The government has brought adult social care in England “to its knees” with years of uneven funding and a “woefully insufficient plan” to fill thousands of staff vacancies, MPs have said in a damning report on a system that provides long-term care for 835,000 people.
The public accounts committee said “chronic underfunding, rising waiting lists and patchwork funding” has placed sustained pressure on local authorities, and the government is falling short on Boris Johnson’s promise in 2019 to “fix the crisis in social care once and for all”.
The Department of Health and Social Care “is not providing the leadership needed to deliver a social care sector that is sufficient to meet the country’s needs”, the cross-party committee concluded.
Meg Hillier, its Labour chair, 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 report comes with almost half a million people on waiting lists for care in residential settings or at home and an ageing population causing rising demand. There is also growing concern that some private providers are enjoying increasing profit margins because the government may not have a grip on value for money in a system that costs councils nearly £24bn a year.
The PAC wants assurances that £2.7bn in additional funding allocated in 2022 to speed up discharges from hospitals into social care and to increase the rates councils can pay for care, “is not simply going into provider profits”.
The committee also said that the government has given little assurance that changes to introduce a £86,000 per person cap on care costs, already delayed to October 2025, can be delivered on schedule. Meanwhile, more than 150,000 care posts are vacant and “the DHSC has still not produced a convincing plan to address the chronic shortages”, the committee said.
Nadra Ahmed, chair of the National Care Association, which represents independent care providers, said: “The intent has been there but the implementation has been quite woeful. The sector continues to become ever more fragile despite the government having published a plan.”
Helen Wildbore, director of Care Rights UK, which represents users of social care and their relatives, said: “It is older and disabled people paying the price – their safety, dignity and rights at risk as services get stretched to breaking point. We hear from people facing uphill battles to get access to care, to get their basic needs met or to have serious concerns with care resolved.”
A spokesperson for DHSC said: “We are committed to reforming adult social care and have invested up to an additional £8.6bn over two years to meet the pressures facing the sector, grow the workforce and improve hospital discharge. The report rightly acknowledges progress to boost care workers’ career progression and training to improve retention, including through a new accredited qualification. To drive forward our vision for reform, we are also investing up to £700m on a major transformation of the adult social care system, which includes investing in technology and adapting people’s homes to allow them to live independently.”
The findings coincided with the first preliminary session on the care sector at the Covid-19 public inquiry, after there were 50,000 deaths related to the virus in UK care homes.
Sam Jacobs, representing the Trades Union Congress, told the inquiry the pandemic hit “a chronically underfunded and fragmented social care sector delivered by many thousands of local authority and private care providers with little central strategic direction … served by an understaffed, underpaid and undervalued workforce.”
Jane Townson, chief executive of the Homecare Association, said a “glaring absence of social care expertise” in the government’s scientific advisory group meant it failed to “adequately consider the unique challenges and needs of the sector in the scientific advice informing policy decisions”.
“Decision makers frequently disregarded and undervalued the dedicated professionals working in social care, who put their own health and wellbeing on the line to continue providing care and support in the most challenging of circumstances,” she said.
