Almost 7,000 people have been waiting more than six months for a social care assessment, as councils face an “avalanche of need”, the Association of Directors of Adult Social Services has warned.
Though there are no statutory timescales for assessments under the Care Act 2014, waits of this length far exceed the one-month targets set by many councils and the four to six weeks deemed reasonable by the Local Government and Social Care Ombudsman (LGSCO).
In response to the figures, from ADASS’s spring survey, published this week, an LGSCO spokesperson said that waits of this length would usually constitute a fault by the council in question, though it would depend on the circumstances of the case.
The survey found just under 55,000 people were on waiting lists for assessments with almost 20,000 others waiting for care and support or direct payments to be started. Almost 160,000 people had been waiting over a year for a care and support review, contrary to the expectation set out in the Care Act statutory guidance of a 12-month interval between planned reviews.
‘People will deteriorate’
ADASS warned that waits of this nature were putting older and disabled people at significant risk.
“Whilst social work teams do their best to prioritise based on the information they glean, it is inevitable that many people will deteriorate, become mentally or physically unwell, lose confidence, fall, or that unreported or concealed abuse or neglect will worsen,” said the survey report.
ADASS said the waiting times reflected an “avalanche of need” directors were facing in the wake of Covid-19 and the failure of resources to keep pace with demand. The research found councils were planning to make savings of £601m to manage their finances this year, equivalent to 3.7% of their net budgets.
Just 21% were fully confident they had the budget to fulfil their statutory duties in 2021-22, down from 33% in the equivalent pre-Covid survey in 2019-20, with confidence dropping across a range of areas.
Three-quarters were less than confident about meeting their duties to promote a sustainable care market, under section 5 of the Care Act, up from 62% in 2019-20. Concerns were particularly acute in relation to residential and nursing care, with 98% concerned about the financial sustainability of some (77%), most (19%) or all (1%) of their providers, compared with 85% for home care. Of directors who had undertaken exercises to determine the costs of care faced by providers, 16% and 15%, respectively, said that at least a quarter of fees paid to residential, nursing or extra care providers were below the cost of care, for older or working-age adults.
The survey also found that 69% of directors were less than confident about fulfilling their Deprivation of Liberty Safeguards duties, up from 43% in 2019-20. With the new Liberty Protection Safeguards system due to come into force next April, directors rated their confidence in their readiness to implement at just 5.3 out of 10.
Prevention important but subject to cuts
And despite directors seeing investing in asset-based approaches and prevention and early intervention as the most important ways of making savings, half were less than confident about meeting their duties to provide preventive services, under section 2 of the Care Act, up from 35% in 2019-20. In addition, ADASS found that directors planned to spend 6.1% less on voluntary and community sector services in 2021-22 than 2019-20 – £465m compared with £504m – suggesting reductions in prevention funding.
“It is likely that this reduction is, in part at least, a consequence of the challenging budgetary situation facing adult social care and the need for directors to prioritise funding on meeting statutory duties which consequently means that budgets for discretionary services have had to be reduced year on year,” said the survey report.
One specific pressure identified by the report was the impact of the government’s shift to a policy of assessing hospital patients’ social care needs post-discharge, implemented last March to help clear hospital beds as the pandemic’s first wave hit.
Directors reported that this has led to a 27% increase in required social work capacity, because of the impact of assessing people in their own homes or multiple intermediate settings rather than in a single hospital.
‘Growing unmet and undermet need’
ADASS said the survey showed a picture of “growing unmet and undermet need which impacts on life and wellbeing”.
It added: “Every day directors, social workers and the councils they are in are having to make invidious decisions about who gets care and support, what they cannot afford to pay for, how much they charge, and to balance maintaining life-saving and sustaining support today versus reshaping care and support for the future.”
On the back of the survey, it called for the government to urgently publish its long-awaited plans to reform the funding of adult social care and to use the forthcoming government spending review to provide sustainable funding to meet immediate pressures and longer-term needs.
Charity Age UK issued a similar message, in blunter terms, in its response to the survey.
Charity director Caroline Abrahams said: “No local government official readily admits they are routinely breaking the law, and the fact that so many have done so in this survey shows just how bad a state social care is now in. We admire the honesty of these directors of adult social services, and sympathise with the increasingly impossible position they find themselves in, trying to spread the jam ever more thinly to meet a tsunami of local care needs – a situation made worse by the pandemic.
‘Ministers fiddle while social care burns’
“While ministers fiddle, social care burns, leaving hundreds of thousands of older and disabled people, and their family carers, without the support they need to live decent, dignified lives. The prime minister has promised to fix social care and he should live up to his pledge. It’s hard to imagine how the results of a survey like this could get much worse, but there’s no doubt they will, unless and until the government delivers on their promises.”
The survey ran from mid-May to mid-June 2021 and was answered by 147 out of the 152 directors. Figures on savings, costs and waiting times have been extrapolated from the data to provide nationwide estimates.