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Adult social care is under “significant financial pressure”

The National Audit Office has revealed that stalled plans and diverted funds have held back reform of the system.

By Zoë Grünewald

More than half of the funding committed to reforming the adult social care system in December 2021 has been diverted to other care priorities, a new National Audit Office (NAO) report has revealed today.

The UK government has implemented significant delays to its ten-year plan to overhaul adult social care, with key reforms facing financial diversions and being scaled back. The ambitious plan outlined in December 2021 aimed at transforming the adult social care system has fallen behind schedule, with only £729m expected to be spent between 2022 and 2025 – a 58 per cent reduction from the initial budget of £1.7bn.

Last year’s Autumn Statement saw the postponement of the £3.6bn charging reform initiative, which was meant to change how people pay for their social care. The initiative would have prevented anyone from paying more than £86,000 for their personal care costs. Instead, the government committed up to £7.5bn to the sector, including £2.7bn of new central government funding, to help ease immediate pressures.

While this provided some relief for local authorities, the NAO report indicates that around a quarter of councils may not spend enough to meet the rising cost pressures associated with the adult social care sector as a result of inflation and growing discharge delays. Plus, one in six councils expect demand for social care to exceed capacity in their area this winter.

The NAO report also highlights that over £1bn of the allocated budget has been diverted to other care priorities, such as the Adult Social Care Discharge Fund and urgent and emergency care, prompting concerns about the government’s commitment to addressing long-standing issues in adult social care. Rising inflation and the sector’s impact on hospital discharge delays have also forced the Department of Health and Social Care (DHSC) to reprioritise, directing funds towards stabilising the sector rather than the envisaged reforms.

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The report also sets out that despite recent signs of improvement, the adult social care system faces significant challenges, including a 37 per cent increase in waiting lists between November 2021 and April 2022. Concerns persist about the care assessment backlog, with survey data revealing that the number of people waiting more than six months for assessment has almost doubled since the end of 2021, reaching around 82,000 in March 2023.

Vacancies in adult social care have also surged by 173 per cent in the past decade, standing at around 152,000 with a 10 per cent vacancy rate. The reliance on international recruitment has increased, with approximately 70,000 staff recruited from outside the UK in the past year.

The NAO report underscores the lack of a coordinated approach within the DHSC, with no overarching programme to manage the ambitious reforms. Of the eight workforce projects announced by the government to tackle staff shortages in the social care sector, only two – supporting international recruitment and adult social care volunteering – are currently being delivered. The remaining six – including the funding of enhanced training and development, and in improving leadership among integrated care systems – are still in development. The NAO says that the department’s “Next steps” paper, published in April 2023, lacks a long-term funded plan for the transformation of adult social care.

To achieve its ten-year ambition, the NAO recommends assessing the impact of reform interventions on local authorities, seeking stakeholder views and outlining a costed plan for charging reform by October 2025.

Gareth Davies, the head of the NAO, emphasised the need for the government to demonstrate its commitment and understanding of the challenges: “If government is to successfully reform adult social care, it will need to manage some significant risks.”

In response to the report, Meg Hillier MP, chair of the cross-party Committee of Public Accounts, said: “Today’s report says DHSC still has a long way to go. It has made some progress but that has largely stalled, with charging reform delayed and wider improvements scaled back. The sector is still struggling with long waiting lists, staffing shortages and both local authorities and providers [are] under significant financial pressure.

“DHSC needs a long-term plan to deliver its vision. It must understand if it is on track and whether its activities are actually improving people’s lives.”

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