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Adult social care: PAC raises alarm as Government falls short of promise to fix crisis

20 March 2024

  • Chronic understaffing, rising waiting lists and patchwork funding place sustained financial pressure on local authorities
  • PAC fears the absence of a long-term funding settlement hinders sector’s ability to implement long-term planning

Government is falling short on its promise to “fix the crisis in social care” as chronic understaffing, rising waiting lists and patchwork funding place sustained pressure on local authorities. In a report published today, the Public Accounts Committee (PAC) calls for stronger leadership, long-term financial support, and a clear workforce strategy to address key shortfalls in the adult social care sector.

In 2021, the Department of Health and Social Care (DHSC) set out a 10-year vision for adult social care. In the same year, the Government committed £5.4 billion funding over three years, on top of existing budgets, to reform adult social care. However, in April 2023 plans for system reform were revised, scaling back short-term plans to £729 million over the period 2022-23 to 2024-25. Worryingly, Government has no roadmap for achieving its vision, or any targets or milestones beyond 2025, with nothing meaningful in place to demonstrate progress.

Workforce vacancies in the sector, which employs around 1.6m people, exceeded 152,000 in March 2023, a vacancy rate of almost 10%. The PAC fears the workforce plan set out to address this shortfall is woefully insufficient to the scale of the task. The DHSC’s future reliance on overseas staff raises significant questions of the impact of proposed visa restrictions and risks of exploitation. The demand for adult social care services in rural areas is of particular concern to the PAC, as it is set to rise against a backdrop of chronic understaffing in these communities.

In 2022-23, local authorities supported more than one million people with care needs, at a cost of £23.7 billion. As at Autumn 2023, there were almost half a million people awaiting attention on their case, and £2.7bn in additional funding was allocated in 2022 in response to emerging pressures. However, the PAC remains unconvinced whether government knows if it is achieving value for money from this additional funding, and seeks assurance that funding for market sustainability and improvement has not instead ended up increasing profit margins for some providers.

The PAC’s inquiry challenged the Government on whether there would ever be a multi-year funding settlement that will allow local authorities to set out long-term programs to achieve the fundamental transformations needed in this sector. Given it has a 10-year vision for adult social care reform, the report urges the DHSC to set out how it will ensure more stable funding, and what it can do to give local authorities greater certainty to plan in the long-term.

Chair's comment

Dame Meg Hillier MP, Chair of the Committee, said:

“Years of fragmented funding and the absence of a clear roadmap has brought the adult social care sector to its knees. Waiting lists are rising, the sector is short tens of thousands of essential staff, and local authority finances are being placed under an unsustainable amount of pressure.

The decision to dedicate a single chapter in the Adult Social Care Reform White Paper to the social care workforce does not do justice to the level of work that will be required and feels to us like a bit of a cop-out. While an NHS-style workforce strategy for social care may not be feasible, the DHSC must set out how it will how it provide leadership across the sector to identify and address workforce challenges.

Whilst we welcome the increase in funding, we fear this will do little to address the key challenges faced by the sector in the absence of a well-funded multi-year strategy. A 10-year vision is all well and good, but this alone is not enough to bring about the fundamental changes this sector so desperately needs.”

Further information

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