By Joe Locker, Local Democracy Reporter
Private providers of care for adults in Nottingham were paid £112m last year, with one care package costing the council more than £400,000 for a single person.
Adult social care covers a vast range of support to help people who are older, and those living with physical or mental disabilities, live independently and healthily.
Support is typically personal and can include home care, residential care and rehabilitation-based care for those leaving hospital.
In Nottingham, more than 7,000 people have received support from adult social care services over the last two years.
While organised and funded by public bodies such as local councils, care is mostly provided by private or not-for-profit companies.
Outsourcing of social care to the private sector has increased over the last decade, as has been the case with many public services since the 1980s under Government policy, because it is said to save money and improve efficiency.
Now, a Freedom of Information (FOI) request, submitted by the Local Democracy Reporting Service, has revealed Nottingham City Council paid private care firms and third-party organisations a total of £101,279,625 in 2021/22, rising to £112,329,360 last year (2022/23), for Nottingham care services.
The costliest care package for a single person in 2021/22 was £411,355, and £435,894.72 the following year.
The top five costliest packages all cost above £300,000, figures show.
Adult and children’s social care accounts for more than 60 per cent of the council’s annual budget, and soaring costs in the sector are contributing to a number of local authorities ending up in significant financial trouble.
Care services are statutory, meaning they must be delivered by law.
In Nottingham a Section 114 notice, effectively declaring bankruptcy, was issued at the end of November amid a £23m budget gap, which is partly due to costs in the sector.
A separate £53m gap is also being reported the following year, beginning April 2024, prompting a consultation on significant cuts to non-statutory services.
“Every council that provides social care is struggling,” says Cllr Linda Woodings (Lab), whose portfolio covers adult social care.
“Really I think the tipping point for adult social care was the [Liz] Truss and [Kwasi] Kwarteng car-crash economic disaster that sent interest rates spiralling.
“We’ve had no resilience in local government funding to deal with spiralling inflation.
“We do check there is not a level of profiteering within the sector. But the care sector is struggling to stay afloat at the moment.
“We have a shortage of staff in social care, and when inflation started rising at the end of last year, other care providers were almost competing for wages for the same staff.
“But where you have a shortage of staff, you will see wages increasing, increasing and increasing. Not unreasonably care providers are saying you need to pay more for this care package because we cannot retain our staff otherwise.
“If you have home care workers going door-to-door their fuel bills have gone up because petrol has increased. And you cannot turn the temperature down in a care home. They have to be warm places.”
Reforming the sector has been in consideration for more than 11 years, after Sir Andrew Dilnot was commissioned by the coalition Government to review and recommend how best to reform social care and reduce costs.
His recommendations included raising the amount of assets a person can have before the state funds their social care from £23,250 to £100,000, as well as capping lifetime care costs at £86,000.
Without reform, the state only helps once assets, including housing, are down to £23,250.
In 2021 then-Conservative Prime Minister Boris Johnson promised to fix adult social care “once and for all”, however the Government has since abandoned the implementation of charging reforms and has delayed further action to October 2025, largely due to the cost of reform to the state.
Money from the proposed reforms has been channelled into social care grant funding instead.
A Department of Health and Social Care spokesman said: “Last year, we listened to local government concerns and took the difficult decision to delay charging reform. This funding is being retained in local authority budgets.
“We remain committed to reform and are investing up to £700 million over this year and next to make major improvements to the adult social care system. This includes £42.6 million to support innovation in care and increasing the Disabled Facilities Grant by £50 million.
“Additionally, we have made up to £8.1 billion available to help local authorities tackle waiting lists, low fee rates, and workforce pressures, £570 million of which will help local authorities improve adult social care provision, in particular by boosting the workforce.”
However Cllr Woodings added: “This is a zombie government and anything difficult has been kicked down the road for the next government to deal with”.
“Part of the problem is that there is no proper solution for adult social care,” she added.
“The Dilnot commission came up with some proposals and I don’t think any of them have been imposed.
“The overall issue of saying ‘councils have to pay this’, but by the way our council is receiving £100m less per year, in spite of the fact inflation has more than doubled the cost of everything over that time, it is not a sustainable solution.
“I don’t want those people to feel guilty about receiving the care they are entitled to receive.
“When we assess somebody’s care, we don’t assess them in light of our budgets so to speak. When you assess someone under the care act you assess what their health needs are, how you can keep them safe and well, and that is the price that you have to pay.
“If inflation sky-rockets, then councils have to find the money for that, and that is the impossible conundrum of funding social care.”
