‘Massive postcode lottery’ in access to adult social care revealed by data, say charities

People face a “massive postcode lottery” in access to adult social care according to official data, charities for older and disabled people and carers have warned.

There were wide differences between and within regions in the proportion of people whose requests for care and support were granted in 2022-23, found an analysis of NHS England data by the Care and Support Alliance (CSA).

The alliance said this showed that councils were screening out people who should be eligible for funded care because of a lack of resource to meet need.

Variations in access to care

According to the NHS England data, 58% of requests in 2022-23 in England ended with no care being provided, which includes cases where the person was signposted to other organisations, such as charities, offered universal services or died while waiting for a response.

However, the average ‘rejection rate’ varied significantly between regions, ranging from 46% in the North East to 68% in the West Midlands, found the CSA.

There were even bigger variations between local authorities, with the proportion of rejected requests ranging from 12% to 85% across English councils. The region with the biggest internal variation was London, where the rate varied between 20% and 84%, while the narrowest gap was in the East of England (36% to 62%).

Councils rationing care, say charities

The CSA said that the scale of the variations meant that councils were turning away people who were eligible for funded care because of a lack of resources, as defined by the single national threshold for care and support set by regulations under the Care Act 2014.

“Over the last few years, it is clear that although the law itself hasn’t changed, it is increasingly being interpreted by local authorities in ways that mean that some people who would have qualified for state funded help with their care ten…years ago, are now being screened out,” said Age UK charity director and CSA chair Caroline Abrahams.

“Why? Because local authorities often simply lack the funding, and sometimes the staff, to do anything other than ‘ration’ the care they offer their local population – in other words, they are having to spread the jam more thinly.”

‘Access to care should not depend on where you live’

For the Association of Directors of Adult Social Services, chief executive Anna Hemmings said: “Access to good quality care shouldn’t be dependent on where you live, but years of lack of investment in social care and financial pressure on local government means councils across the country face a challenge to provide the level of care and support we’d expect for ourselves or family members.

“Social care should be there for all of us but that requires government to commit to investing in a long term, fully funded plan to provide more support to unpaid carers, build a workforce able to deliver the care we need and shift to providing more support at home and in the community.

“We need to show our politicians that social care is a priority that requires action and investment, so that we build a care and support service we can all rely on when we need it.”

Suggested reasons for variations in access

Though the CSA did not interrogate the data further, it suggested various reasons for the variations.

For example, they could be down to some areas having relatively more care staff due to stronger labour markets, some councils being better able to raise resources locally to fund care services and the government’s formula for funding adult care being out of date and no longer reflecting population need.

At a national level, the annual number of requests for care grew by 10.6% from 2015-16 to 2022-23, while the number of people receiving long-term care or short-term reablement services fell by 2.1%, according to analysis by the King’s Fund.

Decline in numbers receiving care nationally

The think-tank’s senior fellow for social care, Simon Bottery, said: “It’s certainly true that rationing of publicly-funded social care by local authorities is a likely explanation for the overall decline in the number of people receiving adult social care since 2015-16, despite an increase in requests for support.

“Funding cuts have hit some local authorities harder than others so these differences could well be a factor in the amount of care provided in response to requests for support.”

However, he said there were other possible explanations for the variations between areas.

This included some authorities making a shift towards a more strengths-based model of care, “with requests for support intended to be addressed through voluntary support in communities rather than automatically through provision of paid-for social care”.

Other possibilities included that some councils had self-assessment tools that may reduce the number of formal requests for care, while Bottery also pointed to past Local Government Association research which found that 78% of the variation in per person spending on older people’s care could be explained by demographic and other factors.

Cap on care costs scrapped

The CSA’s findings were released as the new Labour government announced it would not take forward planned reforms to the system of charging for adult social care. These would have introduced an £86,000 cap on people’s private spending on their personal care and made the means-test for accessing services much more generous.

As a result, it would have resulted in councils funding services for many people with eligible needs for care who currently do not qualify for services on the basis of their wealth.

However, it would not have addressed the issue raised by the CSA of people with eligible needs not receiving the care they are entitled to because of rationing by councils.