By Mithran Samuel and Dan Parton
Adults’ services teams have cut care and assessment waiting lists by 60,000 since last summer and are arranging more home care, but continue to struggle with mounting need.
Directors reported that 434,243 people were waiting for assessments, care packages, direct payments or reviews as of 31 March 2023, down 12% on the 491,663 ADASS recorded for the end of August 2022*.
Councils also commissioned 30% more home care hours from January to March 2023 (54.5 million) than April to June 2022 (42.1 million).
This was amid a halving in the number of hours not delivered due to a lack of staffing capacity, to just over half a million.
Increase in care ‘not keeping pace with need’
ADASS hailed the improvements as a testament to the hard work of adults’ services teams as well as the consequence of £700m in short-term government winter money to fund care packages for people so they could leave hospital.
However, the association warned that the increases in care being delivered were not keeping pace with rising levels of need.
Despite the fall in waiting lists, the number waiting more than six months for an assessment remained stubbornly high, at 82,087 as of the end of March, up 1% on August 2022.
Most directors reported rises in the number of referrals from hospital (81%) and the community (70%), during 2022-23, with large majorities seeing increases in those presenting with mental ill health (81%) or in relation to domestic abuse (64%).
Increased complexity of need
At the same time, three-quarters said the average size of care packages for people discharged from hospital had risen over the previous year, while two-thirds said the same about those referred from the community.
This was reflected in the fact that the three biggest cost pressures directors said they faced in 2023 were increases in the unit price of care packages due to the complexity of people’s needs, unspecified other reasons and staffing costs, respectively.
The latter has been driven by the 9.7% rise in the national living wage (NLW), from £9.50 to £10.42 an hour in April, which ADASS said would load almost £1.8bn in direct and indirect costs on council adults’ services departments in 2023-24.
Though the association said it supported a higher wage floor than this for care staff, it stressed the government needed to fully fund it.
Councils overspent and requiring more in savings
While councils budgeted to increase spending from £16.5bn to £17.7bn in 2022-23, they still overspent overall by £74m, ADASS found.
And though authorities have significantly increased budgeted spend in 2023-24, to £18.9bn, directed reported that they would have to make more savings this year – £806m, up from £597m in 2022-23.
The survey also uncovered evidence of costs being passed from the health service to local authorities due to reductions in people qualifying for NHS continuing healthcare.
ADASS said 79% of directors reported a trend in the NHS reviewing CHC recipients’ needs and finding they no longer qualified, resulting in councils having to fund their care.
As of the end of March 2023, 50,650 people were eligible for CHC in England, down 6% on a year previously, according to official figures from NHS Digital.
Adults’ teams’ hard work praised
“Our findings show that a short-term funding boost from the government and the hard work social care teams have done to rebuild services after the pandemic is making a difference to thousands of people needing support and care, but we’re not out of the woods yet,” said ADASS president Beverley Tarka. “Leaders tell us they are paddling hard to keep up against a tide of increasing and complex needs.”
Tarka said that adult social care needed “a long-term plan for investment” along the lines set out by the ADASS-commissioned roadmap for reform published in April.
That called for care worker pay to be raised, charges for services cut and people to be provided with clear rights to support as part of a shift to a more personalised, accessible and fair system.
Government hails cut in waits
In response to the ADASS survey, a Department of Health and Social Care spokesperson hailed the cut in waiting lists, adding: “We have reduced waiting times, as the survey shows, and this comes despite challenges posed by the pandemic and rising inflation.
“We’re going further by providing up to £7.5bn for social care over the next two years to put the system on a stronger financial footing and help local authorities address waiting lists, low fee rates and workforce pressures.”
While the government is investing more in adult social care from 2023-25, some in the sector have criticised the “up to £7.5bn” figure as misleading on the grounds that:
- £3.2bn has been recycled from the delay to the two-year delay to the social care charging reforms – including the cap on care costs – the government announced last year.
- Some of this £3.2bn is to be shared with children’s social care.
- £1.6bn is reliant on how much authorities can raise through council tax.
The spokesperson also said the DHSC remained committed to its 10-year reform plan for the sector set out in its 2021 white paper, People at the heart of care.
This pledged £1.7bn, from 2022-25, to invest in the workforce, technology, carers’ breaks and housing with care, among other things.
However, the DHSC was heavily criticised after a follow-up paper, published in April this year, cut in half the £500m allocated to the workforce and said that £600m of the £1.7bn remained unallocated.
In its report today, ADASS said this money needed to be ploughed into the sector now.
*The March 2023 figure is based on a more complete sample of councils (142 of the 153), whereas the August 2022 figure was based on responses from 115 authorities.