Adult social care requires a coherent, comprehensive and co-ordinated reform programme, implemented over several years, to create a system that meets people’s needs more effectively, with a focus on personalisation, prevention, workforce, quality, and wider eligibility for services. There is no sign that a credible programme to address these issues is intended by the government.
Key trends in social care are going in the wrong direction
Demand for care is going up, but access to care is going down. Recent analysis by The King’s Fund shows that overall requests for social care have hit a record high, yet support from local authorities has dropped. There has been a small increase (4,000) in the number of working age adults receiving support, but 58,000 fewer older people now receive long-term care than in 2015/16.
Financial eligibility is tighter and charging reform has been put back. If the means test upper threshold had increased in line with inflation since 2010/11, it would have been nearly £5,500 higher (at £28,735) in 2021/22. By not rising in line with inflation, in effect, the means test has got meaner. Meanwhile, the repeated failure to introduce a cap on lifetime care costs means that one in seven people over 65 face catastrophic costs of more than £100,000.
Costs of delivering care are rising. Local authorities are paying more for care home places and home care support. This is driven by increases in care providers’ costs, particularly staffing costs but also relating to Covid-19 infection controls and now wider inflation such as energy and food prices. In real terms, since 2015/16 the average weekly fee paid by local authorities for older people’s care home places has increased by 21 per cent and the average hourly rate for homecare has increased by 14 per cent. Despite these increases, in March 2021, the Department of Health and Social Care told the National Audit Office that most local authorities pay below the sustainable rate for these services. The government had said it would move towards local authorities paying a ‘fair cost of care’ but funding for this has now been redirected just to keep the sector afloat.
The workforce is in crisis. The social care staff vacancy rate is the highest since records began. The overall vacancy rate in 2021/22 increased to 10.7 per cent, equivalent to 165,000 unfilled posts, with the highest vacancy rates in domiciliary care, for registered managers and for nurses. For the first time ever, the workforce actually reduced by 50,000. Care worker pay is a key issue in recruitment. While pay has been increasing – by 16 per cent in real terms since 2012 driven by the national living wage – other sectors competing in the same labour market are offering higher rates of pay beyond those minimum levels to their staff.
Carers are receiving less support. Despite the ambition of the 2014 Care Act, no more carers (314,000) receive support than in 2015/16 and fewer receive paid support such as direct payments. The number of people receiving respite care has fallen substantially, from 57,000 in 2015/16 to 33,000 in 2021/22.
Public satisfaction with social care has never been lower. Just 14 per cent of the public are satisfied with social care. Dissatisfaction has risen significantly to 57 per cent of respondents (up from 50 per cent in the previous year) and reached its highest level recorded.
More detail on these and other trends is available in the Social Care 360 report recently published by The King’s Fund.