Written evidence submitted by NHS Providers (NFS0012)

 

NHS Providers is the membership organisation for the NHS hospital, mental health, community and ambulance services that treat patients and service users in the NHS. We help those NHS foundation trusts and trusts to deliver high-quality, patient-focused care by enabling them to learn from each other, acting as their public voice and helping shape the system in which they operate.

 

NHS Providers has all trusts in England in voluntary membership, collectively accounting for £124bn of annual expenditure and employing 1.5 million people.

 

Key messages

 

NHS operating context and performance

  1. The NHS provider sector – acute hospitals, mental health, community and ambulance trusts – has a vital role in creating a healthy, equitable and productive society. However, as health services strive to serve patients, service users and their local communities, the scale of the challenge and the immense pressures facing them is clear. Levels of demand are higher than ever and continuing to grow. For example:
    1. This year has been the busiest ever for A&E attendances, with monthly record highs. There were 2.36m attendances in October 2024 – 6.2% higher than October  last year (NHSE, 2024b).
    2. The elective waiting list continues to sit at around 7.57m (66% higher than September 2019) and around 23,000 patients continue to be waiting over 65 weeks for elective care (NHSE, 2024c).
    3. Ambulance demand remains significantly higher than pre-pandemic levels for category 1 incidents, with the heightened demand affecting trusts’ ability to meet national response time targets (NHSE, 2024d).
    4. The waiting list for community services continues to be above 1 million.
    5. In our recent survey of trusts providing children and young people’s (CYP) services, 82% of respondents told us that their trust is not able to meet current demand (NHS Providers, 2024).
    6. Demand for mental health services continues to grow, with 416,896 mental health referrals in June 2024 alone, which is over a third higher than in the same period before the pandemic (June 2019). These increases are despite services seeing more people than ever before thanks to welcome increased investment: there were 1.94m people in contact with mental health services in June – the highest number ever recorded  (NHSE, 2024e).

 

  1. To keep up with this level of demand, the level of activity has increased in a number of areas. For example:
    1. Trusts carried out over 2.4 million diagnostic tests in September 2024 – with the NHS delivering sustained levels of activity across tests and checks (NHSE, 2024a).
    2. Over 1,400 patients are starting cancer treatment per working day – this is at a record high level and is 15% above pre-pandemic levels of activity (NHSE, 2024l).
    3. In May 2024, community services carried out the highest number of care contacts on record – 8.99 million contacts within a single month (NHSE, 2024m).
    4. Trusts carried out 2 million care contacts across mental health services in June 2024, which is up by over 18% when compared to the same period before the pandemic (NHSE, 2024n).

 

  1. However, it is clear that NHS capacity is insufficient to meet the level of demand, creating barriers to access and impacting on quality and safety of care. In September 2024, NHS Providers surveyed trusts to gather a snapshot of the issues facing leaders of hospital, mental health, ambulance and community services across England, and published the findings in our State of the provider sector report (NHS Providers, 2024). Respondents were clear on the impact on patients from the pressures faced:
    1. Just over a third of trust leaders (35%) rated the current quality of healthcare provided by their local area as very high or high. 41% rated it as average, 12% as low quality, and 4% as very low. This figure has dropped from 41% last year and 48% in 2022. This figure also remains lower than before the pandemic when nearly half (47%) of trust leaders rated the quality of healthcare as high or very high.
    2. Only 32% of trust leaders predicted that the quality of healthcare provided by their local area in the coming year would be very high or high. Almost half (48%) said the quality would be average, 12% said low, and 2% said very low.
    3. Two fifths of leaders (41%) predicted that the quality of healthcare provided by their local area in the coming two years would be very high or high. 49% rated it as likely to be average, 9% as low, and 1% very low.
    4. Almost four in five trust leaders (79%) were very worried or worried about whether their trust has capacity to meet demand for services over the next 12 months. This is significantly higher than before the pandemic (61% in 2019).
    5. When asked how likely it is that the NHS can meet the constitutional standards within the next five years, a government manifesto pledge, only 14% of trust leaders said it was likely or very likely. Within these responses:
      1. 100% of acute specialist and 100% of ambulance trusts said it was unlikely or very unlikely.
      2. Three fifths of leaders from mental health trusts thought it unlikely or unlikely the NHS can meet the constitutional standards (63% from mental health/learning disability trusts, 60% from combined mental health/ learning disability and community trusts).
      3. Of those from combined acute and community trusts, 41% said meeting the constitutional standards is very unlikely (NHS Providers, 2024).

 

  1. NHS trusts are doing their utmost to expand their capacity through new ways of working and would welcome further national support in enabling increased productivity and value for money. However, this can only go so far. The NHS as it is today can and must work better. It is equally true that patient acuity and complexity are increasing alongside demand, and population needs can be expected to grow further. We therefore agree with the National Audit Office’s (NAO’s) conclusion that “Either much future demand for healthcare must be avoided, or the NHS will need a great deal more funding, or service levels will continue to be unacceptable and may even deteriorate further” (NAO, 2024).

 

  1. Responses to our State of the provider sector survey underline the concerns outlined by the NAO and insufficient prioritisation of prevention and early intervention:
    1. Nearly three quarters of trust leaders (72%) were either worried or very worried about whether sufficient investment is being made in public health and prevention in their local area.
    2. Despite the importance of social care in the prevention of ill health, 82% of trust leaders said they were worried or very worried about sufficient investment being made in social care by local systems and their partners.
    3. When asked to consider the enablers for improving patient care over the next decade, 41% of trust leaders highlighted social care as a top priority for the government. Furthermore, when asked what the biggest challenges are facing  systems, nearly a third (32%) of respondents selected social care capacity.
    4. 62% of trust leaders were either worried or very worried about whether the right support and infrastructure is in place locally to enable a more integrated service across primary care and secondary care (NHS Providers, 2024).

 

The NHS’ current financial position

  1. Trusts are carrying significant levels of financial risk as a result of these challenges. Trusts understand their responsibility to deliver on the NHS’ operational priorities within the funding envelope provided each year. However, in a May 2024 survey of trust chief executives and finance directors, we found that over half (51%) of respondents were extremely concerned about the deliverability of operational priorities within their organisation’s 2024/25 financial allocation.

 

  1. The latest financial data shows that integrated care systems (ICSs) are already £487m off plan, with 31 out of 42 ICSs submitting deficit plans this year, amounting to an aggregated deficit of £2.2bn (NHSE, 2024f). Trust leaders are concerned that the financial outlook for 2024/25 looks to be even more pressurised than in recent years. For context, in 2022/23 systems ended the year with an aggregated deficit of £621m (with 20 systems in deficit positions at year-end) and this gradual deterioration in system financial performance continued in 2023/24, with systems ending the year with an aggregated deficit of £1.4bn.

 

  1. Trusts’ financial plans are predicated on identifying and delivering unprecedented levels of efficiency savings and the value of the October 2021 Spending Review funding settlements have been significantly eroded by persistently high inflation levels, as identified by the Chancellor in her statement to Parliament on 29 July 2024. Trusts had been asked to plan on the assumption that inflation would be 4.4% for 2022/23 and 2.5% for 2023/24. The Office for Budget Responsibility’s reports from the Spring and Autumn Budget shows that inflation (measured by the GDP deflator) was 6.7% over 2022/23 and 6.2% over 2023/24 (OBR, 2024a) (OBR, 2024b).

 

  1. Each year, trusts are asked to identify cost savings in order to bridge the gap between income growth and expenditure growth. Given the persistently high levels of inflation in recent years, trusts have been asked to identify more efficiency savings than in previous years. 92% of respondents to a recent NHS Providers survey of trust chief executives and finance directors felt that the scale of the efficiency challenge in 2024/25 is more challenging than 2023/24. On average, trusts estimated that their required efficiency savings rate for 2024/25 was 5.2%, ranging from 3% to 8%.

 

  1. The Autumn Budget provided the NHS with a welcome boost to both capital and revenue budgets. The government announced it was increasing DHSC resource spending by £22.6bn over the two years ending in 2025/26, representing a 4% real terms growth in NHS resource spending. The capital budget is also set to increase by £3.1bn in 2025/26 when compared to the 2023/24 outturn position, bringing the total capital departmental expenditure limit (CDEL) to £13.6bn in 2025/26.

 

  1. Trust leaders have consistently made the case that long-term financial stability is essential in order to deliver the “next generation” NHS. The recent Budget is the first step in helping to deliver the NHS on a path towards improving productivity and equipping it with the tools it needs in order to meet the challenges of the future. However, as the independent investigation led by Lord Darzi recognises, the recent funding uplift comes off the back of “the most austere decade since the NHS was founded in 1948” (Darzi, 2024). In order for the NHS to continue its path towards financial sustainability, it will require investment in key long-term enablers that will support greater productivity growth.

 

NHS productivity

  1. In Amanda Pritchard’s speech to NHS Providers’ Next Generation conference in November 2024, she noted that despite only a 0.12% real terms increase in income for providers last year, the sector has made significant strides in increasing efficiency and developing patient care (NHS England, 2024). However, there are still difficulties in reaching target activity levels. Official figures from the Office for National Statistics show that quality-adjusted healthcare productivity was 6.6% lower over the 2021/22 financial year than the 2019/20 financial year (ONS, 2024). NHS England’s own estimate of the acute sector productivity gap is approximately 11% lower than pre-pandemic levels (NHS England, 2024g).

 

  1. Improving productivity levels is essential to ensure the NHS will be able to meet the growth in demand that is expected in future years as a result of demographic pressures. Improvements to productivity will provide the health service with the opportunity to deliver more activity within existing resources and ease the long-term pressure of successive annual funding increases to cope with increased demand levels.

 

  1. Trust leaders have reported a number of barriers that are preventing them from accelerating productivity growth. For example, the sustained increase in patient acuity since the pandemic results in trusts requiring more resources and staff time to deliver care to patients who are presenting with more complex conditions. Furthermore, the pandemic had a serious detrimental impact on NHS staff. The latest staff survey results show that 30.4% of staff feel burnt out because of their work (NHSE, 2024h). Although it is difficult to quantify the effect of burnout and low morale on NHS productivity levels, the relentless pressure on staff over the last few years has likely had an adverse impact on discretionary effort from staff, on which the NHS is often so reliant. Our members have questioned whether this tangible drop is likely to be permanent or not and whether this will need to be considered as part of workforce planning going forward.

 

  1. Our recent report, Providers Deliver: achieving value for money, and a recent NHS Providers survey of our members highlight a number of measures trusts are implementing to help reduce expenditure and increase activity levels. Such measures include: workforce initiatives aimed at improving retention and staff wellbeing; implementing new models of care and improving patient pathways; streamlining pathways to improve discharge rates and theatre utilisation; and digital investment that will free up staff time to ensure they can work in the most effective way possible. Despite the various barriers trusts are facing in stimulating productivity growth, they continue to work flat out at identifying and delivering innovative local solutions that will improve their productivity levels.

 

  1. However, while a portion of the productivity gap is within the gift of trusts to address, trusts will need government support to address both productivity and the service’s long-term sustainability. We set out the barriers below, and agree with the NAO’s recommendation that NHSE “should identify the factors that have limited growth in productivity both before and since the pandemic and develop plans to tackle them”. We have valued working with NHSE to this end, and would also encourage, in any development of official measures of healthcare productivity, holistic consideration of value and patient outcomes.

 

NHS financial management and support

  1. NHS Providers strongly supports the NAO’s recommendations on ensuring that annual planning processes are completed well in advance of each financial year starting. We agree too with the NAO on the importance of enabling a long-term financial perspective to aid planning and maximise the value that can be gained from investment.

 

  1. In our recent State of the provider sector survey, 62% of respondents felt that longer term planning cycles would support them in their role as trust leaders when interacting with national oversight and regulatory bodies. Furthermore, one in five trust leaders cited a lack of long-term strategic focus as one of the biggest challenges facing their integrated care system.

 

  1. Trust leaders will welcome the government’s announcements at the recent Budget to improve the current fiscal framework, including a commitment to holding regular spending reviews setting out departmental settlements for a minimum of three years as well as setting five-year capital budgets at regular spending reviews to provide greater certainty for capital projects. It is hoped that this will provide trust leaders with greater certainty over the medium term and avoid short-term decision-making.

 

  1. In July 2021, NHS England introduced the Recovery Support Programme (RSP) which replaces the quality and finance special measures programme in operation between 2013 and 2021. The RSP is designed to offer intensive support – delivered by NHS England or an external third party, such as a management consultancy – to trusts and systems classified in segment four of the NHS oversight framework. This support provides additional oversight and scrutiny of financial decisions and monitors the effectiveness of financial controls.

 

  1. Overall, trusts involved in the RSP have shared positive feedback on the level of support they have received as part of the programme, especially its focus on the interaction between financial delivery and operational performance. Trust leaders have shared that their financial deficit has often reduced as a result of support they’ve received through the RSP.

 

  1. However, some trust leaders shared their concerns that financial recovery was often too focused on meeting short-term targets in line with the annual planning cycles, rather than aspiring for long-term financial sustainability. If the NHS is to be financially sustainable, trusts must be given the headroom to understand the root causes of financial issues and be supported to tackle such challenges with a view to long-term sustainability.

 

  1. With this in mind, NHS Providers supports the NAO’s recommendation that national bodies should diagnose the underlying financial weaknesses across NHS bodies and develop plans to remove such barriers and the long-standing challenges affecting financial sustainability.

 

Challenges to and enablers of NHS financial sustainability

  1. Long-term sustainability is dependent on a number of key enablers which would help transform the NHS and equip it with the right tools to tackle the challenges of the future. We consider each of these in turn below:
    1. Investing in NHS infrastructure to future-proof the NHS estate
    2. Delivering the NHS Long Term Workforce Plan and improving staff retention and wellbeing
    3. Targeting the prevention of ill health and tackling health inequalities
    4. Expanding primary and community care capacity to ensure care is provided in the right place at the right time
    5. Placing social care on a sustainable footing

 

Investing in NHS infrastructure to future-proof the NHS estate

  1. The 30 October Budget allocated a welcome £3.1billion increase in the capital budget over 2024/25 and 2025/26. Of this, £1billion is to tackle reinforced autoclaved aerated concrete (RAAC) and the repairs backlog, and £1.5billion is for new surgical hubs and diagnostic scanners. The remainder is allocated to upgrading GP surgeries, pandemic preparedness and health protection, and establishing mental health crisis centres. It is also welcome that government has committed to setting five-year capital budgets at regular spending reviews as well as publishing a 10-year infrastructure strategy alongside Phase 2 of the Spending Review.

 

  1. This is vital and welcome funding, and trusts recognise the continuing intense pressures across government finances and departments. This funding helps to address the prolonged underinvestment in capital, but there is still a significant way to go in correcting this. By investing in eliminating the maintenance backlog and the systematic renewal of our facilities, technology and estates we will improve the quality and safety of patient care and deliver even greater value for money.

 

  1. We fully endorse the NAO recommendation that “as part of the next spending review, DHSC and NHSE should identify and explain to HM Treasury what further capital investments across government could have the greatest impact on NHS productivity and preventing serious ill health”. Crucially, the NAO adds that “As part of this assessment, they should determine the opportunity costs of not making this investment, including the potential impact in future years on NHS services, employees, and patients”. A long-term and sustained approach to capital investment in the NHS is essential.

 

  1. Current capital allocations remain insufficient to cover the cost of delivering safety critical repairs to NHS estates and equipment. In a recent NHS Providers survey of trust chief executives and finance directors, 90% of respondents said that the level of operational capital available to their organisation was insufficient. Trusts have reported that they simply do not have sufficient resources to deliver safety critical repairs to buildings, update antiquated equipment and invest in transforming their estates.

 

  1. The latest estates return information collection (ERIC) data for 2023/24 highlights the significant deterioration of the NHS estate in recent years. The NHS maintenance backlog (which measures how much needs to be invested to restore assets to suitable working condition) now stands at a record-high level of £13.8bn (NHSE, 2024k). Even more concerning is that the proportion of the maintenance backlog that is categorised as ‘high’ risk is now over seven times higher than the equivalent figure for 2013/14 – now standing at £2.7bn.

 

  1. The rising maintenance backlog has a significant impact on trusts’ ability to care for patients, with medical procedures often being disrupted, postponed or cancelled due to faulty equipment or safety hazards. There are also particular challenges for mental health trusts where outdated buildings and facilities are not providing suitable therapeutic environments for patients accessing mental health services. Sufficient investment is also required for the ambulance sector in order to ensure staff and ambulance crews are equipped with the tools they need to deliver urgent and emergency services effectively.

 

  1. Trusts involved in the New Hospital Programme (NHP) continue to wait for clarity on the funding and delivery timeline for their new buildings. The maintenance backlog in trusts with NHP schemes is nearly £5.7bn – more than 40% of the total repairs backlog.

 

  1. Over 100 applications were made from trusts for the final eight places on the NHP, highlighting the significant demand for capital investment for trusts to overhaul their ageing estates. Furthermore, given the national focus on elective recovery and the relative absence from the NHP of mental health and community trusts, many trust leaders are concerned about the underinvestment in mental health and community services. It remains clear that the NHP alone is insufficient to meet the total capital funding needs of the NHS.

 

  1. Despite £3.9bn of capital funding held nationally by NHS England, trusts continue to experience significant difficulty in accessing strategic capital envelopes to help kickstart investment in major health infrastructure projects. Trusts continue to share that there is insufficient capacity within their capital allocation - and by extension, the wider capital departmental expenditure limit (CDEL) – to deliver safety critical repairs, update antiquated equipment and invest in the transformation of their estate. 91% of respondents to our recent survey of trust chief executives and finance directors stated that they did not have sufficient access to capital funding to invest in the transformation of their estates.

 

  1. Increasing capital investment in the NHS is essential to securing a high quality, productive service now and for the future. Trust leaders would welcome discussion with government about removing current barriers to capital spending (e.g. reforming CDEL) and exploring alternative routes to capital investment for the longer term. In a recent survey of trust chief executives and finance directors, 68% of respondents stated that they were unable to explore alternative routes to strategic capital funding effectively.

 

  1. A sustainable funding settlement for the NHS, with a strategic investment approach across revenue and capital will make short-term funding needs clearer and offer greater long-term returns. It will also show where productivity of the NHS is interdependent with factors such as staff wellbeing and investment in digital capacity, equipment and modernising the estate, as well as social care and the wider determinants of health.

 

Delivering the NHS Long Term Workforce Plan and improving staff retention and wellbeing

  1. Trust leaders welcomed the publication of the NHS Long Term Workforce Plan (LTWP) in June 2023 alongside an initial funding envelope of £2.4bn to fund the specific LTWP ambition for additional domestic training places up to 2028/29. The LTWP’s modelling is predicated on the assumption that labour productivity will grow by between 1.5% and 2% each year and it recognises the connection between productivity and a well-resourced workforce. NHS England has made clear that “recovering productivity is categorically not about staff working harder” (NHSE, 2023b).

 

  1. As a result of the challenging financial context, trusts understand the national focus on tightening control on substantive staffing levels and consolidating the growth in staffing numbers experienced in recent years. Significant progress has been made on reducing the health services’ reliance on temporary staffing, notably bank and agency staff. Trusts have virtually eliminated off-framework agency spending and have reduced total spending on agency staff by £500m over the 2023/24 financial year. Agency spending (as a proportion of total pay costs) is at its lowest level since 2017 (NHSE, 2024j).

 

  1. However, trusts are also concerned that the current focus on restricting workforce growth is at odds with the necessity to increase total workforce numbers if the health service is to keep pace with the trajectories set out in the LTWP. Moreover, recent NHS staff survey results and the reduction in young people applying to medical schools show that work needs to be done to improve retention and staff wellbeing if the NHS is going to have sufficient workforce pipelines to manage future demand levels. This is further underlined by the results of our State of the provider sector survey, where a significant proportion of trust leaders were worried about staff wellbeing:
    1. Three quarters of trust leaders (75%) were extremely or moderately concerned about the current level of burnout across their workforce. 
    2. Over three quarters of trust leaders (78%) were extremely or moderately concerned about workforce morale (NHS Providers, 2024). 

 

  1. In describing the situation, one combined mental health / learning disability and community trust leader told us that “Burnout is inevitable for staff working in a number of our clinical services if current conditions continue”, and an acute specialist trust leader commented that “Morale amongst staff is broadly good, but the risk of burnout as the demand for services is a worry”. A leader from a community trust told us that “Covid followed by industrial action has also adversely impacted on the resilience of our staff who no longer will go that extra mile” (NHS Providers, 2024).

 

  1. Trust leaders will welcome the steps government has already taken to reset and repair industrial relations following a prolonged period of industrial action taken by various staff groups. Industrial action has had a significant impact on the NHS’ ability to reduce the size of waiting lists and deliver financial balance. NHS England estimated that strike action through to the end of the 2024/25 financial year cost the NHS approximately £2.4bn (NHS England, 2024l).

 

  1. Ahead of the first update to the LTWP due in summer 2025, we would urge focus on nurturing a thriving health and care workforce and making the NHS a great place to work. This includes prioritising action to improve retention – through raising staff morale, reducing burnout and ensuring staff are adequately supported in their roles. Full implementation of agreed deals with trade unions will be vital to return industrial relations to a strong footing, and trust leaders welcomed the action from government to expedite the pay review process to ensure that the process is re-aligned with the financial year. This is a helpful step forward in providing trusts with the certainty they need to plan for the year ahead.

 

Targeting the prevention of ill health and tackling health inequalities

  1. Population health is determined by a wide range of factors, including poverty levels and deprivation, housing, education, welfare, the environment, structural racism and employment opportunities. The NHS is a vital partner for government in supporting an approach which looks to prevent ill health and prioritise the health and wellbeing of the wider population. Trust leaders support the government’s proposal to shift towards allocating more resources to the prevention of ill health, rather than only taking responsibility for health when we are sick.

 

  1. However, in recent years there has been a significant financial strain on public services, with many local authorities unable to cope with balancing growing demand for services and severe financial pressures. It is also notable that the public health grant has been extensively cut by 28% on a real-terms per-person basis since 2015/16 – with the largest cuts to the areas most in need (Health Foundation, 2024). The public health grant is specifically important for delivering preventative services in communities, many of which are targeted at children and young people – providing an opportunity for early intervention and promoting positive health outcomes.

 

  1. In a recent NHS Providers survey of trusts, 85% of respondents felt that they did not have sufficient resources to tackle health inequalities and 94% felt that they did not have sufficient funding to invest in the prevention of ill health to manage future demand growth. While trusts are provided with ongoing recurrent funding to tackle health inequalities, due to the financial pressures across the entire health system, there is significant concern that the level of funding provided does not match the scale of the challenge.

 

  1. Trust leaders support the NAO’s recommendation on an intensification of effort to manage current and future demand for healthcare by preventing more serious ill health. It is key to pursue a cross-departmental approach to health and wellbeing, and we would encourage including integrating health impact assessments into the work of every government department. If the government’s mission is to tackle the wider determinants of health, then its approach should involve specifically targeted improvements to the health of the population, especially in the most deprived areas, in order to address health inequalities.

 

Expanding primary and community care capacity to ensure care is provided in the right place at the right time

  1. Historically, much of the focus on the NHS and the health service more broadly has been on hospital and ambulance performance, often at the expense of primary care, community services and mental health services. However, if the NHS is going to be able to cope with the expected increased levels of growth in demand for its services, then it will need to pivot towards investing in early intervention schemes and adopt a population health management approach to healthcare delivery.

 

  1. Capacity across primary and community care needs to expand. This will enable the health service to target effort and resources into initiatives that will reduce the number of patients requiring care, enable people to access care much closer to home and at an earlier stage of illness, reducing the risk of deterioration and avoiding hospital admission. This is also important in enabling long-term conditions to be managed effectively to prevent any further deterioration and ensure patients continue to receive the most appropriate level of care, in the most appropriate setting.

 

  1. While trust leaders recognise that mental health services have received increased investment in recent years, with the introduction of the Mental Health Investment Standard (MHIS) following publication of the NHS Long Term Plan, it is important to note that such funding increases have not kept pace with the rise in demand in recent years. In order to meet the level of unmet need for mental health services, it is vital that investment in mental health services must be continually prioritised

 

Placing social care on a sustainable footing

  1. Following the Chancellor’s statement to Parliament on 29 July 2024, trust leaders have expressed their concerns that the long-awaited adult social care charging reforms will not proceed. Trusts understand the government’s fiscal position and the necessity to ensure value for money is delivered for taxpayers. However, the NHS depends on a social care sector that is able to support the health service to deliver care and keep patients healthy at home. While charging reforms would not necessarily resolve all of the challenges facing the social care sector, it was an important first step in placing social care services on a path towards sustainability.

 

  1. Trust leaders have expressed significant concerns about the financial challenges facing other public services, particularly across local government, which have obvious knock-on effects for the social care sector. Recent survey findings published by the Association of Directors of Adult Social Services (ADASS) describe an exceptionally challenging financial situation, with many directors of adult social services reporting that they do not feel confident that their budgets will be sufficient to meet their statutory duties (ADASS, 2024). The sector has seen a significant rise in demand over recent years as well as a similar increase in the acuity of need which has resulted in more people requiring more intensive care and support. This presents obvious challenges for constrained budgets, but the volume of demand and resultant financial pressures also result in social care providers having insufficient resources to direct additional funding towards early intervention schemes and preventative support.

 

  1. Trust leaders would urge a long-term, multi-year settlement to place social care on a sustainable footing. They would also welcome implementation of a workforce strategy for the adult social care sector. We welcomed the Skills for Care adult social care workforce strategy which provides a clear vision that will bolster the adult social care workforce. It is clear that if government wants to deliver on its mission to improve the health of the population, then it must look to invest in the social care workforce and deliver fair pay for those working in the sector. Failure to support the social care workforce undermines efforts across the health system to shift to a more preventative care model and results in poorer health outcomes for patients.

 

November 2024