Councils rationing adult social care through ‘subjective’ eligibility judgments, finds think-tank

Councils are rationing adult social care through “subjective” eligibility judgments, a think-tank has concluded.

The Institute for Government (IFG) said that a long-term decline in the number of people receiving adult social care, amid increases in requests for support, was most likely down to rationing, not the use of strengths-based practice to make people more independent and less in need of care.

The IFG made the claim in a report analysing the performance of adult social care, published last week.

Decline in numbers receiving care

Its assessment referenced the fact that 30,090 fewer people were receiving council-arranged long-term care as of March 2023, compared with eight years earlier, a drop of 4.6%. This was driven by a 10% fall in the number of older people receiving care.

Over the same period, the number of annual requests for support rose by 10.6%, to just over two million in 2022-23.

The IFG said that the government’s failure to uprate the savings thresholds for accessing council-funded care since 2010, reducing their value by 25%, had made it harder for people to access care.

And, despite the Care Act 2014 formally setting a nationwide needs threshold that has remained unchanged since 2015, it found councils were “effectively using subjective judgments about need to further ration care to adults” because of government cuts to local authority funding in the 2010s, the IfG claimed

Few councils ‘admit they are rationing’

“Few local authorities would admit publicly that they ration long-term care and would instead claim that they are following a ‘strengths-based’ approach to care – in which people are empowered to live and contribute to their communities, rather than relying on long-term support,” said the IfG.

However, the think-tank said that local authority leaders it spoke to “frequently tell us privately that they have no choice but to ration services”.

Also, its analysis of NHS England (formerly NHS Digital) data on adult social care activity and finance did not support the idea that strengths-based practice was leading to fewer people needing care.

Reduction in use of reablement

Firstly, the number of people receiving short-term packages to maximise independence (ST-Max), such as reablement services, was 4% lower in 2022-23 (251,260) compared with the record high of 2019-20 (261,065) and 1.2% below 2014-15 levels (254,550).

And while the number of these packages grew by 2.8% from 2014-15 to 2019-20, this was below the increase in requests for care (4.6%) and the adult population (4.8%) during this time.

“These are all imperfect proxies for demand for adult social care, but if local authorities were investing in short-term care to improve the likelihood of someone not having to access long-term care, it would be reasonable to expect that the number of ST-Max packages would have grown more quickly than 2.8%,” the IfG said.

Less support for carers

The IFG said that increasing support for carers would indicate that councils were shifting to a more strengths-based approach.

However, while the number of requests for support from carers dropped by 16% from 2014-15 to 2022-23, the number receiving support fell by an even greater amount, 30%.

Thirdly, the amount of money councils spent on information and early prevention – services designed to delay, reduce or prevent people having care needs – had remained relatively flat in real terms from 2015-16 and 2022-23.

Councils had also become slightly less lightly to signpost people to other services over time, with 27.3% of requests resulting in signposting in 2022-23, down from 28.5% in 2016-17. Over the same period, the proportion of requests resulting in no further action rose from 27.3% to 29.5%, making it the most common outcome of a request in 2022-23.

“Given all the evidence available, it is reasonable to infer that the main reason for declining rates of people accessing long-term support is the rationing of care,” said the IFG.

Unmet need ‘a major problem’

Fellow think-tank the King’s Fund drew the same conclusion in a report earlier this year.

The IFG said the level of rationing meant “unmet need is a major problem”, which was likely adding to NHS pressures.

Its report came with increased government funding having led to a 10% real-terms increase in planned adult social care spending in 2023-24, compared with 2022-23.

The Association of Directors of Adult Social Services said this had been “welcome and important in ensuring more people get the care and support they need than otherwise would have done so”.

Long-term, fully funded plan needed – ADASS

However, ADASS joint chief executive Cathie Williams said that the IFG report “sets out why this is not a strategy to make sure we can all get the care and support we need, when we need it and in the way that works for us”.

“Social care directors and their teams need to be able plan longer term for good support in the place we call home, with a skilled and valued workforce and support for those of us who are unpaid carers,” she added.

“This means co-production with communities, long term investment in technology, accessible housing with care and preventative services. It also requires working with NHS primary, community and mental health services to support wellness and wellbeing rather than crisis, sickness and just keeping us alive.

“We are a growing and ageing population, inequalities are increasing and more people are living with disabilities. This can’t be achieved overnight – we need a long-term, fully funded plan for adult social care to meet our needs today and in the future.”