Fee Rate Interactive Map arranged by Constituency
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The Association For Real Change (ARC England) Learning Disability Research Unit Local Authority Fee Rate Map, which shows that in many cases fee rates do not cover the cost of care.
Over 80% of local authorities provided their fee rate data in response to our Freedom of Information request and the map shows a wide variation in fee rates between areas in England and Wales. It can be seen that in many local authorities’ fee rates have fallen behind provider costs and that annual uplifts have not kept pace with inflationary pressures.
Inflation and cost of living pressures have combined with the requirement that providers meet annual National Minimum Wage or National Living Wage increases to mean some services are now financially unsustainable. We are concerned that this could lead to people with learning disability and autistic people no longer being supported to live well within their communities.
– In supported living services, where staff wage payments represent approximately 85% of providers’ costs, the 2019-20 National Minimum Wage increase by 5% to £8.21, resulting in a rise in operating costs of 4.13%.
– By 2022-23 the NMW increase to £9.50 made an operating costs rise by 8.23%, in a sector already hit by severe recruitment and retention problems, due in part to low pay and competition from rival sectors like retail and hospitality which can afford to pay higher wages.
Our Fee Rate Interactive Map has been designed to be a tool for collaboration between commissioners and providers in forthcoming conversations about fee rates and inflationary uplifts. ARC England would therefore like to invite all local authorities to use the interactive maps as a benchmarking tool when setting fee rates and uplifts with providers. (See below for Local Authority Fee Rate Interactive Map online briefing Invitation.)
ARC England Director Clive Parry says:
“We are hearing from our members that providers are using reserves to cover operating costs and in some cases are having to hand back contracts because they are not being paid enough to allow them to deliver safe, high-quality care and support at the rate offered by commissioners
“The widening gap between fee rates and operating costs is why we are now calling on the Government to demonstrate that they understand and value learning disability and autism services by taking action to ensure that local authorities can commission services for people with a learning disability and autistic people at sustainable rates.
He continues, “It is important to recognise, however, that there are examples of good practice where, despite a lack of resources, efforts are being made some local authorities to set fee rates that better keep pace with inflationary cost pressures.”
As the House of Lords Adult Social Care Committee puts it in their recent report Adult Social Care Committee A “gloriously ordinary life”: spotlight on adult social care report December 2022,
“Adult social care and the budgets of local authorities for its delivery have been chronically under-funded for many years — both a cause and a consequence of the lack of attention paid to the sector. For example, while the total budget for publicly funded adult social care in 2022/23 is £17.1 billion, the commissioning budget for the NHS for the same year is £153 billion. This is despite the fact that the adult social care workforce is larger than that of the NHS.”
Freedom of Information Request Methodology
The fee rate data was obtained through a Freedom of Information request to all 177 local authorities in England and Wales. ARC England would like to thank all the local authorities who supplied their data for their support. The data has been used to create an interactive map showing the average weekly/hourly rates being paid to providers and the percentage fee rate uplift for the last five years.
The Freedom of Information requests were sent to 155 English and 22 Welsh upper tier local authorities. The response rate in England was 84%. We are continuing to work with the Welsh local authorities to collect their responses as requests to them were sent out later in the process.
The Freedom of Information request and data visualisation are by Polimapper.
Freedom of Information Request Questions
Local authorities were asked:
Please could you provide:
- The average (arithmetic mean in £ and pence) hourly rate you pay for externally provided learning disability and autism services (not your in-house services) for each of the service types by hourly rate or weekly rate (if hourly is N/A) as follows:
– Residential homes (including profound and multiple learning disability (PMLD) services and respite care)
– Supported living
– Day services
– Domiciliary care
- The average (arithmetic mean as a percentage) annual fee uplift (inflationary uplift) you have implemented for each of the last five years (2018, 2019, 2020, 2021 and 2022) for externally provided learning disability and autism services (not your in-house services) for each of the service types as follows:
– Residential homes (including profound and multiple learning disability (PMLD) services and respite care
– Supported living
– Day services
– Domiciliary care
ARC England is grateful to all the members of the ARC England Learning Disability Research Unit Steering Group who made this piece of research possible.
Freedom of Information request to 155 upper tier local authorities in England and 22 upper tier local authorities in England and Wales.
The voice of the adult social care sector
In recent weeks and months there have been many voices calling on the Government to take action in relation to the impact of the long-standing financial pressures in the Adult Social Care sector.
- Learning Disability and Autism Social Care providers Financial impact assessment, Cordis Bright, October 2022
“Inaction effectively places these consequences squarely on the shoulders of people with a learning disability and/or autism, and their families. It will ultimately deny them choice and dignity of a decent, fulfilling and stable quality of life. Providers will do all that they can to protect the people they support but they are not the government, and they are already going beyond their charitable or business remits by sustaining loss making services.”
“This is the bleakest autumn survey we have ever had. Only a handful of directors have any confidence they may be able to get through the winter with the funding they have and the care workers available locally. We were fearful in the summer; we are fearful now. This affects all of us.”
- Adult Social Care Committee A “gloriously ordinary life”: spotlight on adult social care report, December 2022
“Adult social care and the budgets of local authorities for its delivery have been chronically under-funded for many years—both a cause and a consequence of the lack of attention paid to the sector. For example, while the total budget for publicly funded adult social care in 2022/23 is £17.1 billion, the commissioning budget for the NHS for the same year is £153 billion. This is despite the fact that the adult social care workforce is larger than that of the NHS.”
- Community Integrated Care Unfair To Care Report, BBC News December 2022
ARC England member and one of the UK’s largest providers of support for people with learning disabilities and autism – says pay pressures facing social care are now “untenable” and “immoral”.
- Phil Hope, Co-Chair of the Future Social Care Coalition, Learning Disability Today December 2022“Unfair To Care shows us that the recruitment and retention crisis in social care is here to stay for an entire generation unless the government takes serious action to fix social care. Warm words about the rise in the living wage are simply not enough to retain staff.“The current number of social care vacancies is simply staggering and will only continue to grow without a commitment to pay fair for care. Unfair To Care makes it clear that it is untenable to lurch from crisis to crisis, with just a sticking plaster to remedy the far deeper problems in social care.”
- Vic Rayner. National Care Forum, October 2022
“Good quality and well-resourced social care is good for growth – it is preventative in nature, allowing people to retain their independence for longer, doing the things they want to do, living in and contributing to their communities and working if they wish.”
- Martin Green, Care England. June 2022
“…it is vital that the Adult Social Care sector receives assistance from the Government to continue to provide the necessary and vital care they provide to the 1.5 million people with learning disabilities, especially in the light of the pandemic and the extra obstacles it presents when it comes to providing outstanding care.”
- Rhidian Hughes, VODG. October 2022
“Social care is in a fragile and unsustainable position. Every day, charities make harsh decisions about the services they are able to offer to disabled people, whether the costs of services can be covered by commissioners and if they have the workforce available to meet people’s needs.”
- Jackie O’Sullivan, Mencap. November 2022
“Social care desperately needs long-term investment and we cannot continue like this,” said Jackie O’Sullivan, Mencap’s director of communication, advocacy and activism. “We are relying on the goodwill of good people for the sector to stay afloat and it’s clear that the system is broken.”
- Rachel Dodgson, Dimensions August 2022
“If the NHS outcompetes social care on pay, both lose. The government must benchmark minimum support worker pay at NHS band 3. Benchmarking pay against NHS pay scales will ensure that support workers receive parity of both esteem and pay, and would encourage people to change lives, not simply sit on checkouts.”