Calculating the cost of care

By James Maker and Daniel Sperrin | 25 May 2022
  • James Maker

In little more than 16 months’ time, England will be on the brink of the biggest changes to the adult social care system in the post-war period, with the introduction to seminal changes to the way we fund and pay for care in this country.

To help both local and national government prepare, the County Councils’ Network (CCN) and Newton have today published a new report, Preparing for Reform. It provides new and detailed local and regional analysis on the operational and financial implications for local authorities, providers, and residents.

In undertaking this project, more than 100 people were engaged from across the sector, including local authorities; small, medium, and large care providers; residents; and voluntary sector organisations.

Bespoke postcode level wealth and asset data was also collated and analysed, supplied by CACI, to understand the impact of both the cap on care and the extended means-test nationally, and regionally.

Much of the attention that has followed the publication of the Government’s two social care White Papers last year has understandably centred on the financial implications of reform. Councils are right to be concerned.

As our new analysis shows, by 2031-32 councils will require around 50% of the Health and Social Care National Insurance Levy (£5.6bn-£6.2bn per year of a total levy of £12bn) to implement the proposed changes related to charging reform.

While the principles of many of the reforms may be broadly welcomed, they fall short of ‘fixing’ social care in terms of a sustainable resource to fully fund the reforms and meet pre-existing financial pressures in the system.

Perhaps rather less commented on up to now has been the enormous workforce challenge that will result from implementing the charging reforms.

Equally as significant to the financial impact of reforms is the operational impact – particularly the requirement for local authorities to find large numbers of additional staff if substantial changes to the operating model are not made. This is going to take concerted action by both local and central government to tackle it.

The analysis suggests that approximately 200,000 more assessments per annum will need to be conducted. As a result, and the extra case-holding responsibility, an additional 4,300 social work staff will be needed (a 39% increase in posts currently filled) and an additional 700 financial assessors will also be needed (a 25% increase in posts currently filled) if no changes to existing ways of working are made.

In addition, directing this task will fall to senior leaders already focused on recovery from the pandemic, the introduction of new assurance frameworks, and the development of integrated care systems.

Given the well-known existing workforce challenges, recruiting additional staff on this scale is clearly an impossible task.

To help alleviate some of the additional pressure, the report makes some suggestions that can be taken forward by local and central government.

At a national level, a major national recruitment and workforce development strategy for local authorities and care providers is called for.

The report also proposes that phasing the implementation of the reforms would allow local authorities more time to recruit staff, redesign roles, and implement the new technology solutions which will need to be a vital part of the future operating model.

Meanwhile, local authorities will want to explore alternative operating models. As well as continuing to do everything they can locally to increase the productivity of their social care workforces, including exploring the role that digital and technology can play, alternative approaches to managing demand, including self-assessment, the role of unqualified staff, and trusted assessment will be crucial.

Strengthening strategies to promote independence and maximise the role of community services and assets will also help to mitigate the financial pressure, ensuring it is only those who truly need more intensive support who are placed in residential and nursing beds.

Among the complexity and scale of these reforms are significant opportunities, but there is still work to be done.

Phasing these reforms will allow authorities to continue the already significant transformation journeys they are on which will allow them to prepare to realise these opportunities.

Daniel Sperrin is a director at Newton and James Maker is a director at the County Councils’ Network

To obtain a copy of the full report, and request a custom data pack showing the financial and operational analysis for your authority, visit

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