Keiron Broadbent • November 12, 2024

The Care Association has today sent the following letter to Wes Streeting, the Secretary of State for Health and Social Care to express our concerns on the implications of the increases to National Insurance and the Minimum Wage announced in the Budget.


Rt Hon Wes Streeting MP

Secretary of State for Health and Social Care

Department of Health and Social Care

39 Victoria Street

London

SW1H 0EU

 

12 November 2024

 

Dear Secretary of State,

 

On behalf of the West Midlands Care Association (WMCA) and our care provider members (providers), we write to express urgent concerns regarding the implications of the 2024 Autumn Budget on the social care provider market. This Budget has generated significant anxiety among social care providers, who employ the majority of the 1.59 million people (as of 2023/24) working across the adult social care sector in England delivering £68.1 billion in essential community care and support services.

 

As the representative body for nearly 600 member social care providers across the West Midlands, Herefordshire, Warwickshire and Worcestershire, WMCA supports care homes, nursing homes, domiciliary care, supported living, day services, and many more. Local Care Associations like ours, along with our provider members, play a critical role within the Health and Social Care Neighbourhood Model, delivering person-centred care and support throughout our communities and neighbourhoods.

 

We are deeply concerned that, unless fully addressed, the financial pressures introduced in this Budget could severely compromise the stability and sustainability of social care services in our region. Social care, chronically underfunded for years, now faces an existential risk due to mandated wage cost increases set to take effect from April 2025: 

 

  • National Living Wage: Set to rise by 6.7% to £12.21, with rates for younger workers increasing by 16.3% to £10 and for apprentices by 15.2% to £8.60.


  • Employer National Insurance (NI) Contributions: Increasing by 1.2%, with a lowered threshold to £5,000.

 

While these wage increases are critical to attracting and retaining talent, they impose a severe financial strain on social care providers already constrained by fixed fees set by Local Authorities. Unlike industries such as retail or leisure, where prices can be adjusted to offset increased costs, social care providers rely on Local Authority fees for financial sustainability. 


This dynamic creates substantial challenges, as providers lack the resources to absorb these rising costs without sufficient support. The impact on the sector could be devastating, resulting in: 

 

  • Provider Closures: Rising wage costs may force some providers out of the market, creating further strain on Local Authorities and the NHS.

  • Workforce Attrition: The many providers currently paying above the National Living Wage (NLW) may be compelled to revert to the new NLW, leading to attrition as workers seek higher-paying roles elsewhere. Such workforce losses could exacerbate pressures on the NHS, increasing A&E attendance and delaying hospital discharges.

  • Negative Outcomes for Service Users and Increased NHS Pressure: Disruptions in care services will inevitably impact vulnerable populations, placing additional strain on local healthcare systems and almost certainly increased length of stay in hospital due to delayed discharges.

 

We are also concerned that, while NHS employers will receive compensation for the increased NI contributions, there is no declared commitment to similarly support social care providers. This discrepancy undermines our shared aim of aligning support for both health and social care, as emphasised in the Darzi report. Divorcing social care reform from NHS support could prevent us from achieving effective, sustainable outcomes for those who rely on our services. Moreover, three strategic priorities for the NHS—Hospital to Community, Analogue to Digital, and Treatment to Prevention—can only be fully realised through robust partnership and integration with the wider social care sector. Additionally, the overall costs of healthcare delivery would be increased as people would spend more time in the most expensive healthcare setting (the acute hospitals) rather than the most cost efficient (the community).

 

In light of these concerns, we respectfully request assurance that these additional wage costs, due to take effect in April 2025, will receive full funding to support the sector’s stability. Such a commitment would alleviate significant uncertainty and enable providers to make sound decisions for the future. Prompt action to provide these assurances could prevent premature provider exits, helping to mitigate further pressure on the system especially as we enter the winter season.

 

We are fully committed to working with our Local Authorities and our provider members to minimize disruption to local essential services and ensure optimal outcomes for those in our care. We look forward to your support and partnership in addressing these pressing matters.

 

Thank you for your attention and consideration.

 

Yours sincerely,


Keiron Broadbent

Chief Executive Officer

West Midlands Care Association 



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Care Association Alliance sets out a national funding model for adult social care, designed to give families certainty, providers stability, and councils the resources to do their job (read the full repo rt here ) A new CAA report proposes pooling the financial risk of an ageing population nationally, rather than leaving it with 153 individual councils. The core of the model: ring-fenced national funding shared on a needs-based formula, a national tariff for care, and an independent body to keep it honest. Individuals keep a means-tested contribution, but with a lifetime cap and a raised capital threshold, so no one faces unlimited costs or has to sell their home. Councils keep assessment, planning, safeguarding and oversight, but are relieved of carrying a national demographic risk on a local budget. Backed by the Rt Hon Damian Green, Chair of the Social Care Foundation and former Deputy Prime Minister responsible for social care policy. The Care Association Alliance (CAA) has published a proposal for how England should fund adult social care for older people. Its report, Adult Social Care Funding Reform, describes a national funding settlement built on a straightforward idea: the cost of growing old and needing care is a national risk, and it should be met nationally, while care itself continues to be arranged and delivered locally. A national risk carried on local budgets At present, primary responsibility for adult social care sits with 153 local authorities under the Care Act 2014. They assess need, commission services and manage local provider markets. They also carry the full financial weight of demographic change, a pressure that is national in scale and rising quickly. The number of people aged 85 and over is projected to double within twenty years, and the Office for Budget Responsibility estimates that simply maintaining today's system will require public spending on social care to grow by 3.1 per cent a year over the next decade, compared with the 0.7 per cent average delivered between 2009/10 and 2022/23. That pressure shows up directly in the price of care. On average, councils pay £24.10 an hour for home care, while the Homecare Association puts the minimum sustainable rate at £32.14. The National Audit Office found in 2021 that authorities were commissioning care at below the sustainable cost of care, and the King's Fund reports that in 2025/26, council fee increases of around 5 per cent were outpaced by provider cost increases of 8 to 10 per cent. This is not a matter of councils choosing to underpay. It is what happens when local budgets are asked to absorb a national cost. Providers take the strain through thinner margins and deferred investment, and families often meet it through the higher fees paid by those who fund their own care, on average 41 per cent more than the council-funded rate. One settlement, built as a system The CAA argues that these are symptoms of a single structural mismatch, and that they need to be fixed together. Its proposed national funding settlement rests on three principles: pooling the financial risk of demographic change nationally, a statutory entitlement to support triggered by assessed need, and continued local delivery within a national framework. In practice, the settlement has five main components: A ring-fenced national care grant , distributed to councils on a needs-adjusted formula, so that funding follows need rather than local fiscal capacity. A reformed means test , with a raised capital threshold, frozen at £23,250 since 2010/11, and a lifetime cap on what any individual can be asked to pay. A national tariff for residential and home care , set at the independently assessed cost of sustainable provision, which councils commission at or above. A bundled funding model for residential care , with assessed packages that are portable when people move. A reformed Deferred Payment Agreement scheme , so that no one is required to sell their home to pay for residential care. Underpinning the settlement is an independent National Care Assessment Body, sitting outside both the NHS and local government, which would verify the cost evidence, review the tariff and report where provision falls short. Local authorities retain their role as commissioners and delivery leaders, close to their communities and provider markets, but are relieved of being the sole bearer of national financial risk. The report is explicit about what it does not propose. This is not a free care service on the model of the NHS, and it does not absorb social care into the health service. Individuals who can contribute to the cost of their care will continue to do so, within a reformed means test and a lifetime cap. The word national describes the funding architecture, not the way care is provided. The proposal is offered as a contribution to the Casey Commission, which is beginning to test public views on who should receive care, what the state should guarantee and what individuals should contribute. The CAA says funding reform is the necessary first step, and Adult Social Care Funding Reform is the first in a programme of papers it will publish over the coming months. Melanie Weatherley MBE, Co-Chair of the Care Association Alliance, said: “No family should receive worse care because of where they happen to live, and no provider should have to choose between keeping a contract and delivering care safely. These are not failings of the people running the system. They are what happens when a national risk is carried on local budgets. If we fund care nationally, price it honestly through a national tariff, and ask an independent body to keep it that way, we can give families certainty, providers stability, and councils the resources to do the job they are asked to do. “This paper is not a criticism of local authorities, who are doing a demanding job under real pressure. It is a practical plan to put the whole system on a sustainable footing, and we hope it is useful to Baroness Casey's commission as it begins its work.” The Rt Hon Damian Green, Chair of the Social Care Foundation and former Deputy Prime Minister responsible for social care, said: “The case for reform is widely accepted. What has been missing is a workable, affordable plan that a government of any colour could adopt. This paper offers exactly that, and a cross-party route to deliver it.” (read the full report here ) ENDS Notes to editors The Care Association Alliance is the national umbrella body for local care associations in England, a member-led organisation with more than 50 local care associations, collectively representing over 10,000 independent care providers across every English region. It is a founding participant in the Care Provider Alliance. The £24.10 per hour figure is a national average local authority domiciliary care fee, not a per-council figure. It is cited alongside the Homecare Association's minimum sustainable rate (£32.14), the National Audit Office's 2021 finding on below-sustainable-rate commissioning, and the King's Fund's 2025/26 fee-versus-cost analysis, all set out in full in Adult Social Care Funding Reform (Paper One), published [DATE] 2026. Additional figures are drawn from the Health Foundation REAL Centre, the OBR, the King's Fund, the IFS and Social Care 360. The funding-gap projection runs to 2032/33. Baroness Casey's remarks were made on 7 July 2026, in a BBC Radio 4 Today interview and a speech to the Local Government Association's annual conference, in which she confirmed the Casey Commission will begin testing the views of the public this month ahead of its first report, due this year. Spokespeople are available for interview. Media enquiries: Melanie Weatherley MBE, Co-Chair of the Care Association Alliance.
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