Councils are struggling to meet rising requests for adult social care support and some people are cutting back on their home care amid the cost-of-living crisis while “completely overwhelmed” family carers try to fill the gaps, the health watchdog has said.
The Care Quality Commission (CQC) also reiterated the call for a national workforce strategy for the sector – noting the lack of one despite the announcement earlier this year of an NHS Long Term Workforce Plan.
The health regulator, which published its annual assessment of the state of health and adult social care in England, said providers are facing increased running costs including food and electricity, which has led to higher rates for those receiving care.
Some providers are also struggling to pay staff in line with inflation, affecting recruitment and retention in the sector.
We're very concerned that the market remains very stressed, very fragile— James Bullion, CQC
The report stated: “This is likely to have an impact on people, both in the quality of care they receive and in providers’ ability to reinvest in care homes – data from our Market Oversight scheme shows that care home profitability remains at historically low levels.
“Local authority budgets have failed to keep pace with rising costs and the increase in the number of people needing care.
“As adult social care places funded by a local authority are often less profitable, there is the risk that people who live in more deprived areas, and are more likely to receive local authority-funded care, may not be able to get the care they need.”
Some people have had to reduce their care visits “to a minimum”, impacting their quality of life, the CQC said.
Its analysis of NHS England data showed that the total number of new requests to councils for adult social care support rose by 3% between 2020/21 and 2021/22, reaching almost two million.
But 568,685 requests for services were not met, while 522,850 requests received only universal services or were advised to contact non-council services such as the voluntary sector. The latter was up 2% on the previous year.
Less capacity in the system with around a “15% drop in the amount of publicly funded homecare” combined with accessibility problems and the cost of living is seeing people “taking a step back” from the number of hours of care they can afford, the CQC’s interim chief inspector of adult social care and integrated care, James Bullion, said.
We continue to call for a national workforce strategy that raises the status of the adult social care workforce and ensures that career progression, pay and rewards attract and retain the right professional staff in the right numbers— Ian Trenholm, CQC chief executive
He added that there is a knock-on effect on the NHS when people do not get the care they need at home.
He said: “The impact of that is twofold. For them, it might mean fewer personal care tasks being supported, but it also might mean a worsening of health and, therefore, an impact on the NHS.”
An added consequence is that relatives providing care are left “completely overwhelmed”, he said, adding: “Family carers are the backbone of the social care and health system in fact.
“If they tip over then the system will tip over. So we are very concerned that local authorities and ICSs (integrated care systems) address the needs of carers going forwards.
“It’s those kind of issues we mean by the sort of two-tier and the stretched nature of social care.”
The report also warned that despite ongoing problems with capacity there has been “increasing pressure” in the past year to discharge people from hospital, noting examples of people being discharged too early without appropriate risk assessment or having a care package or intermediate care in place.
The report stated that “unsafe discharges are putting people at risk, potentially leading to poorer outcomes in their health and care, and being re-admitted to hospital.”
The current model of social care in England is not fit for purpose and reform is long overdue— Sally Warren, The King’s Fund
The CQC said a social care workforce strategy is badly needed and welcomed efforts by Skills for Care, the strategic workforce development and planning body for adult social care in England, which last week said it is working with various organisations to develop a strategy identifying what is needed over the next 15 years.
In its recent report, Skills for Care estimated that some 440,000 extra staff will be needed to keep in line with the projected number of people aged 65 and over in the population by 2035 who might need care.
Ian Trenholm, CQC’s chief executive, said: “We continue to call for a national workforce strategy that raises the status of the adult social care workforce and ensures that career progression, pay and rewards attract and retain the right professional staff in the right numbers.”
Mr Bullion said a third of all providers are now reporting struggles with recruitment and retention of staff, while a quarter of providers said they are considering withdrawing from the social care market because of these issues.
He said: “So we’re very concerned that the market remains very stressed, very fragile. And that’s despite us acknowledging the market sustainability grants that Government have given to councils and that councils have passed on. It’s been outpaced by the costs.”
David Fothergill, from the Local Government Association which represents councils, said: “As this important report highlights yet again, social care needs a dedicated workforce plan to address the recruitment and retention crisis, especially as we approach winter, including action on staff pay, conditions, skills, training and development.
“Immediate investment is needed in the Autumn Statement to end the gridlock, address unmet and under-met need and ensure timely access to social care for all who need it, not just those who are able to afford it.”
While adult social care providers said recruiting staff from overseas “has enhanced the diversity and skills of their team and helped resolve staffing issues”, the CQC also warned of a “growing trend of unethical international recruitment practices”.
The regulator said it made 37 referrals for concerns regarding modern slavery, labour exploitation and international visas in 2022/23, which was more than four times the number made in 2021/22 when eight referrals were made.
A Department of Health and Social Care spokesperson said the Government is “investing record sums into health and social care services to improve access to care and cut waiting lists, one of the government’s top five priorities”.
They said this included up to £8.1 billion “to put the adult social care system on a stronger footing including buying more care packages, helping people leave hospital on time and boosting the workforce”.
