Correspondence

Adult social care winter letter 2023 to 2024

Published 28 July 2023

Applies to England

Letter from Minister of State for Social Care

Dear colleagues,

I am writing today to set out the key steps needed so that adult social care systems are resilient and able to provide people and their carers with the support they need this winter.

This letter also sets out our expectations for how NHS organisations will work with adult social care in both the planning and delivery of support. This is part of a joined-up approach to planning across the health and care system this winter, alongside the letter sent to NHS organisations yesterday. We are writing much earlier than in previous winters, following your feedback and to give more time to incorporate additional actions into your local planning.

All parts of the adult social care sector play a critical role over the winter period, including:

• residential care
• domiciliary care
• extra care and supported living
• shared lives
• intermediate care
• voluntary and community services
• local authority adult social care staff including social workers and occupational therapists, families, and unpaid carers

I want to thank every one of you for your work to support people who draw on care, your efforts to drive improvement and for what you do to represent those that make up the adult social care sector. Many of you have worked with us to develop these measures and I am grateful for your input.

The actions set out here build on the plans you will already have developed, including capacity plans under the Market Sustainability and Improvement Fund (MSIF), as well as capacity and demand plans for intermediate care. Further action is, however, needed in most areas to ensure that health and care systems’ capacity plans address projected changes in demand over the winter period and include sufficient contingency to meet different demand scenarios, taking account of the latest local assessments of risk.

It is essential that we take a ‘whole system’ approach to supporting people and their carers this winter. This means integrated care boards (ICBs) and integrated care partnerships (ICPs), local authorities, health and care providers and the voluntary sector all being actively involved in joint planning for winter and working together to support individuals who draw on care. Effective, joined-up working across health and social care will make sure people get the best possible outcomes and that we make effective use of the combined resources of the system.

As part of this approach, health and care organisations should involve people receiving care and their carers in decisions, helping them to stay well at home and avoid hospital admissions where possible, providing fast and responsive urgent and emergency care for those who need it and making sure that people admitted to hospital can return home as soon as possible once they are well enough.

The social care workforce is at the heart of the government’s plans for a better and more sustainable social care system. That’s why I am pleased to confirm how the £600 million of funding from our April Next steps to put People at the Heart of Care publication will be spent over this year and next. The majority of this funding will be provided through a new MSIF workforce fund worth £570 million over 2023 to 2024 (£365 million) and 2024 to 2025 (£205 million). This new grant will allow local authorities to further boost adult social care capacity and support the adult social care workforce, including on pay. The remaining £30 million will be made available to local authorities on a targeted basis to reflect particular local pressures this winter in relation to urgent and emergency care.

NHS England wrote yesterday to ICBs and trusts setting out the approach to winter planning and the key steps needed to deliver operational resilience across the NHS this winter, see Delivering operational resilience across the NHS this winter. The letter sets out 10 high-impact interventions to improve winter resilience and a set of recommended winter roles and responsibilities across health and care organisations. The NHSE letter also asks systems to review their operational plans for winter and plan for surge scenarios. It is a collective responsibility to ensure there are resilient plans in place for winter across health and care systems and we encourage local government to participate collaboratively in this exercise. As set out in the policy statement about the £570 million MSIF workforce fund, we are asking local authorities to provide by 28 September 2023 a summary description, aligned to NHS winter surge plans, of how they will ensure sufficient capacity to meet potential adult social care surges in demand over winter, including through use of this fund.

Together, the support and actions set out below will put adult social care on as firm a footing as possible as we enter winter this year. It has taken a huge effort to get us here, with all parts of the sector working together. Thank you for your continued support in this work, and all year round.

Yours sincerely,
Helen Whately
Minister of State for Social Care

Workforce capacity, market sustainability and improvement

As a follow-up to our announcement on Next steps to put People at the Heart of Care, we have today confirmed that we are allocating an additional £600 million over 2 years to local authorities. Of this, £570 million will be provided through a workforce fund that builds on the existing MSIF and will enable local authorities to make tangible improvements to adult social care workforce capacity, including to boost care worker pay.

We expect this funding to support more workforce and capacity within the adult social care sector, helping reduce avoidable admissions to hospital and support timely and effective discharge of patients from hospital and community settings where social care is required.

Supported by this funding, local authorities should in advance of winter:

• take the actions set out in their capacity plans for long-term care, submitted in June as part of MSIF, to address any anticipated gaps between demand and available capacity

• ensure sufficient advance commissioning of most care to enable providers to plan in advance and ensure they have the workforce needed to deliver the required services

• work with the NHS to keep demand and capacity projections under review and ensure sufficient cross-system capacity to meet potential surges in demand

• reflect any increases in planned intermediate care capacity in their refreshed BCF demand and capacity plans in October

• work closely with providers to use the £570 million funding to grow workforce capacity, for example, by investing in improved pay for people who work in care

• draw on evidence and best practice to determine the best way of using the additional funding to achieve tangible improvements in capacity

Local authorities should encourage providers to follow the advice and recommendations in the national campaign toolkit (PDF, 10.5MB) to help build good recruitment campaigns, including using campaign badging, social media and printed assets to help attract candidates with the right values.

We will continue to work with the 15 regional partnerships to support ethical overseas recruitment, including by sharing best practice approaches to support arrangements being delivered as part of the £15 million international recruitment fund. Local authorities should help promote effective use of the international recruitment code of practice and the Skills for Care international recruitment website to ensure providers follow appropriate processes when recruiting from overseas and that international recruited staff know where and how to get help if needed. We are also committed to ensuring ethical international recruitment and we are working with the regional partnerships to ensure instances of unethical practice are identified and reported to the relevant enforcement agencies. Illegal employment practices will be fully investigated by the enforcement agencies.

We are continuing to make good progress on implementing the £250 million workforce reform package, as outlined in Next steps to put People at the Heart of Care. Further detail on implementation will follow shortly.

Intermediate care and discharge from hospital

Managing and maintaining sufficient capacity within intermediate care is crucial to people keeping well in their communities, preventing avoidable admissions into hospital over winter and supporting timely and effective discharge for those admitted to hospital. This includes support for individuals both in their own home and in other community settings. Managing capacity across this range of services requires joint working between ICBs and local authorities, as set out in the Better Care Fund (BCF) planning requirements.

The NHSE letter includes a summary of ICBs’ responsibilities in relation to high-impact actions to prevent avoidable emergency admissions (including frailty services, virtual wards, urgent community response services, single point of access for urgent care, and acute respiratory infection hubs) and support timely and effective hospital discharge (including care transfer hubs). NHSE will also develop an intermediate care framework by autumn, recommending actions for systems to scale up post-discharge intermediate care services ahead of, and through, winter 2023 to 2024.

The NHSE letter also sets out associated primary care responsibilities over the winter period. This includes delivering actions from the ‘Primary care access recovery plan’ that will support winter resilience, particularly:

• increased self-directed care
• expanding community pharmacy services
• improving access to general practice
• supporting practices to move to cloud-based digital telephony and to access the right digital tools
• improving online patient journeys
• enhancing navigation and triage processes

Local authorities should continue to work with ICBs to ensure an integrated approach across health and social care. This includes:

• commissioning intermediate care services that help keep people well at home, prevent avoidable hospital admissions and support timely and effective hospital discharge

• ensuring systematic involvement of social care and community health providers in planning intermediate care services

• keeping under review their BCF capacity and demand plans for intermediate care, considering trends in demand, in line with the BCF policy framework and planning requirements, and submitting refreshed capacity and demand plans in October

• improving data flows where BCF capacity and demand plans show limited data or insights available to support local areas’ ability to forecast demand for these services accurately throughout the year

• supporting NHS winter surge planning, including considering contingency arrangements for a significant flu or COVID-19 wave

Most local areas have made encouraging initial progress in reducing delayed discharges since the allocation of the 2022 to 2023 discharge fund. But delayed discharges are still too high, and we need to reinforce action to reduce delays and improve outcomes. We recognise that this means not only reducing delays for those admitted to hospital but also preventing avoidable admissions in the first place. Local authorities should continue working with ICBs to:

• deploy this year’s £600 million discharge fund in ways that have the greatest impact in patient safety and experience and in reducing delayed discharges, both to improve outcomes following hospital admission and help prevent avoidable A&E and ambulance delays for patients who need emergency care, alongside planning how to deploy next year’s £1 billion discharge funding

• systematically embed good practice in the use of care transfer hubs to manage discharges for patients with more complex needs, one of the 10 high-impact interventions set out in the NHSE letter and part of the support offer for the UEC recovery plan

When working together to reduce delayed discharges, local authorities and ICBs, working with acute trusts, community and/or social care providers and the voluntary sector, should ensure a strong focus on:

• supporting people to return to their normal place of residence, wherever possible

• the principles of discharge to assess, providing interim packages of support (where needed) pending assessment of longer-term care needs

• involving and supporting families and unpaid carers

It is now mandatory for care providers to complete Capacity Tracker monthly. Local authorities should encourage more frequent data submission on currently available vacancies and on staffing, especially from those providers who could support discharge. We acknowledge that some systems are working with alternative data and/or ‘social care match-making’ systems to facilitate discharge, which we support, and that in these circumstances there may be an additional data burden to completing Capacity Tracker. We do, however, need Capacity Tracker to continue to be used, not least because one lesson from the pandemic is the need for more coordinated data collection from the sector.

Energy and adverse weather

Local authorities and care providers should:

• develop business continuity plans to prepare for localised disruptions caused, for example, by severe winter weather, including disruptions to energy supply, disrupted transport and staff shortages, while considering the impacts of these events on ‘business as usual’ activities over the colder winter period

• refer to the government’s Adverse Weather and Health Plan, to support planning and response to adverse weather in winter

• work with local response forums (LRFs), local organisations and those working in the care sector to identify and prioritise those most at risk during the colder winter period

• communicate with LRFs, local organisations and social care workers about the impacts of localised energy disruptions (for example, power cuts) and/or adverse weather over winter, and signpost them to support available, for example, from the local authority and utilities suppliers

• encourage eligible individuals to sign up to their energy suppliers’ Priority Services Register (PSR), including encouraging existing PSR customers to update their personal information before winter to ensure they receive the best possible communications and targeted assistance

• encourage individuals who depend on electricity to power medical equipment to speak to their healthcare provider about what to do in the event of a power cut and to ensure equipment and backup systems have been recently serviced and tested

Infection prevention and control (IPC) and visiting

We expect providers to continue to follow ongoing IPC guidance including the infection prevention and control resource for adult social care and the COVID-19 supplement to the infection prevention and control resource for adult social care. Local authorities and health protection teams (or other relevant local partners) should continue to support providers on IPC.

Providers should:

• encourage staff and service users across adult social care to take up eligible vaccinations wherever possible

• ensure they are aware of service users who may be eligible for COVID-19 treatments wherever possible

• ensure they have enough LFDs to test those eligible for COVID-19 treatments if they develop respiratory symptoms over winter. Care homes should also ensure they have enough LFDs to conduct outbreak testing of the first 5 linked symptomatic residents if multiple residents develop symptoms

• ensure staff who have respiratory symptoms or who test positive for COVID-19 are able to stay away from work in line with guidance

• continue to use PPE in line with guidance, including the risk-based use of face masks

• enable visits between loved ones in care settings, with at least one visitor permitted in all circumstances

Unpaid carers

NHS and primary care services should consider contingency plans for unpaid carers and make relevant information available to health and care professionals, to help prevent avoidable admissions and support discharge from hospital. This includes the identification of unpaid carers, see NHSE communication from last October Coding unpaid carers.

Health and wellbeing boards should continue to ensure that funding earmarked in the BCF is used to support unpaid carers with short breaks and respite from their caring responsibilities.

Where a local authority considers it necessary to do so, it may allow a direct payment to be used to pay for care provided by a family member (or someone who lives with them as a spouse or partner), in accordance with The Care and Support (Direct Payments) Regulations 2014.

As set out in statutory guidance on hospital discharge and community support, hospital discharge teams should take into account the views and circumstances of any unpaid carers, as well as those of the individual, in decisions on hospital discharge. DHSC expects to publish an update to the statutory guidance on hospital discharge and community support in September.