The National Audit Office (NAO) has published a report about the adult social care market, highlighting that an estimated 24% of adults aged 65 and over have unmet care needs. The NAO warns of increasing demand in the future and calls for the government to set out a ”cross-government, long-term, funded vision for social care” as a matter of priority.
The adult social care arrangements in England are fragmented. The Department for Health and Social Care (DHSC) has overall responsibility and is ultimately accountable to Parliament for the social care system. Local authorities are responsible for commissioning adult social care, spending £16.5bn in 2019-20 on 14,800 registered organisations across 25,800 sites, most of them privately run. The Ministry of Housing, Communities and Local Government (MHCLG) oversees funding and financial rules for local authorities.
The report comments that the current accountability and oversight arrangements do not work in a vast and diverse social care market where DHSC lacks visibility of the effectiveness of care commissioned. Significant data gaps remain and DHSC cannot assess the outcomes achieved across the system and whether these are value for money.
Lack of certainty over funding is a problem for local authorities, which are under significant financial pressures following a 55% cut in central government funding between 2010-11 and 2019-20 in addition to COVID-19. Spending on social care has increased since 2013-14, meaning it is taking up an increasing proportion of budgets. This has caused some councils to engage in commercial risks in an attempt to raise funds but these are not always successful, as the example of Croydon Council highlights.
Concerns covered by the NAO include the warning by the Competition & Markets Authority (CMA)’s care homes market study of the risk of providers leaving the market, as well as worries about the financial resilience of many larger providers. DHSC does not collect adequate data to assess the financial resilience of small and medium-sized providers. Limited investment in the 1.5m people that work in social care is also discussed, including ongoing issues around low pay and a lack of training affecting recruitment and retention. The report says local authorities are reluctant to challenge providers on workforce development because of low fees and criticises DHSC for failing to develop a workforce strategy since 2009 despite committing to do so.
DHSC projects that demand for adult social care will increase significantly as people live longer and, as a result, so will the costs. Between 2018 and 2038, it estimates that the total costs of adult social care will more than double to £55.8bn - it is clear that a long-term sustainable plan for funding is required.
The NAO concludes: “High-quality care is critical to the well-being of some of the most vulnerable adults in society. Yet levels of unpaid care remain high, too many adults have unmet needs and forecasts predict growing demand for care.
“The lack of a long-term vision for care and short-term funding has hampered local authorities’ ability to innovate and plan for the long term, and constrained investment in accommodation and much-needed workforce development.”
Oliver Simms, Manager, Public Sector Audit & Assurance for ICAEW, commented: “The COVID-19 pandemic has focused attention on adult social care and highlighted the financial pressures that local authorities and care providers are under in a system that struggles to meet current demand, let alone expand to meet growing needs over the coming decades.
“The National Audit Office report contains a number of specific recommendations for central government to improve its oversight of the social care system, but more importantly it adds to the calls for a comprehensive long-term strategy for adult social care. Without a comprehensive plan that enables all those involved in the provision of adult social care to plan ahead and invest in new capacity, it will not be possible to deliver on the government’s commitment to support those most in need.”
