Government falling short on promise to “fix crisis in social care”: Public Accounts Committee

The 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, the Public Accounts Committee (PAC) has warned.

In a report published today (20 March), the committee has called for stronger leadership, long-term financial support, and a clear workforce strategy to address key shortfalls in the adult social care sector.

The PAC said: “Two years on from the Department for Health and Social Care (DHSC)’s long-awaited white paper People at the heart of care - a 10-year ‘vision’ for adult social care - plans for reform have once again gone awry.”

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, the report noted.

The PAC said it “remains unconvinced” whether government knows if it is achieving value for money from the additional funding, and sought assurance that funding for market sustainability and improvement “has not instead ended up increasing profit margins for some providers”.

The report found that workforce vacancies in the sector exceeded 152,000 in March 2023, a vacancy rate of almost 10%.

The PAC warned the workforce plan set out to address the shortfall is “woefully insufficient” to the scale of the task.

The committee said: “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.”

The PAC reached the following six conclusions:

• It is far from clear if Integrated Care Systems are making a demonstratable difference to adult social care delivery.
• The committee remains unconvinced as to whether the Department knows if it is achieving value for money from the additional funding going to adult social care.
• Local authorities are having to plan and commission adult social care services against a backdrop of fragmented and uncertain funding.
• Notwithstanding its recent efforts to make adult social care a more attractive career, the Department has still not produced a convincing plan to address the chronic staff shortages in the long-term.
• Long-awaited workforce reforms are way behind schedule and too dependent on a ‘novel’ payment system.
• The Department faces significant challenges in delivering its ‘vision’ for adult social care reform, and Parliament and the sector must be able to hold it to account for its progress.

The committee challenged the Government on whether there would ever be a multi-year funding settlement that would allow local authorities to set out long-term programs to achieve the “fundamental transformations” needed in the sector.

The report urged 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.

Further, the report recommended the department set out how it will lead the sector to identify and address workforce challenges.

Dame Meg Hillier MP, Chair of the Public Accounts 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.”

Responding to the report, Cllr Kaya Comer-Schwartz, social care spokesperson for the Local Government Association, said: “We strongly support the committee’s call for long-term financial support and certainty for social care, a workforce strategy to address staffing shortfalls and a road map for reforms.

“Adult social care remains in a precarious position, with overstretched budgets, significant unmet and under met need, and remaining instability within the provider market. Any reforms need to invest in prevention and recovery in both health and social care in order to be successful.

“It is crucial that the impacts of any social care reforms on councils are thoroughly assessed and are manageable, costed and centred on people who draw on care.”

Lottie Winson