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Social care has lost out on more than a billion pounds of funding promised by the government in December 2021 to reform the system, according to a new National Audit Office (NAO) report.
The report Reforming adult social care in England says that only £729 million may now be spent between 2022 and 2025 on reforming the adult social care system, representing a 58% fall in the budget. The rest has been diverted to other care priorities.
In 2019, the government promised to “fix the crisis in social care”. Following the Covid-19 pandemic, in September 2021 it published Build Back Better: Our Plan for Health and Social Care.
Yet, the NAO says the sector remains challenged by chronic workforce shortages, long waiting lists for care and fragile provider and local authority finances. Although there are some early signs of improvement in some of these, it remains to be seen whether these trends will continue and at what cost.
Gareth Davies, head of the NAO said: “Adult social care reform has been an intractable political challenge for decades. Government has set out its ambition to meet this challenge and now needs to demonstrate how it is delivering on these plans. If government is to successfully reform adult social care, it will need to manage some significant risks, including its own capacity and that of local government to resume charging reform activity alongside system reform.
“To maximise its chances of succeeding, government will need to ensure it understands the impact of its ambitions on local authorities and other stakeholders and establish a costed plan which ensures delivery of its long-term goals.”
Adult social care covers social work, personal care and practical support for adults with a physical disability, a learning disability, or physical or mental illness, as well as support for their carers.
As people live longer and with more complex conditions more people are likely to need adult social care to support them to live the lives they want. In 2022-23, local authorities in England spent £23.7 billion on adult social care, supporting more than one million people with care needs.
The Department for Health and Social Care (DHSC) reprioritised reform funding and activity to reduce delayed discharge pressures, but the report says rising inflation has compounded other long-standing pressures. For example, waiting lists have increased by 37% between November 2021 and April 2022.
At last year’s Autumn Statement, government postponed its £3.6 billion charging reform initiative and committed up to £7.5 billion to the sector, including £2.7 billion of new central government funding, to help ease immediate pressures.
Yet, the NAO says that there is local variation and funding may not be reaching areas that need it most because government has not updated the formula used to distribute most local government funding for adult social care since 2013-14.
The Voluntary Organisations Disability Group said that the issues with the system are well known but the government is choosing not to address them. There is no long-term plan for the social care workforce, no sustainable funding settlement and no meaningful integration of services despite the policy rhetoric.
It added that disabled people continue to be disproportionately affected by current approaches and much more needs to be done to ensure all those who need it, can access services and receive the right level of support for them.
Vacancies in adult social care in England have increased by 173% in the past decade and, despite a recent fall, stand at around 152,000 (a 10% vacancy rate). Around 70,000 staff have been recruited from outside the UK in the past year.
As there is no established an overarching programme to coordinate the reforms, making it difficult to know if it is on track to achieve its objectives, the NAO says DHSC is delivering on two of its eight workforce projects – supporting international recruitment and adult social care volunteering – the remaining six are in development. Some projects within digital, data and assurance have made better progress.
It recommends that DHSC assesses the impact of its current and planned reform interventions on local authorities and seeks stakeholder views to ensure its plans are manageable. It should also set out a costed plan for implementing charging reform from October 2025, and map the funding required to deliver its planned reform outcomes.
Care England expressed concern over the finding and said that while the need for care is on the rise, the plans and funding for system reform are being scaled back.
Professor Martin Green OBE, Chief Executive of Care England, said: This is symptomatic of a broader issue Care England has long since called to be addressed. The solution to the adult social care puzzle is long-term thinking, yet the NAO report finds government over-reliance on short-term policies.
“This report underscores the need for long-term investment into the social care sector with clear measures of success. Care England implores the government to heed this warning ahead of the Autumn Statement this month. With the NAO’s report painting a picture of a broken system, the government must make true on their manifesto promise to fix social care not just for now, but for the long-term.”
‘Social care is essential to people’s quality of life and daily experiences and should be prioritised as such. Yet this report again demonstrates the significant lack of progress, prioritisation and understanding this government has for social care.