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Social Care Provision in the UK and the Role of Carers Debate on 24 June 2021 Author: Thomas Brown Date Published: 17 June 2021

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Social Care Provision in the UK and the Role of Carers Debate on 24 June 2021 Author: Thomas Brown Date Published: 17 June 2021 Library Briefing Social care provision in the UK and the role of carers Debate on 24 June 2021 Author: Thomas Brown Date published: 17 June 2021 On 24 June 2021, the House of Lords is due to debate a motion moved by Baroness Jolly (Liberal Democrat) that “this House takes note of social care provision in the United Kingdom, and the role of carers in that provision”. The term ‘social care’ covers a wide range of support provided to children, young people, and working age and older adults, as well as their carers. This support can be provided formally, either by local authorities, private companies, charities, or other bodies; informally, by family members, friends, or neighbours; or through a combination of these. Although in practice it can include support for both children and adults, the term is often used as shorthand for adult social care in debates on the subject. Social care is a devolved matter and provision differs across the UK: • In England, local authorities hold both responsibility for children’s social care and a formal role in assessing the need for and commissioning adult social care. Differences in budgets, costs and local authorities having discretion to provide adult care services to individuals outside of eligibility thresholds have led to variations across the country. The adult social care system has been the focus of longstanding calls for reform. The UK Government has said it will bring forward proposals to “fix” adult social care in England later this year. • In Scotland, where an entitlement to free personal social care has been in place since 2002, the Scottish Government has pledged to create a National Care Service. • In Wales, there is a cap on non-residential care fees and a £50,000 capital limit on residential care costs for adult social care. • In Northern Ireland, where the health and social care system is integrated, health and social care trusts hold responsibility for adult social care. Carers may be professionals working in the sector, volunteers working for charitable bodies, or unpaid, so-called ‘informal’ carers within families and communities. In each of the UK’s four nations, the paid social care workforce represents a large proportion of employment. Estimates suggest there are 1.6 million people working in the adult social care sector in England alone. There is a strong reliance on informal carers across the UK, and most adult social care is delivered in this way. Estimates for the number of unpaid carers vary. The Government’s family resources survey indicates that 7% of the population provided unpaid care in the 2019/2020 financial year. Reports suggest this number may have risen dramatically following the onset of the coronavirus pandemic. This briefing provides an introduction to and overview of the subject. The House of Commons Library briefing Coronavirus: Adult Social Care Key Issues and Sources (12 May 2021) provides further information on issues relating to adult social care in England during the Covid-19 pandemic. 2 1. What is social care? The term ‘social care’ can include all forms of personal and practical assistance for children, young people and adults who need extra support, including those who care for others.1 In practice, this means the term can cover a huge range of activities, from child protection to end-of-life care.2 Children’s social care includes support for children with disabilities; those requiring protection from harm; and children looked after by a local authority.3 It can include foster and residential care placements. Meanwhile, adult social care can include supporting individuals and their carers with needs ranging from managing and maintaining nutrition to assisting with personal hygiene and toilet needs. It can also include help with: • being appropriately clothed; • being able to make use of the adult’s home safely and maintain a habitable home environment; • developing and maintaining family or other personal relationships; • accessing and engaging in work, training, education or volunteering; • making use of necessary facilities or services in the local community including public transport and recreational facilities or services; and • carrying out caring responsibilities for a child.4 Both adult and children’s social care can be delivered in formal settings such as day centres or residential homes, or in an individual’s home, depending on a recipient’s needs.5 Care can be provided by paid carers, volunteers, and/or unpaid carers who may be relations, friends or neighbours of the recipient. Unpaid care is often referred to as ‘informal care’.6 2. Social care provision across the UK In general, the funding and provision of formal social care is a devolved matter.7 This means the devolved governments in Scotland, Wales and Northern Ireland hold responsibility for social care in their jurisdictions. The UK Government remains responsible for social care in England. 1 Scottish Government, ‘Social care’, accessed 14 June 2021; and National Audit Office, Adult Social Care at a Glance, July 2018. 2 King’s Fund, ‘What is social care and how does it work?’, accessed 14 June 2021; and ‘Bite-sized social care: what is social care?’, 11 May 2017. 3 Institute for Government, ‘Children’s social care’, accessed 14 June 2021. 4 National Audit Office, Adult Social Care at a Glance, July 2018, p 5. 5 King’s Fund, ‘Key facts and figures about adult social care’, 20 November 2019. See also: National Audit Office, Adult Social Care in England: Overview, 13 March 2014, HC 1102 of session 2013–14. 6 House of Commons Library, Informal Carers, 7 June 2021. See also: House of Commons Library, Support for Family and Friends Carers Looking after Children, 11 September 2019. 7 Department of Health and Social Care, Government Response to the Health and Social Care Committee report on Adult Social Care: Funding and Workforce, 29 January 2021, CP 360, p 5. See also: Scottish Parliament Information Centre, Adult Social Care and Support in Scotland, 3 December 2020; Senedd Research, ‘Social care: a system at breaking point?’, 17 May 2021; and Northern Ireland Assembly Research and Information Service, ‘Supporting carers in Northern Ireland: where are we with legislation and policy?’, 24 July 2018, and ‘Carers in Northern Ireland: some key statistics’, 26 July 2018. 3 2.1 Social care in England Children’s social care In England, local authorities (LAs) fund and deliver children’s social care.8 Their statutory responsibilities include a duty to safeguard and promote the welfare of ‘children in need’, defined to include both disabled children and those taken into care.9 LAs are also responsible for delivering non- statutory services for children and young people, such as children’s centres.10 The Government has noted that LAs “describe their children’s services by using a four-tier model, which may be represented as a pyramid or continuum of needs”.11 Non-statutory services fall within tiers one and two, while statutory services fall into tiers three and four: • Tier 1: Universal services such as schools, and health visiting. • Tier 2: Targeted services for children and families beginning to experience, or at risk of, difficulties; for example school counselling, parenting programmes, and support for teenage parents. • Tier 3: Specialist services for children and families with multiple needs such as intensive family support, and services for children with disabilities. • Tier 4: Specialist services for children and families with severe and complex needs, including child protection services, and looked after children.12 In 2019, the National Audit Office (NAO) reported there were 404,710 children in need as at the end of March 2018.13 In addition, LAs spent £8.8 billion on children’s services in 2017/18 against a budget of £8 billion. This translated to 91% of LAs having overspent on children’s social care that year. The NAO found that there was “significant variation” between different local authorities in both the activity and cost of their children’s services. Adult social care Adult social care includes personal care and practical support for working age or older adults with a physical disability, a learning disability, or physical or mental illness.14 It also includes social work, in which qualified, registered professionals assist individuals to try to improve outcomes; and support for carers. Adult social care is usually provided once a person reaches the age of 18.15 The term ‘social care’ is often used as shorthand for adult social care. 8 Institute for Government, ‘Children’s social care’, accessed 14 June 2021. See also: House of Commons Library, Children’s Social Care Services in England, 12 March 2021; and Local Authority Support for Children in Need (England), 13 January 2020. 9 Children Act 1989, s 17. In 2018, the Association of Directors of Children’s Services found LAs had almost 300 statutory duties to provide services for children and young people (Institute for Government, ‘Children’s social care’, accessed 14 June 2021). 10 National Audit Office, Pressures on Children’s Social Care, 23 January 2019, HC 1868 of session 2017–19, p 6. 11 Department for Education, Children’s Services: Spending and Delivery, 6 July 2016, p 7. 12 ibid, p 9; and House of Commons Library, Children’s Social Care Services in England, 12 March 2021, p 6. 13 National Audit Office, Pressures on Children’s Social Care, 23 January 2019, HC 1868 of session 2017–19, p 4. 14 National Audit Office, Adult Social Care at a Glance, 16 July 2018, p 4. See also: Institute for Government, ‘Performance tracker 2019: adult social care’ and ‘Performance tracker 2020: adult social care’, accessed 14 June 2021. 15 Department of Health and Social Care, ‘Care and support statutory guidance’, 21 April 2021.
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