Social care teams make dent in waiting lists but more carer burnout and mental health needs means that fewer people are getting the support and care they need.
New findings from a survey of social care leaders shows short-term funding boosts from Government has helped reduce the number of people waiting for care and increased support for people at home. But increases in care delivered are not keeping pace with increased needs, according to a report by the Association of Directors of Adult Social Services (1a).
Despite the progress, care waiting lists remain far too high and ADASS is warning could rise again this winter without more staff. And 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 (1b)
To improve social care, boost our economy and enable carers to continue working, social care leaders are calling on the Government to commit to:
- Invest 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
- Increase support to carers and improve workforce pay: international recruitment is not a long term fix
- a fully funded, 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. But that means the health and wellbeing of many thousands of people continues to deteriorate while they wait for assessments, care or direct payments. 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. We’ll likely go into this winter with waiting lists still higher than in 2021 and these could rise further during the winter (1c).
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 they need – has increased (2). 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 (3a). 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 previously the NHS would have arranged or delivered (3b).
Social care leaders report a growing need for social care support to help people with poor mental health, homelessness and domestic abuse in our communities. 81% of Directors report an increase in the number of people approaching their council with mental ill health, 51% have seen a rise in rough sleepers needing help, and 64% report a rise in domestic abuse relating to people with care and support needs (4).
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. (5) 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. Once again, this data demonstrates the importance of social care in supporting people to continue working, which has the potential to further boost the economy.
Findings reveal recruitment and retention of care staff remains a challenge and continues to undermine progress. This is 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. (6)
Social care leaders say they are caught in a vicious cycle, struggling to prioritize support to keep people healthy, independent and working, so they can continue to contribute to the economy and their communities (7). It would also reduce the number of people with higher needs in future. 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. 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 (8). Directors have had to identify an increased level of savings from their social care budgets for 2023/24 (9), putting further pressure on the support they can offer people.
Last year we spent £19bn on adult social care in England (10), employing 1.5m people (11) – more than the NHS – and it contributed £51.5bn to the economy (12). But the impact that 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. They 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.
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 thousand 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 .
“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.”