ADASS report finds increases in social care delivered are not keeping pace with increased needs
A report by the Association of Directors of Adult Social Services (ADASS) has revealed that increases in care delivered are not keeping pace with increased needs, despite short-term funding boosts from the UK Government helping to reduce the number of people waiting for care and increased support for people at home.
According to ADASS, despite the progress, care waiting lists remain far too high and warns that the numbers could rise again this winter without more staff.
In response to the findings, Beverley Tarka, President of the Association of Directors of Adult Social Services said: “Our findings show that a short-term funding boost from the Government and the hard work social care teams have done to rebuild services after the pandemic is making a difference to thousands of people needing support and care, but we’re not out of the woods yet. Leaders tell us they are paddling hard to keep up against a tide of increasing and complex needs.
Additionally, it says a record NHS backlog, rising mental health needs, support around domestic abuse of people with care and support needs, and carer breakdown means most councils are not confident they can offer the minimum social care support in their communities required by law.
To improve social care, boost the economy and enable carers to continue working, social care leaders are calling on the Government to commit to investing in support that helps people avoid the need to go to hospital or a care home, and support for people to recover, get back on their feet and back home after hospital during this winter.
Commitments also included increasing support to carers and improving workforce pay. International recruitment is not a long term fix, a long-term plan to transform social care to ensure everyone in England can get the care and support they need when they need it.
A huge effort by social care teams to rebuild services after the challenges of Covid 19, has reduced care waiting lists from a high watermark of 542,000 in April 2022 to 430,000 at the end of March 2023. This means the health and wellbeing of many thousands of people continues to deteriorate while they wait for assessments, care or direct payments.
ADASS says that because of this, some will end up having to go to hospital or a care home instead, undermining their independence and costing the NHS and councils much more in the long run, and warns that the UK will likely go into this winter with waiting lists still higher than in 2021 and these could rise further during the winter.
The survey shows that in the battle to free up NHS acute beds, council social care teams are needing to support more people coming out of hospital with complex health and support needs.
Three quarters of councils say the size of care packages for people being discharged from hospital, the number of hours and numbers of carers needed, has increased.
Over half say they’ve seen an increase in the numbers of people needing social care due to delays to hospital admissions or not being admitted at all.
81 per cent of directors either strongly agreed or agreed that increased NHS pressures will lead to adult social care taking responsibility for services which the NHS would have previously arranged or delivered.
Family and unpaid carers are bearing the brunt of an under-resourced and over-stretched system. Carer burnout was the number one reason directors gave for breakdown in unpaid carer arrangements.
A further 91 per cent of directors said that unpaid carers are coming forward with increased levels of need in their local area.
It is likely that as more people reach crisis point, there will also be a rise in carers forced to reduce hours or leave work. This data demonstrates the importance of social care in supporting people to continue working, which has the potential to further boost the economy, says ADASS.
Findings reveal recruitment and retention of care staff remains a challenge and continues to undermine progress, despite some difference being made through recruitment of care workers from other countries which, though welcome, is unsustainable.
Whilst there’s been significant increase in the delivery of homecare hours since the pandemic, over half a million hours of homecare were unable to be delivered across the English regions due to lack of staff. This is equivalent to around £14.7 million worth of care that could have helped people stay independent at home, supporting carers and providing jobs.
Social care leaders say they are caught in a vicious cycle, struggling to prioritise support to keep people healthy, independent and working, so they can continue to contribute to the economy and communities, which would also reduce the number of people with higher needs in future.
According to ADASS, this is being exacerbated by the lack of capacity in NHS community health services, leaving more people becoming unwell and going to hospital or into a care home.
Beverley commented: “While the focus on people coming out of hospital is important, we need to focus more funds on keeping people independent and out of hospital in the first place so that they don’t end up needing more costly and complex medical care, which is bad for them and for the public purse.
“To meet the challenges, we need a skilled and valued workforce to do this – bringing pay in line with equivalent posts in the NHS is important first step. And we need to offer investment in training and real career prospects in the profession so we can compete with other sectors.
“In the short-term we are urging the Government to unlock the £600m social care reform funding they have held back so we can improve both staffing and support carers to help keep people in their homes. But to make real progress, we need a long-term plan for investment like the one in the roadmap we published in April, and the political will to make social care a priority over the next ten years so everyone can get the care they need, when they need it in the future.”
The survey reveals that more councils overspent on their adult social care budget last year and there was a worrying increase in those relying on reserves to fund these pressures. Directors have had to identify an increased level of savings from their social care budgets for 2023/24, putting further pressure on the support they can offer people.
According to the Spring 2022 report by ADASS last year, £19bn was spent on adult social care in England, employing 1.5m people and it contributed £51.5bn to the economy.
The impact it has on people’s lives, and the wider economy, is being undermined because councils can’t spend more on preventing people from getting ill in the first place.
Directors are having to focus more funds on providing complex care to people coming out of hospital, or increasingly people who should be admitted to hospital but are having their treatment delayed.
Responding to survey, Cllr David Baines, Vice-Chair of the Local Government Association’s Community Wellbeing Board said: “This crucial annual report gives a comprehensive view of the many pressures facing social care, their consequences for people, the workforce and providers, and the legitimate and serious concerns of directors of adult services.
“While the decrease in the number of people waiting for care assessments is a positive and notable achievement, a record NHS backlog, rising mental health needs, support around domestic abuse of people with care and support needs, means that demand continues to rise for councils.
“The fact that directors are having to plan savings of £806 million as part of wider council budget-setting in 2023/24, further demonstrates the extremely challenging situation adult social care is facing.
“It is deeply concerning to see that most councils are not confident they can meet all of their statutory duties required by law. This, partnered with the increase in the number of unpaid carers reporting burnout, could have serious impacts for many people who draw on care and support.
“This report shows the impact of a chronically underfunded system and the pressures councils continue to face. We support the recommendations of this report and urge the Government to implement a fully costed, long-term, sustainable plan to fund social care.”
Matthew Taylor, chief executive of the NHS Confederation commented: “The findings in the report show how social care teams make a massive difference in supporting our communities, provided the right funding from the government is in place. At the same time the report reinforces the problematic ad-hoc and short-term approach the government have taken, particularly with regards to investment in social care.
“The increase of demand for care means that there needs to be a focus on consistent, long-term funding in all areas of social care as well as investment in primary and community health services which, in turn, would support all social care services. By having appropriate backing, people can get the right support from their local social care services and continue their recovery in the comfort of their own homes. Better social care goes hand in hand with a functioning NHS and helps keep people out of hospital.
“The underlying issue is staffing and with gaping vacancies in social care, the government must listen to the suggestions in the report and unlock the £600 million funding so that teams have the right workforce in place. NHS leaders will know that without a significant boost to the social care workforce, the government’s investment in measures to improve hospital discharge and keep patients healthy and out of hospital will be hindered.”
Cllr Martin Tett, Adult Social Care Spokesperson for the County Councils Network, said: “This year’s report from the Association of Directors of Adult Social Services (ADASS) again shows an adult social care system under significant pressure, particularly from people discharged from hospital who have complex health and support needs. It also highlights workforce and financial issues within the system, which have been long-running challenges.
“The study does, however, highlight the art of the possible when local government is given the financial backing it requires. Whilst waiting lists for care assessments are still stubbornly high, councils have worked hard to reduce the total waiting list by over 100,000 people since April last year by digitalising and investing in services. The County Councils Network (CCN) had called on the government to re-prioritise funding for its delayed reforms into frontline services last Autumn, and we are pleased that this is having an impact.
“Looking further ahead, it is clear that short-term funding boosts are not a panacea to solving all the issues within the care system, despite some successes this year. This government has set out an ambitious roadmap for reform that encompasses changes to charging thresholds, workforce, and greater digitalisation, but the next government must fully-fund this package to ensure its success.”
