Story updated 22 July 2022
Most directors of adult social services lack confidence they will meet their legal duties this year because of inadequate funds, a survey has found.
Just 12% said they were fully confident their budgets would be sufficient to meet their duties under the Care Act 2014 and other frameworks, such as the Deprivation of Liberty Safeguards (DoLS), found the Association of Directors of Adult Social Services’ annual spring survey, published yesterday.
This was down from 21% in 2021-22. At the same time, the proportion of directors who had no confidence they had the budget to meet their duties doubled, from 8% to 17%, with 69% now partially confident.
A large majority of directors (82%) lacked confidence in their ability to fulfil their Care Act duty to promote diversity and quality in the provision of care, with 64% saying the same about their DoLS duties.
The situation has been driven by rising levels and complexity of need against a backdrop of increasing costs, driven by recruitment and retention problems in the provider sector and the impact of increases in the national living wage (NLW).
ADASS found significant evidence of mounting need, including that:
- 83% of councils had seen increases in the average size of care packages for people discharged from hospital and those seeking support from the community, since March 2020. Directors linked this to increasing complexity of need.
- Two-thirds of councils (65%) said they saw an increase of more than 10% in the number of referrals for people discharged from hospital in 2021-22, with a further 17% seeing a lower increase.
- Just under a third (30%) reported an increase of more than 10% in the number of referrals from the community, with 44% reporting an increase that was lower than this.
- A quarter (26%) had seen a 10% plus increase in referrals due to carer breakdown, with a further 47% saying there had been an increase of less than 10%.
ADASS found that councils were planning to spend £17.1bn on adult social care in 2022-23, up from a spend of £16.4bn in 2021-22.
However, they also reported that they needed to increase spend by this amount – £686m – in order to meet the same level of need as in 2021-22, because of demographic pressures.
But these pressures were exceeded by those arising from the £977m estimated costs of the 6.6% rise in the national living wage (NLW) – the pay floor for those aged 23 and over – to £9.50 an hour.
Most of this (£561m) related to council spending on independent providers, where the average wage for a care worker was £9.29 in 2020-21.
This was exacerbated by increasing recruitment and retention difficulties among providers, with 84% of directors saying this was driving up unit costs in care homes.
52% rise in adult social care vacancies
The scale of this issue was spelt out in a separate report this week from Skills for Care, which found there was a drop of 50,000 in the number of filled posts in adult social care from 2020-21 to 2021-22, to 1,620,000, the first fall since records began in 2022-23.
Over the same time, the number of vacant posts rose by 52% (55,000) to 165,000.
ADASS found that councils were expecting to make £597m in savings in 2022-23, equivalent to 3.5% of their budgets, and a similar figure to the two previous years.
The most popular source of savings – cited by 31% of directors – was using “asset-based and self-help approaches” to help reduce the number of people needing long-term care. This was followed by making efficiency savings (24%).
However, growing number of councils are looking to make cuts to care, with 17% reporting they would be reducing personal budgets or services, up from 8% in previous survey.
‘We face the most difficult winter’
On the back of the findings, drawn from 144 of the 152 English local authorities, ADASS chief executive Cathie Williams said that “without immediate and substantial help from the government, we face the most difficult winter we have ever experienced during which more people will miss out on vital care, others will wait longer for support and choice and quality will decline still further”.
The government is investing £5.4bn in adult social care over the next three years, £3.6bn of which will go on reforming its funding, to introduce an £86,000 cap on people’s liability for personal care and a more generous means-test, and ensuring councils pay providers a “fair cost of care”. The rest of the funding will go on initiatives to support the training, development and wellbeing of the workforce, worth £500m, and to reform the way social care is delivered.
However, critics have argued that none of £5.4bn reform funding will deal with current pressures on the system, a sentiment Williams reiterated.
“Measures so far to ‘fix’ social care simply do not address the scale of current funding and workforce challenges and are crying out for a long-term, properly funded plan,” she said.
In response to the results, a Department of Health and Social Care spokesperson said councils were receiving “record annual funding” to deal with cost pressures, alongside investment in reform.
Adult social care funding streams
In 2022-23, this includes allowing authorities to raise council tax by up to 2% without the need for public approval through a local referendum. They can also raise the adult social care precept – which provides dedicated funding for the sector – by 1%, or by more if they have not made maximum use of the precept in previous years.
In addition, the government increased its social care grant – which can be spent on adults’ or children’s services – by £636m to £2.346bn. Based on responses to its survey, ADASS calculated that 59% of this (roughly £1.4bn) would be going on adult social care.
There has also been a 4.4% rise, to £7.2bn, in the Better Care Fund, a combination of government grants to councils and NHS resources, designed to fund services to help people remain independent at home for longer.
The DHSC spokesperson added: “Reforming adult social care is a priority and we are investing £5.4bn over the next three years to end the lottery of unpredictable care costs and support the workforce.
“This includes £3.6bn to enable all local authorities to move towards paying providers a fair cost of care, and a further £1.7bn to begin major improvements across adult social care in England – on top of record annual funding to help councils respond to rising demands and cost pressures.
“Our social care workforce are valued, appreciated and supported, which is why we are also providing an additional £500m for training to boost career opportunities.”