The care sector is in crisis and the Chancellor’s recent budget is in danger of finishing off already stretched providers.

Many now feel the issue is no longer about care but cost, as Local Democracy Reporters Simon Finlay and Gabriel Morris found out…

Carlton Horn is sitting in his snug, one-bedroom flat on the outskirts of Canterbury surrounded by Star Wars pictures, Dr Who Tardises and a glass-fronted cabinet full of DVDs.

On the floor are two Top Gear box sets beside his easy reclining chair.

There is a games console in front of the TV and a laptop open on the kitchen table; snow globes and other mementos of places he’s been to on the shelf.

On this chilly winter afternoon, Carlton has been watching the live coverage of the assisted dying bill making its way through the House of Commons, a subject he has taken a keen interest in.

It looks for all the world like a bachelor pad and it has been his home for the past seven years.

Carlton speaks quickly and animatedly about many things - for instance, the minutiae of Disney costume designs and flourishes a red plastic folder with coloured in pictures of favourite characters.

He talks about steam trains, his trip to Walt Disney World in Florida and the cost of public transport.

Running his hand over his head, Carlton seems a little agitated in answering some apparently innocuous questions.

Alongside him is Tamsin Gregory-Conquest, who heads up Kent Autistic Trust’s (KAT) Positive Behaviour Support team and has spotted a classic sign of anxiety symptoms.

In some autistic people, an anxiety trigger can cause a prickly sensation across their heads.

With a tender, but almost imperceptible, lean into his direction, Tamsin knows what to do and what to say. The moment passes easily and Carlton is calm once more.

Carlton, a gentle, friendly and funny man, is one of 100 individuals in the care of KAT and is more capable in everyday life than many.

But he still needs a significant amount of support to live as independently as he does. The CCTV camera on the ceiling of his sitting room is a simple reminder of that.

Carlton, who has a complicated family history and was bullied at primary school, says: “If it weren’t for them (KAT) I don’t know where I would be or what I would do.”

His is a shining example of care giving at its purest; its simplest. And the clue is in the word “care”.

But the care sector is in crisis. Already stretched beyond its means, the Chancellor’s autumn budget with double changes in national insurance and a rise in the minimum wage could prove existential.

Compared to many charities, KAT is in a relatively strong position. Of revenues of around £9 million, 88% goes on care and the rest on other day-to-day bills.

It employs 300 full and part-time staff and there is nothing for fripperies. It is the same story across the sector, even those run as independent, private businesses.

Most of KAT’s income is derived from local authorities, principally Kent County Council, Medway Council and some London boroughs.

KAT chief executive Christine Edwards-Daem says: “It has been such a shock to see how they are going to raid what we don’t have. We need to highlight our plight. In 32 years of leading services, I have never seen something to have such an impact.”

Today, she is not in any mood to mince her words. Christine says the whole sector is reeling from a “triple whammy” of extra costs contained in Mrs Reeves’ recent budget.

Increasing the employers’ national insurance contribution while also lowering the threshold by 45% was compounded by a hike in the minimum wage.

While few in the charitable sector would begrudge their staff a modest lift in their take home pay, overall it means care providers will have to find an extra 11% just to stand still.

“This is a tax tsunami,” she says. “You will see the collapse of the social care sector and vulnerable people will have nowhere to go except into hospital and that cost will end up with the NHS.

“If providers go bust it will leave a smaller number of larger providers, which could create a monopoly.

“This is a problem that we can’t resolve and that is the same message I am getting from colleagues in the sector. We do feel we have the local authority (KCC) on board and they are teetering on the brink anyway.”

Many charitable providers feel the sector should be exempt from the national insurance rises, a view shared by KCC leader Cllr Roger Gough.

KAT has modest reserves - enough to tide wages over for a couple of months - but more than 75% of the care sector are already dipping into theirs.

For KAT, the changes will add £350,000 to the annual costs which is likely to be unsustainable.

Christine is at pains to point out KCC - which pays KAT to provide support for vulnerable adults in need of social care - is mindful of the charity’s predicament and it is reciprocated.

“The Chancellor’s budget will place many adult social care organisations in jeopardy…”

In many ways, KCC’s current financial woes are mirrored at KAT - insufficient funding to cover the cost of the services it provides.

The KAT boss recently had a meeting with Cllr Gough and his relevant cabinet member Cllr Dan Watkins, which she says achieved “a really good agreement going forward”.

At KCC’s scrutiny meeting on December 4, deputy leader Cllr Peter Oakford acknowledged that the unexpected increase of 11% was not mitigated by the 3% uplift budgeted by the council.

“They are realistic and understand this position, as we do,” he told members.

The care sector needs a lot of people which is why the national insurance costs will become so burdensome. Once the new minimum wage kicks in, it will be faced with an even higher bill thereafter.

The warnings have been coming loud and clear since Mrs Reeves’ October 30 budget statement.

Community Integrated Care, one of the country’s biggest care-providing charities with 6,000 front line employees, is facing the prospect of a £12m increase in its staffing costs.

Chief executive Jim Kane says: “The Chancellor’s budget will place many adult social care organisations in jeopardy, threatening essential services for thousands of people with care and support needs.

“Urgent action is needed. We hope this outcome is unintended and we call on the Chancellor to review the budget’s impact on the social care system, especially for the charity providers.”

To the Care Provider Alliance (CPA), the very government its members believed would be their saviour has instead condemned it to “potential collapse”.

A survey of 1,180 care and support providers showed that, without immediate government intervention, 73% will have to refuse new care packages from local authorities or the NHS and more than half (57%) will hand back existing contracts.

It is against that background that KAT is engaged in a “collaborative approach” with KCC, knowing a mutual understanding of the crisis can be the only solution.

The CPA study shows 77% of providers face having to dip into reserves and almost two thirds (64%) face having to make redundancies, while 22% are now planning to close.

The Kent Integrated Care Alliance (KICA) has been promoting the #ProvidersUnite campaign asking the government to think again, particularly since, it claims, the care sector is already underfunded by £8.4bn.

A letter available to send to the Chancellor states: “We write as a united voice, urging you to consider the profound impact of the proposed tax increases on all those who depend on us.

“It’s putting us in an impossible position because we are simply not going to compromise the quality of care that we give…”

“Like GPs, pharmacies and hospices, we are independent businesses and charities embedded in every corner of our communities, committed to supporting citizens with diverse needs. With the state funding more than 70% of our work, we deliver an essential public service.

“The current budget measures risks eroding the foundations of the public services we deliver, which extend far beyond elderly care.

“They include mental health, domiciliary care, learning disabilities, supported living and other specialised services.

“To remain viable, these services require appropriate levels of state funding to meet the varied and growing needs of our communities.”

Few in the care sector believe that Mrs Reeves’ announcement of an extra £600m pledged to social care will be enough to make a difference.

Tamsin, sitting at a table in the residential home’s dining room, is far from optimistic about the future.

She’s worked at KAT for 14 years. Cheerful by nature, her demeanour changes as she assesses what she sees on the ground.

She says: “It’s putting us in an impossible position because we are simply not going to compromise the quality of care that we give in places like this.

“Social care is now in such a precarious position and it’s almost at breaking point.”

People are leaving jobs they love and are good at for less stressful lives driving forklift trucks in warehouses or working in supermarkets for marginally better money, she says.

“We lose staff for many reasons but we know that there are struggles with housing and living costs. So it becomes social care versus other sectors.

“Say if we have not got day services for high needs specialist care people, they will end up with their parents who may not be able to cope. It can affect their mental health, resulting in them being in hospital or even sectioned. This is real.

“I have been here for 14 years and there has been a noticeable shift in that time. Back then it was all about the person - how are they doing, what are their needs and how can we help them? That was the starting point. Now it is all about money.

“There is a saying in the industry which has started to creep in - ‘care doesn’t have to be great, it just has to be good enough’.”