Care demand rising with more expected, as service capacity lags below pre-Covid levels, says ADASS

Demand for care has risen in the first part of the year, with further rises predicted, despite capacity for certain services remaining below pre-pandemic levels, an Association of Directors of Adult Social Services (ADASS) survey has found.

The latest ADASS stocktake on the impact of Covid, answered by 91 of the 152 directors in March and April, found increases in requests for support, across multiple areas of need, since November 2020.

The biggest rise was in people presenting with care needs after being discharged from hospital, which had risen in 75% of areas, with 55% of directors reporting an increase of more than 10% in demand.

This was followed by rises in referrals from the community, which were up in 69% of areas, with 32% of directors saying demand had grown by over 10%.

Demand for mental health support had increased for 68% of authorities since November 2020, while there had been a rise of 3.8% in Mental Health Act assessments in 2020-21 compared with 2019-20.

Carers ‘not seeking help until they break down’

Sharp rises were also reported in referrals caused by a carer breakdown, unavailability or sickness, which were up in 67% of areas, and by over 10% in 27%.

Despite this, the number of requests for carer’s assessments reported by directors was down by 13% from 2019-20 to 2020-21.

ADASS said this suggested that carers, who had taken on “significant responsibilities during the pandemic”, were not seeking help until they broke down.

Referrals related to domestic abuse and safeguarding rose for 57% of directors. However, ADASS said that, based on previous research, demand in these areas was likely to increase as the lockdown lifted, as that was the pattern in 2020.

People seeking support as a result of the temporary closure of services, such as day centres, rose for 56% of responding directors, while 21% reported an increase of more than 10%.

Day centre capacity below pre-pandemic levels

Based on figures supplied by responding directors, ADASS found that day centre capacity – which shrunk sharply last spring as a result of the first lockdown – was 26,810 places lower than pre-pandemic levels, with an estimated 52,684 places available across England. Capacity had increased from an estimated 42,099 places in October 2020, based on previous ADASS research.

Capacity for community-support schemes and other types of day provision were also operating at much lower than pre-pandemic levels.

The ADASS report said it was not clear whether the gap was due to social distancing and infection control rules – and so would close further as lockdown lifted – or the need for councils and individuals to rethink provision and provide, potentially, more personalised alternatives.

It added: “Where people are happier with that alternative provision, it may well be that previous models do not return to pre-pandemic levels, quite simply because they have had a better offer.”

Since November 2020, 53% of local authorities responding had seen providers close, cease trading or hand back contracts, affecting 2,487 people, with a fairly even split between home care users and care home residents.

‘Unsustainable trends’

ADASS president Stephen Chandler said: “Some of the numbers we are seeing are phenomenal. The trends are unsustainable and show why the government must publish its plans for social care as a matter of urgency.

He added: “Adult social care has stepped up during the pandemic and is providing care and support both for many more people who have been unable to get admission to hospital and for many more who have been discharged. Without social care, the NHS would collapse.”

Caroline Abrahams, charity director at Age UK, said: “Councils are in no position to meet the tsunami of demands for care they now face. They were struggling to provide enough good care for their communities before the pandemic arrived, let alone now.

Abrahams continued: “We have warned for months now that families and friends who stepped in to provide care for their loved ones while the virus raged were reaching their physical and emotional limits and it gives us no satisfaction to be proved right.

She added: “Social care is emerging from the pandemic severely wounded and it badly needs government to do more to help. In 2019 the prime minister promised to ‘fix social care, once and for all’ and given the rising demand for care its more important than ever that he stands by his word.”