a small care provider. I would be amazed if this was the only council doing this, and we were the only provider that had been forced to bear these costs.”
The judgment reinforces the rights of eligible individuals to access essential care, empowers adult social care providers across England to pursue outstanding payments from local authorities, and serves as a critical reminder to councils of their statutory responsibilities.
The case is now on course to proceed to a full trial in the High Court.
Local authorities join initiative providing digital support to carers
By Integrated Care Journal
1 million carers across England are benefiting from tech-powered support, as 1 in 4 (25 per cent) local authorities across the country have joined an initiative providing essential, digital services for all those who look after loved ones in their communities over the course of this year.
Nine local authorities across Cheshire and Merseyside have become the latest to join a new initiative aiming to provide digital support to carers. The service is being delivered by carer-led digital community, Mobilise, and can be accessed remotely via Mobilise’s online hub by anyone caring for a loved one in regions where local authorities are participating in the initiative.
Under the Care Act 2014, local authorities have a duty to promote and provide services to unpaid carers in their area, to put support the wellbeing of carers and reduce the risk of carer burnout.
The digital support services include:
An online peer community of thousands of fellow carers from across the UK – with the chance to share advice and experiences through a community forum and during regular events, such as the ‘virtual cuppa’
Easy-to-use, self-service tools outlining the different forms of support which carers may be entitled to – including Carer’s Allowance – and guidance on how to navigate eligibility criteria and access various benefits
Tailor-made support guides on everything from how to balance caring with full-time work, to managing personal health and wellbeing while looking after someone else
Information on carers’ rights and relevant social care law, in line with the latest government guidance
An AI-powered ‘assistant’ is also available to help carers quickly and easily find the specific information, resources or support that they need.
Cheshire and Merseyside is home to some of the UK’s highest density areas of unpaid carers, with more than one in ten residents living in St Helens, Knowsley and Halton providing some form of unpaid care.
“It’s reassuring to know that my experience as an ‘unofficial’ carer for my husband is valued, and that there is support and advice available from Mobilise if and when I need it.”
Sheila Walsh, a carer in St. Helen’s
Chair of the Adults and Health Committee at Cheshire East Council, Councillor Jill Rhodes, said: “By joining this initiative, we’re taking a significant step towards recognising and supporting the invaluable contribution of our local carers. The Mobilise digital tool will empower unpaid carers to access the help they need, when they need it.”
Cheshire and Merseyside councils follow thirteen local authorities in the North East, who joined the same initiative earlier this year through a similar collaboration. This saw over a quarter of a million carers living in the North East alone gain access to additional digital support. The North East is home to the largest proportion of people supporting relatives or loved ones in any region across the UK.
With Cheshire and Merseyside onboard, a total of 38 local authorities across England have provided added support for carers so far this year as part of the tech-enabled initiative with Mobilise, on top of existing provision. The free on-demand services are aimed at supporting individuals across the UK with the day-to-day realities of caring.
Suzanne Bourne, Co-Founder and Head of Carer Support at Mobilise, commented: “It is amazing to see all nine local authorities across Cheshire and Merseyside coming together to harness the power of technology, and widen access to support for unpaid carers. They join many other local authorities across England in this mission. And, with Cheshire and Merseyside onboard, a quarter of all local authorities across England are now providing additional, digital support for carers. We can’t wait to see the impact for all those who provide care across Cheshire and Merseyside, and beyond.”
Councillor Del Arnall, Cabinet Member for Adult Social Care at Knowsley Council, said: “Through joining this initiative, carers in Knowsley can use Mobilise to easily access a range of support services on-demand and link in with their peers across the UK to share advice and reduce isolation.”
For more information about the support now available in Cheshire and Merseyside, see here. To start accessing support today, the Mobilise app can be downloaded via the Apple App Store or Google Play, with more information available on Mobilise’s website.
Reforming diabetes care in care homes: training, collaboration, and compassion
By Navodi Kuruppu
Navodi Kuruppu spoke with Lynne Reedman, Founder and Service Lead for DUET Diabetes, and Martin Scivier, diabetes patient and advocate, and #dedoc° member, to discuss the impact of Covid-19 on care home residents with diabetes, the importance of peer support, and the urgent need to prioritise care for vulnerable and older populations.
In 2020, the first wave of the Covid-19 pandemic had a devastating impact on care homes in England; with over 40 000 residents dying by the end of 2021, 97.8 per cent of whom were aged 65 and over. Numerous investigations and the ongoing Covid inquiry have already highlighted major shortfalls in care homes, including lack of testing and personal protective equipment (PPE) for residents and staff. [1][2]
Delivering quality care during the pandemic was an even bigger challenge for residents with long-term conditions like diabetes. A skill gap in diabetes care among staff and deficiencies in technologies resulted in a lack of clarity and coordination regarding who to contact for immediate help, which led to preventable hospital admissions and increased mortality.[3] However, these deficiencies were not the result of the pandemic, but rather pre-existing gaps in the system that the Covid-19 crisis exposed and exacerbated.
Training of staff in social care is fundamentally important says Lynne Reedman
At least one in four care home residents currently has diabetes, however, an estimated 13,500 care home residents live with undiagnosed diabetes.[4] By 2050 the number of people aged over 85 is estimated to exceed eight million in the UK, which is likely to place additional strain on the social and residential care sectors.[5]
Lynne Reedman founded DUET Diabetes in 2015 from a desire to improve the understanding and knowledge of those looking after adults with diabetes. Designed to improve the skills and confidence of carers, nurses and healthcare support workers and the standards of diabetes care they provide, DUET Diabetes seeks to address knowledge gaps that were brutally exposed during the pandemic. Lynne argues that to solve these challenges, social care must be guided by three key principles that DUET Diabetes champions: communication, collaboration and education.
The 2022 National Advisory Panel on Care Home Diabetes (NAPCHD) was established to address the root causes of inadequate diabetes treatment in care homes. Their report identified several issues, including a lack of knowledge of key principals of ethical diabetes care on the part of care home staff, diabetes care teams and social services; ethnicity-related challenges in clinical care; and the importance of residents’ emotional wellbeing – all of which led to poor management of diabetes complications.[6]
Lynne observes that many team members including nurses in care homes lack a basic knowledge of diabetes best practice, reiterating the fact that diabetes training is currently not mandatory for care home staff. She says, when you talk to [the staff], a lot of them don’t have much confidence or knowledge [of diabetes care].
Residents shouldn’t have to wait for a district nurse to come in and manage their diabetes. We need a care sector that knows and fully understands diabetes and knows how to support these people.
Lynne Reedman, Founder and Service Lead at DUET Diabetes
Lynne strongly advocates for the implementation of a basic diabetes awareness programme across the social care sector, coupled with extra training to enable staff to disseminate knowledge within their own organisations. The NHS Diabetes Prevention Programme (DPP), along with campaigns organised by Diabetes UK and other organisations around the country, has played a central role in raising awareness at both national and local levels. Lynne’s proposal is innovative, in that it considers the combined needs of diabetes and social care, with the aim of supporting an all-around prioritisation the condition that is necessary to bridge the gaps specifically found within social care. You have to treat a person as a whole in care homes, she insists, and the care has to be tailored to each resident.
The NAPCHD proposes a multi-disciplinary model, focusing on collaboration between care homes, community and specialist services, primary care, and other key stakeholders. Within this model, the resident with diabetes is placed at the centre, supported by a nurse-led facilitator from the GP-Primary Care Unit and adult social services. Local Primary Care Networks (PCNs) would play a key role in supporting this service, by deploying existing primary care nurses with diabetes experience into facilitator roles, following additional training. While funding for this model may require agreements across multiple agencies, health economic studies are anticipated to demonstrate its cost-effectiveness, showing reductions to hospital admissions, ambulance callouts, GP visits, and medication expenses.
Using insulin pens, checking expiry dates, monitoring technology devices, maintaining a good diet and level of physical activity – there is a lengthy list of a daily actions that diabetes patients must juggle. These challenges are compounded for older patients with diabetes, who may encounter more difficulty caring for themselves daily. Studies have shown that diabetes may decrease mobility and restrict activities of daily living (ADL) by approximately 50-80 per cent, with this decline becoming more pronounced with age.[7]
One important aspect that the review does not touch upon is the role of peer support in diabetes care for older patients. Whether in a care or nursing home, emotional support is just as important as physical care.
Martin Scivier, a diabetes advocate, fully recognises the power and value of peer support. Now 75, Martin was diagnosed with type 1 diabetes (T1D) in 1954. Seventy years later, he feels healthy and lucky, having experienced only a few diabetes-related complications. To give something back to the diabetes community, Martin started running his own blog, Martin Scivier’s Mellitus – Type 1 Diabetes, in 2022, documenting his journey and experiences with T1D.
When I go to the hospital for appointments, I just sit there in the corner and don’t talk to anybody, I keep myself to myself. And then I see the nurse, see the doctor, and then I go out and go home. But thanks to social media I have found this wonderful diabetes community and started to get involved. Thanks to peer support, I am not on my own
Martin Scivier, Diabetes Advocate and T1D Patient
In 2018, Martin joined social media, finding many self-help groups on Facebook, Twitter and WhatsApp, such as the #GBdoc hub. I never went to diabetes camps when I was younger, so I used to be very much on my own, recalled Martin, but now I have all these new friends. This peer support acted as a hugely important space for Martin to feel supported and comforted after his regular check-ups at the hospital.
Martin’s story is testament to the power of peer support and its capacity to provide a safe space where patients like him can find comfort in sharing their experiences, feel supported and be reassured they are not alone. Martin has an optimistic outlook on the future, which he aims to realise through his advocacy and engagement with organisations like PPP. However, he was quick to acknowledge that many others are not as fortunate as him.
Older people need and deserve more says Martin Scivier
The NAPCHD strategic document acknowledges that many care home residents are highly vulnerable, and their diabetes condition is often worsened by complications, including uncontrolled hyperglycaemia, hypoglycaemia, which can lead to eminently preventable hospital admissions. It is estimated that 75 per cent of people with diabetes die because of cardiovascular complications, many of which could be prevented.[8]We have lost too many people along the way because of complications [of diabetes], adds Martin.
However, the condition and complications are often compounded by another factor – loneliness. Age UK has reported that around 1.4 million older people often experience loneliness each year in the UK.[9] Another study has found that loneliness is a bigger risk factor for heart disease in patients with diabetes than diet, exercise, smoking and depression.[10] Loneliness can also lead to decreased daily activity, contributing to increased inflammation and blood pressure, cognitive and motor decline, anxiety and depression.[11] Healthcare systems and providers must recognise that loneliness is a significant risk factor, affecting both psychological and physiological health outcomes, as well as health-related behaviours of older adults with diabetes.[12]
Martin shares Lynne’s belief that better training leads to better care. He recalled the 2016 education model run by Benikent within Swale CCG to improve diabetes management in care homes.[13]
Through this model,unregistered practitioners in care homes were trained diabetes management to improve diabetes care and delegation of insulin, ultimately seeking to provide individualised care plans and appropriate diabetes-specific training for all staff in the care. [14] Martin argues that this proves to me 100 per cent that any training is better than no training. But compulsory training would be brilliant.
PPP’s Diabetes Care Programme seeks to bring different stakeholders to the table. Hearing the stories of patients with lived experience of diabetes, together with the perspectives of experienced professionals, makes clear the importance of person-centred diabetes care. This approach supports both the medical aspects of the condition, such as managing complications, reducing hospitalisations, and lowering mortality rates among the elderly, as well as the human elements of treating patients fairly. As described by Martin, patients deserve to be treated with dignity and respect.
An individual should be cared for with dignity and respect. Their rights should be paramount.
Martin Scivier, Diabetes Advocate and T1D Patient
To learn more about how to get involved in the 2025 Diabetes Care Programme, visit the website here.
Martin Scivier, Author and Diabetes Patient AdvocateLynne Reedman, Founder and Service Lead, DUET Diabetes
Accelerating remote monitoring innovation in social care
By Fiona Brown
With the number of people who will require at-home care set to increase, innovation to boost capacity and drive efficiencies in social care is desperately needed, writes Fiona Brown, Chief Care Officer at Lilli.
In the ever-evolving landscape of social care, the need for transformational system-wide change has become increasingly apparent. Capacity and demand are reaching a critical level, with 73 per cent of healthcare leaders saying a lack of social care capacity is having a significant impact on their ability to tackle the elective care backlog. This is where new proactive care technology emerges as a vital ally in addressing challenges like workforce shortages and access to services.
However, navigating this path to technology adoption amid a stretched workforce, bureaucratic hurdles and a lack of long-term solutions to social care capacity, presents its own set of challenges. Procurement processes, often burdened by strict and outdated internal controls, can create barriers to meaningful change. Instead of embracing a holistic approach to technology integration, these internal barriers can lead to the development of tenders with narrow specifications, overlooking the wider system impact.
Pilots, while valuable for testing and refining solutions, often fall short of achieving lasting impact due to insufficient time for advocacy or momentum building, unclear outcomes and an organisational requirement for quick financial returns. In addition, lack of early engagement with the market further complicates efforts to drive systemic change. As a result, pilot fatigue can set in across teams. To counteract this trend, there needs to be a shift towards long-term commitment to proven solutions to see real transformation.
Across the sector, central government has launched several types of competitive and highly sought-after technology funds for organisations to apply for, including the Adult Social Care Technology Fund and the Digitising Social Care Fund. Yet more recently a new type of fund has been launched directly from the technology sector. The Proactive Care Fund (PCF) aims to expedite the adoption of home monitoring technology by offering local authorities and integrated care boards (ICBs) up to £1 million of matched funds, ushering in a new era of efficiency and efficacy in care delivery.
Home monitoring technology that discreetly monitors patterns of behaviour and indicators of wellbeing has been proven to help to address many of the key challenges in the system – from staff shortages to shrinking budgets – by supporting carers to right-size care packages, keeping people living independently for longer.
The technology can empower carers to be on the front foot and proactively respond to signs of health decline before conditions become acute. Data from remote monitoring company, Lilli, for instance, shows that it can generate thousands of additional carer hours, and accelerate hospital discharge by up to 16 days. Moreover, for every £1 spent on the technology, £9 can be reallocated into the care budget.
The PCF provides the necessary support and resources for organisations to break free from the reactive delivery of care and adopt a proactive care model to explore and implement innovative technologies with confidence while realising the benefits of saving money, time and resources.
Central to this paradigm shift is the creation of a conducive procuring environment within the sector. The PCF addresses this need head-on by streamlining procurement processes and providing matched funding to alleviate financial pressures. By facilitating quick and easy access to transformative technologies, the PCF empowers organisations to embrace innovation quickly without undue burden. G Cloud contracts, committed to a minimum of 12 months, offer organisations the time and flexibility needed to realise the tangible benefits and assess the broader impact on the care ecosystem.
Last year, several organisations – including borough councils, county councils and ICBs – across the UK saw successful applications through the first PCF. These included Hillingdon Council, Medway Council, Oxfordshire County Council and North Central London ICB, who embraced the initiative to support a variety of adult social care services and enable their residents to live safely and independently.
According to the latest research, the number of people who will require publicly funded care at home in the UK is expected to grow by 36 per cent between 2024 and 2035, so it is crucial that transformation happens now to prevent further crisis in the future. The PCF represents a significant step towards accelerating the adoption of proactive models of care, while having a positive knock-on effect across the rest of the health ecosystem, reducing pressure on emergency services, reducing hospital admissions and speeding up hospital discharge. In current times, where central and local government are struggling to fund basic services, private sector initiatives, with a track record of savings and efficiencies, could prove to be part of the puzzle to help a sector in crisis.
To find out more about Lilli’s remote monitoring technology, please visit www.intelligentlilli.com.
Social care system in sustained crisis despite ‘record’ investment, report finds
By Integrated Care Journal
2023 Sector Pulse Check report describes the current situation in social care as “arguably more perilous than ever”.
Unsustainable financial and workforce pressures are forcing adult social care providers to turn down new admissions and close services, as government grants are not reaching the people who need them most, according to a new report commissioned by Care England and the learning disability charity, Hft.
Based on a large-scale survey of adult social care providers, the 2023 Sector Pulse Check report finds that despite the sector receiving a £7.5bn funding boost in Chancellor Jeremy Hunt’s 2022 Autumn Statement, there has been little progress in the key challenges facing social care.
In a statement, Care England described the current social care environment as “arguably more perilous than ever.”
Professor Martin Green OBE, Chief Executive of Care England, commented: “The narrative that social care is under pressure is not a new one. What’s disappointing is that we find ourselves in a worsening crisis amid the Government’s narrative of ‘record investment’ into the sector.
“While the Government did make substantial commitments in the 2022 Autumn Budget, the outcomes have not matched the ambition. The new money into the sector has not led to tangible change or any significant progress towards ‘fixing adult social care’.
The report highlights how headwinds facing the social care sector include rapid and dramatic energy cost increases and unfunded rises in the National Living Wage, which contributed to 40 per cent of adult social care providers ending 2023 in deficit, the report says.
Recent funding initiatives from the government, such as the Market Sustainability and Improvement Fund and the International Recruitment Fund, have failed to mitigate funding concerns for the majority of providers, the report states; 84 per cent of care providers surveyed said that these measures made no difference to their organisation’s overall financial sustainability over the past year.
This has resulted in a reduced capacity for the sector to deliver care across providers, and the report finds that:
43 per cent of providers closed services or handed back contracts;
18 per cent offered care to fewer people;
39 per cent considered exiting the market altogether.
Workforce challenges remain widespread
The findings are concerning for a sector already facing deep-rooted and systemic challenges, particularly around workforce retention and recruitment. Despite a recent rise in international recruitment, staffing shortages remain widespread across the sector, with approximately one in 10 posts vacant in 2023/23. Nearly half (44 per cent) of organisations had to turn down admissions due to a lack of staff in 2023, the report finds.
Care England’s statement argues that the government’s approach to mitigate workforce are not working, and cites the recent tightening of overseas care staff and growing concern over the state of local government finances. Hft and Care England are calling on the government to implement immediate measures to support the care sector, including improving commissioning practice, revising VAT arrangements and removing barriers to ethical international recruitment.
Professor Martin Green OBE added: “It’s clear that the way our system is funded needs a rethink. For years, adult social care providers have absorbed increased costs and inflationary pressures without corresponding funding. When money is made available it simply isn’t cutting through. Recent changes to immigration rules and an insufficient Local Government Finance Settlement this year further suggest a government that is heading in the wrong direction. The sector’s needs are now on red alert.
“Our long-term vision remains one of a sustainable sector that is financially viable and an attractive destination for staff. While this may seem a distant reality, there are a range of policies at the Government’s disposal that would help turn the tide and put us on the path towards a sustainable future. As we count down to a general election, the Government must now make good on their promise to fix our sector.”
Steve Veevers, Chief Executive of Hft, said: “It is difficult to offer words of hope and motivation when the past 12 months have seen the adult social care sector engulfed in a sustained state of crisis.
“Despite moving away from the immediate challenges posed by the COVID-19 pandemic, there has been little respite from the fundamental financial and workforce pressures that have faced our sector for many years. The fact that 43% of providers told us they closed a part of their organisation or handed back contracts last year is testament to this.
“Our report provides several realistic, practical and impactful suggestions – including reforming VAT, revisiting the new visa laws for international workers and establishment of national commissioning standards – which we shouldn’t delay in implementing if we want to see real change from the next Government.”
Speaking to ICJ at the launch event, Veevers argued that ICSs, with their remit for joining local services, present an ideal avenue through which to improve access to social care. However, in line with recommendation area four in this year’s Sector Pulse report, he stressed that social care representation on integrated care boards and integrated care partnerships needs to increase in order to adequately reform the sector.
RIVIAM Digital Care’s Hospital Discharge: ready for NHSE’s Care Traffic Control Centre roll out
By Claire Hopkins, RIVIAM Digital Care
Delayed discharge cost the NHS an estimated £1.7 billion in 2022/23. RIVIAM’s Hospital Discharge service connects third sector partners and NHS trusts with the data they need, speeding up discharge, reducing readmission rates and supporting system-wide efficiency.
In 2023, RIVIAM introduced its Hospital Discharge service which is currently being piloted at the Royal United Hospitals Bath NHS Foundation Trust (RUH). Following the pilot, the service will be available on all wards to fast-track patient hospital discharge. The service enables RUH ward teams to make patient referrals simultaneously to multiple community, housing and voluntary sector services working together using RIVIAM at the Community Wellbeing Hub (CWH) in Bath and North East Somerset.1
Staff at the RUH can then see the status of the care in real time via RIVIAM’s Care Control Dashboard. NHS England plans to expand such Care Traffic Control Centres across England to boostcapacity and improve patient flow.2 RIVIAM’s Hospital Discharge service is a ready-made digital solution to support this ambition.
The challenge
According to NHS England, there are “more than 12,000 patients every day in hospital despite being medically fit for discharge.”3 Data from The King’s Fund also suggests that discharge delays in England increased throughout 2022 and that the cost of delays in 2022/2023 was at least £1.7 billion, at a time when the NHS is pushing to find cost savings.4 For patients, being stuck in hospital when they are fit enough to leave is also upsetting.
One of the challenges with reducing delayed discharges is how to access capacity in the care system provided by social care, community, housing and voluntary sector organisations. To make and coordinate discharge dependent referrals to these services often means multiple different referral routes and phone calls – this takes time that hinders patient flow and could be better spent delivering care.
For community, housing and voluntary sector services receiving referrals, it’s hard to access the latest patient information and to co-ordinate referrals for the best follow up care.
RIVIAM’s Solution
With RIVIAM’s Hospital Discharge service, ward teams at the RUH complete an Onward Admission Referral form giving them one place to refer a patient to a wide range of available community, housing and voluntary sector services at the CWH. This includes commissioned discharge dependent services which cross local authority boundaries.
Immediately reducing admin burden, the referral process is quick and seamless. RIVIAM also auto checks the patient’s details against the NHS Spine Mini service ensuring a high level of data accuracy is captured during the referral process.
Ward teams then use a Care Control Dashboard to see in real time what’s happening regarding the care they have requested for a person. Status updates and useful information are easily accessible. Online communication reduces the need for phone calls and emails which introduce time delays to a patient’s discharge.
A view of the dashboard is also available for the 20 different partners at the CWH so staff can easily see the person’s most recent ward, their expected discharge date and the different services requested.
Integration with the hospital’s Electronic Health Record (EHR), Cerner Millennium®, means that the dashboard data is seamlessly updated in near real time providing timely visibility of this critical information.
For CWH partners, RIVIAM makes it easy to co-ordinate care for a person with each other, reducing duplication, providing efficiencies, and improving the person’s experience.
Benefits of using RIVIAM’s Hospital Discharge service:
Improves patient care and prevents readmission. People leave hospital as soon as they are medically fit with the right support in place.
Frees up beds. Patient flow of those who are Clinically Ready for Discharge is improved, relieving pressure on hospital beds.
Utilises community and voluntary sector capacity. People can recover from a hospital visit at home, with access to local services.
Increases team productivity through data-driven decision making. There is one place for ward staff to see the latest information about the community care lined up for a person, communicate with them more easily and make quick decisions about discharge.
Delivers integrated care. Health, social care and voluntary sector providers can receive, manage and co-ordinate and care delivery and communicate with hospital ward teams.
Greater system-wide efficiency. Real time integration with electronic health records (EHR) provides seamless information flows and insights to reduce time delays, duplication and enable improved care.
“The impact of this digital transformation is plain to see. For ward staff, the ability to easily make referrals to multiple organisations at the click of a button is revolutionary. However, the ability for Discharge Co-ordinators to then easily see when support has been put in place gives much more assurance that a person can return home safely. This platform is not just a tool; it’s a conduit for change, enabling us to reach those who need us most,right when they need us.” – Simon Allen, CEO, Age UK Bath and North East Somerset
To find out how RIVIAM can support your organisation via hello@riviam.com or 01225 945020.
1 The CWH uses RIVIAM’s Multi-agency Referral Hub service to receive and manage referrals in Bath and North East Somerset for 20 social care, community, housing and voluntary sector organisations.
Recommendations from the report covered enabling DHSC to ease the burden of social care providers operating in multiple ICS footprints who deal with a variety of Shared Care Record formats, the support of digital inclusion among people receiving adult social care by local authorities and mandatory basic digital training for adult social care professionals.
The government has recently announced that £600 million is to be allocated to the adult social care sector to boost winter capacity, fund a research programme to determine future policies for social care, and follow through on commitments made in the Next Steps to Put People at the Heart of Care white paper. In order to achieve these goals, DHSC should not undermine the importance of investing in digital technologies within the social care sector, which will increase efficiencies and reduce pressure on frontline staff.
Examples of this type of technology are provided by The Access Group and include Access Assure and Oysta Technology – part of their Technology Enabled Care (TEC) solutions. The Health, Support and Care division (HSC), of which Access TEC is a part, works with more than 10,000 registered care providers, more than 200 local authority departments, and 50 NHS trusts, providing technology that helps these organisations deliver more efficient and personalised care.
Access Assure is a key pioneering technology supporting the adult social care sector by allowing vulnerable individuals to live independently for as long as possible and giving their loved ones peace of mind that they are safe, even when alone in their homes.
Alex Nash founded Alcuris – now Access Assure – in 2015 following his grandfather’s diagnosis with dementia, after noticing a lack of sufficient updates on his wellbeing. He developed a digital care solution that learns the behaviours of individuals and supports their independent living, while also providing the necessary information to the relevant health and care professionals.
The platform uses insights from social alarm and smart sensor technology to enable caregivers to provide proactive care by seeing where anomalies in data could be caused by health complications. These can include notifying carers if someone hasn’t been mobile, which could be due to a potential fall, or if they haven’t been going to the toilet regularly, which may be a symptom of a urinary tract infection (UTI), which is one of the biggest causes of hospital admissions for older people in the UK.
NHS East Lothian has been using the product since 2019 to review patient data and make decisions about the care of each individual. The system has enabled them to change care packages by identifying issues such as UTIs, making their delivery of care preventive of larger issues. By connecting direct costs in care to the use of Access Assure at NHS Lothian, it can be seen that each UTI avoided, or detected early on, produces a cost avoidance of around £3,000 per event.
A 2020 white paper titled Next Generation Telecare: The evidence to date, focusing on 29 family members users using Access Assure, also showed that 83 per cent of families felt it provided increased reassurance because even when not with their loved ones, they can still support them remotely and check-in.
Across the Access Assure customer base, staff have reported significant improvements to their work experience since using the technology. Tools embedded within the system have streamlined administration processes, helping staff cut admin time from 4 hours to a few minutes per individual, releasing time to care. Local authorities can also access the data to intervene swiftly, reducing the need for emergency care and improving quality of life for individuals. When the average wait time for an ambulance is 56 minutes and each callout costs the NHS around £252, the ability to pinpoint potential health complications early with platforms like Access Assure can prove significant in alleviating current pressures on emergency care.
Plus, the Access Assure dashboard, which has been developed over the last year, allows all Access Assure devices and their data to be pulled together into a single resource. Considering the insights provided by Access Assure, the Next Generation Telecare white paper also highlighted that over 40 per cent of care plans were amended after close interrogation of the data, resulting in better care for individuals and a reduction in hospital visits. The dashboard highlights information which can be saved as a PDF so that local authorities can quickly recognise any anomalies and spot where intervention may be needed.
Using Access Assure, patients can be supported to live independently for longer, and care providers and staff are able to drive care management forward. And collectively, with Access’ other technology enabled care solution, Oysta Technology, and wider HSC portfolio of technology, health and care professionals can take a more proactive and preventative approach to person-centred and participatory care. Access TEC supports NHS, local government and registered care organisation customers wishing to ensure service-users maintain and enhance their independence and confidence, while having dignity, security, and reassurance. These solutions also prevent, reduce or delay hospital admissions or the need to access care home settings and improve the quality of life for the cared for as well as family members and informal carers so that people are supported to stay safe, happy, and healthy in the communities they call home.
Protecting the dignity of vulnerable people through technology
By Gavin Bashar
Gavin Bashar, Managing Director at Tunstall Healthcare, discusses why it’s important to protect the dignity of vulnerable people and how technology can be used to achieve this while improving health and care outcomes.
As the health and care needs of our population change, it’s important to uphold the dignity and rights of those who use health, housing and social care services. There are a number of strategies and innovations that providers can implement to help them deliver high quality services that support the dignity of vulnerable people.
Protecting the dignity of vulnerable people
As the health and care needs of our population change and the number of older people increases, it is important that service providers understand why and how care provision can play a crucial role in protecting the dignity of vulnerable people.
Dignity can be defined as the state of being worthy of honour and respect. When it comes to health, housing and social care services, this particularly focuses on being able to provide care that is tailored to meet the needs of each individual, their circumstances and wishes.
Robust and integrated systems can be well placed to deliver improved outcomes for citizens, reducing their need for emergency and more extensive care, such as hospital admission. The longer that people are able to remain independent without the need for acute services, the more their dignity and quality of life will be protected.
The role of technology
One of the prime objectives for technology-based solutions is to put people at the heart of their own health and care needs, protect their independence and dignity, and achieve citizen-focused outcomes. With the right digital frameworks in place, services can become focused on engaging each individual with their own health and care support.
When technology is embedded seamlessly into care and support services, it can be transformative, helping people to live happy, fulfilled lives in their homes and communities. Digital tools can also be used to ensure timely and appropriate responses to emergency events, encourage greater engagement from citizens, and provide more person-centred care.
Developments in the provision, scale and quality of digital technology can support improvements in how care providers are able to collaborate and provide person centred care. The UK’s transition to a digital communications network brings a once-in-a-generation opportunity to modernise, improve and shift the sector and its thinking from a reactive, to a proactive delivery model. This in turn can improve health outcomes for citizens, deliver efficiencies, and enable people to live independently for as long as possible.
Investment in digital solutions will support health and social care providers in reconfiguring services to make them more agile and integrated, leading to better outcomes. Utilising data and technology to create a connected approach can also provide actionable insights to deliver more informed, and more effective care.
Importance of collaboration
Last year saw the introduction of integrated care systems (ICSs) across the UK. ICSs should help us to integrate services effectively and drive collaboration between service providers, such as care homes, GPs and hospitals. Collaboration across sectors is essential to keep people healthy, reduce inequalities, enhance productivity and value, and support economic and social development. ICSs will play a key role in enabling us to remove silos between health and social care providers, while increased collaboration will reduce duplication and fragmentation, disseminate best practice and progress in technology.
Through collaboration we can create a truly joined up approach where we listen to citizens, understand their everyday needs and work together to bridge gaps in our services. Building on ongoing collaborations will see a system begin to emerge that is better connected and user focused. The latest generation of digital solutions broaden the circle of care to engage families, friends and communities, and promote services that are connected and data-driven.
Strong relationships between health and care providers and end users is vital to ensure users feel both respected and protected. This in turn can lead to clearer communication, giving care providers the opportunity to deliver care that is targeted to the requirements of individuals.
The workplace and a cultural shift
The digital transition is an opportunity to create a clearer and consistent approach to care delivery. Collaboration is essential but to encourage this, a cultural shift must take place. While technology has sometimes previously been viewed as an additional aspect of service delivery, embedding digital solutions into services will contribute to the successful transformation of existing care models, and provide more intelligent insight to improve health outcomes and protect the dignity of vulnerable people.
Increasing system capacity and capability, as well as providing a foundation for future technological advancement, will see health and care services more able to effectively meet the changing demands of the population. There are compelling benefits for all stakeholders when it comes to technology, particularly from an economic and operational perspective. By driving education within the health and care landscape and building on an already shifting culture, we’ll see more professionals become open to the idea of using technology and transfer their skills, knowledge and experience to the people they care for, to create a digitised world.
A dignified future for care users
As people live longer, increased pressure is put on our care services. Technology has the ability to aid the management of this and potentially reduce pressure points. If successful and integrated digital services for citizens can be realised, the benefits flow will through the health and care system. If we get our approach right, citizens can live independently for longer and have more choice and control.
As we look to a more digital future, we must consider how we can best harness the power of the connected world and the value that can come from technology solutions. By committing to investment in more technological solutions, we will reform our services, improve outcomes and place users at the centre of care to protect their dignity.
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