Deepening Inequalities in Adult Social Care: A Call for Urgent Reform


Inequalities in access to adult social care are deepening due to the cost of living crisis, staff shortages, and squeezed council budgets. This is the stark message conveyed by the Care Quality Commission in its annual State of Health Care and Adult Social Care report.


The regulator has identified a concerning trend where council funding for care is failing to keep up with the growing need. The number of care requests per 100,000 population increased by 4.9% from 2017-18 to 2021-22, while the number of people receiving care decreased by 2.2% during the same period.


Furthermore, it has come to light that a quarter of care providers surveyed in July 2023 have contemplated leaving the sector in the past year. This is primarily because council funding has failed to keep pace with their escalating costs for food, energy, and staffing.


The dire situation is taking a toll on service capacity. There has been a 0.6% reduction in the number of registered care home beds in the year leading up to July 2023. Home care providers that are hard to replace have delivered almost 15% fewer hours of care in the first three months of 2023 compared to the same period in 2021.


As a consequence, care home profitability has reached historic lows. Given that council-funded care is less profitable than private care, a larger proportion of fees are coming from private sources in the past year. This poses a significant risk of leaving those in deprived areas, who rely on state services, without essential care.


Specialist services for people with learning disabilities and autistic individuals, such as supported living, have witnessed a notable decline in profit margins from 2021-23. This decline is primarily attributed to rising staff costs. However, with a limited presence in the private market, they have less capacity to subsidise state-funded provision through self-funder fees. Consequently, increased funding becomes imperative for their survival.


The Care Quality Commission has also identified a distressing scenario where self-funders are forgoing necessary home care due to the cost of living crisis and higher provider fees. Staffing shortages have led to providers prioritising urgent visits over less critical ones, sending a single carer when two are needed, causing an overload on staff schedules, overlapping calls for workers, and insufficient travel time between visits.

While there was a reduction in social care job vacancies in 2022-23, primarily due to international recruitment, 54% of providers surveyed reported recruitment difficulties, and 31% faced challenges in retaining staff. The Care Quality Commission has welcomed Skills for Care’s efforts to create a sector-led social care workforce strategy. However, it emphasizes the need for the government to develop its own staffing plan, as the sector alone cannot resolve these issues.


Charity coalition, the Care and Support Alliance, has described the 2022-23 State of Care report as “undoubtedly the worst we have ever seen,” painting a bleak picture of the current state of social care. The growing inequality in access to social care, especially for those with limited financial resources living in deprived areas, is a matter of profound concern.


The Association of Directors of Adult Social Services has also voiced their concerns, highlighting that funding is falling short of meeting people’s needs. This has led to fewer individuals being able to access care, especially those who cannot afford to pay for it themselves, resulting in overworked, stressed, and underpaid care staff.

The Nuffield Trust, represented by senior policy analyst Sally Gainsbury, asserts that local authorities were already struggling to meet the increasing demand for care services before the rising cost pressures came into play. Consequently, more people, particularly in deprived areas, are unable to access the care they require.

The prevailing situation has prompted widespread calls for the government to allocate more funds to the social care sector in the upcoming autumn statement and provide long-term investment in social care. Immediate investment is deemed necessary to address unmet and under-met needs and ensure timely access to social care for all who require it, regardless of their financial means.


Provider representative body, Care England, insists that social care should be recognised as a vital component of national infrastructure. They stress the importance of government support to foster an environment where the sector can flourish, rather than struggle.


In response, the Department of Health and Social Care has defended its record by highlighting an additional £8.1 billion allocated for the adult social care system from 2023-25. This funding is intended to strengthen the sector by purchasing more care packages, facilitating timely hospital discharges, and bolstering the workforce. It includes various allocations, such as extra funding through social care grants, tackling delayed discharges, and market sustainability and improvement funds, with a particular focus on workforce shortages.


Nonetheless, Gainsbury from the Nuffield Trust argues that continued short-term funding injections into social care only breed uncertainty and render the sector vulnerable to shocks. Long-term investment is necessary to build the workforce and infrastructure required for the future.


More about the CQC’s report can be found here:

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