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NAO report lays bare shortfalls in adult social care

31 March 2021

Short-term funding and a lack of a long-term vision is hampering planning, innovation and investment in adult social care, according to a report by the National Audit Office (NAO).

The Department of Health and Social Care (DHSC) sets policy and has overall responsibility for social care, while Local Authorities have to commission it, often from private providers.

Current accountability and oversight arrangements for adult social care are ineffective. Although the CQC rates most care as good, DHSC can’t tell how effectively local authorities commission care and the outcomes achieved. It has no legal powers to intervene or hold individual authorities to account. This limits the Department’s ability to assess how well money is being spent, or what additional funding is needed to support care users.

The DHSC has not met previous commitments to tackle recruitment and retention challenges for the 1.5 million people who work in care. It has not produced a workforce strategy since 2009, despite committing to do so in 2018. The Department told the NAO that a workforce strategy would be dependent on the next spending review and wider reforms committed to in the recent White Paper.

The DHSC does not have a clear strategy to develop accommodation for adults with care needs and does not monitor the condition of current accommodation itself. Uncertainty about future funding and care policy mean providers are reluctant to invest in accommodation. Funding for new investment is ad-hoc with no co-ordinated, long-term vision across government about how new accommodation will be developed or existing accommodation adapted to meet care needs.

In 2019-20, local authorities spent a net £16.5 billion on care. 839,000 adults accessed long-term support through local authorities. Pre-COVID-19, Carers UK estimated there were around 7.3 million unpaid carers in England. Around 24% of adults aged 65 and older have unmet care needs.

Future demand for care is likely to rise in the next two decades. The DHSC projects that around 29% more adults aged 18 to 64 and 57% more adults aged 65 and over will require care in 2038 compared to 2018. Over this period, the total cost of care is projected to rise by 90% for adults aged 18 to 64, and 106% for adults aged 65 and over.

DR UK Head of Policy Fazilet Hadi said: “The lack of DHSC oversight and planning for social care is clearly demonstrated in the NAO report.

“The government is beginning to engage on the shape of social care reform.

“It is vital that reform is based on the right to independent living contained in article 19 of UN CRPD, that it is based on personalisation, parity with health and that it is given the required level of funding.

“Disabled people should also have clear ways of challenging poor decision making.”