Recovery post pandemic for adult social care hasn't been easy, but in the first survey of social care directors since this difficult period, there are some green shoots of hope.
Numbers of people waiting for care, an assessment or direct payment have reduced by about 112,000 since last year. More homecare is being delivered, achieved, in part, by increasing salaries for care workers. This is good news for everyone; higher wages value the vital work of care staff, it helps keep people healthy in their own homes and brings longer-term savings to councils who reduce their reliance on more expensive residential homes.
Yet, despite a short-term funding boost from the Government and the best efforts of directors and their teams to turn the tide, the report also shows a slow slide into an increasingly unsustainable situation for adult social care. In March 430,000 people were waiting for care, an assessment, or direct payment, still 10% higher than in 2021. ADASS is warning that the waiting list could increase again over the colder months. We know people's health deteriorates while they wait, some will end up in hospital or a care home instead, costing the NHS and councils more in the long run.
Directors are also reporting a rise in referrals for support for people with mental health needs – a situation likely to increase further following the Met Police's announcement that they will no longer attend mental health call outs where isn't a risk to life. Support for people experiencing domestic abuse and homelessness has also risen. A lot of the time it is unpaid and family carers who are stepping in to fill the gaps, often to the detriment of their own health and well-being because they aren't getting the support they need. Our survey shows carer burnout is the number one reason for carer breakdown over the past year.
The complexity of people's care needs is also changing; we are seeing more homecare hours being delivered but to a smaller group of people who have greater needs. This is, in part, being driven by the NHS's battle to free up bed space, with people being discharged earlier and requiring multiple visits a day, sometimes from more than one carer. At the same time, a record NHS backlog for treatment means social care is providing the safety net while people are waiting to go to hospital or simply aren't admitted at all. And with a lack of capacity in community health services available such as district nurses and health visitors, social care is doing more, in new ways, but without the additional resources to pay for it. Our survey shows more councils overspent on their adult social care budget last year and there has been an increase in those relying on reserves to fund these pressures.
This all characterises the vicious cycle we find ourselves in; with the political focus and resources being channelled into discharge and immediate need, leaders tell us they are struggling to invest in prevention and well-being services to keep people out of hospital or residential care facilities. Last year we spent around £19bn on adult social care in England employing 1.5m people – more than the NHS. But the impact that has on people's lives and the wider economy is being undermined by councils 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.
So, what needs to change and where are the solutions? In the short-term we are urging the Government to unlock some of the social care reform funding they have held back so councils can support carers to help keep people in their homes. Alongside this, we need to improve the community NHS services to support our work in keeping people independent and safe at home. International recruitment has been helpful in boosting staffing numbers, but we also need to grow a sustainable domestic workforce by improving pay in line with NHS band 3 and offering people real career prospects. And 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, which is bad for them and for the public purse.
But to make real progress, we need a long-term plan for investment across social care and community health, like the Roadmap we published in April. And we need the political will to make social care a priority now and, in the future, so everyone can get the care they need, when they need it.
Beverley Tarka is president of The Association of Directors of Adult Social Services and director of adults and health at Haringey LBC
