More demand, less supply and less personalisation, finds five-year analysis of adult social care

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Demand for adult social care in England has gone up as council-funded provision has fallen and personalisation has gone into reverse, a report had found.

The King’s Fund’s latest ‘Social care 360’ analysis found that councils received 120,000 more requests for support in 2019-20 than 2015-16, but provided short or longer-term support to an estimated 14,000 fewer people.

At the same time, the number of people receiving direct payments fell in 2019-20, as it had done in each of the two preceding years,  which the fund said suggested a reduction in personalisation.

While local authority spending on adult social care, which fell sharply from 2010-15 due to the coalition government’s cuts to local authorities, had returned to just above 2010-11 levels in real terms by 2019-20, spending per person remained lower.

Greater demand and reduced supply

Among those aged 18-64, requests for support rose from about 500,000 in 2015-16 to 560,000 in 2019-20, with only slight rises in those receiving long-term (285,000 to 290,000)  and short-term support (21,000 to 28,000).

For older people, requests also went up by 60,000, to 1,370,000, and while the numbers receiving short-term support rose from 190,000 to 203,000, this was more than outweighed by the drop in those receiving longer-term support (587,000 to 548,000).

The fund said that the increasing demand reflected higher levels of disability – with 19% of younger adults reporting a disability in 2019-20 up from 15% in 2010-11, according to a government survey.

It said a “key driver” of the reduced provision was available funding as, despite councils spending more overall in 2019-20 than 2015-16, much of this had been channelled towards higher unit costs for providers, due to the need to meet year-on-year minimum wage increases.

The think-tank also raised the prospect that the reduced provision could reflect a success story, in terms of greater independence, but said this could not be established one way or the other.

“Local authorities may be increasingly using effective short-term approaches that aim to help people regain independence rather than rely on long-term support. However, it is by no means clear the extent to which this is happening.

“It is also possible that the adoption of asset-based and self-help approaches, is leading to less uptake of formal services. However, it is currently impossible to measure how extensive – or indeed effective – such approaches are in practice, and there are concerns about the capacity of the voluntary and community sector and family carers to support them.”

The report warned that the trend of increased demand and reduced provision risked continuing with the National Audit Office finding that 41% of councils expected to make “substantial savings” to balance their budgets in 2021-22, and a further 53% expecting to make some savings.

Less personalisation

The report found that the number of people receiving direct payments had fallen for a third successive year, from 126,000 to 123,000, leaving 39.5% of working-age adults and 16.9% of older people getting the payments, the lowest proportion since 2015-16.

In explaining the trend, it cited feedback from disabled people’s groups that some councils offered much more support than others for people to manage their payments, while limited choice of service could prove a barrier to update in some areas.

More positively, however, it said national personalisation partnership Think Local Act Personal had highlighted positive stories of people using direct payments during the Covid-19 pandemic, with some councils adopting a less prescriptive approach to monitoring them.

‘Decade of neglect’

“Following a decade of neglect, there is a continuing gulf between what people need and what they receive,” said the report’s lead author, King’s Fund senior fellow Simon Bottery. “The latest data paints a bleak picture with few causes for optimism. Even where measures have improved, there are often caveats.”

The findings come amid reports that the goverment’s long-awaited proposals to reform social care funding will be further delayed (source: inews).

Bottery added: “Demand is likely to go on increasing but local authorities do not have the money to meet it. If we are to avoid reporting on a further bleak round of indicators in future years, we urgently need the long-term, wide-ranging reform for adult social care that the prime minister promised after the general election.”

The report made six recommendations for social care funding and reform:

1. Increasing funding to keep pace with demand – which would require an estimated £1.9bn extra a year by 2023-24 – meet unmet need, improve quality and cover the further costs of Covid-19.
2. Widen eligibility for support, initially by enabling councils to apply Care Act 2014 criteria more fairly and, in the longer-term, widening access further.
3. Improving pay, training and development for social care staff.
4. Giving people more control over their care, including by increasing the number of direct payments.
5. Investing more in preventive services, such as reablement.
6. Providing more support for carers, particularly in light of the extra responsibilities they have faced as a result of Covid.