The National Audit Office Report on adult social care in England examines the market and the Department of Health and Social Care’s (DHSC) role in overseeing it now and into the future.

This Report, like many others before, is an evidence-based call for wholesale reform of the adult social care system and how it is funded.

In light of ongoing concerns on the lack of sustainable funding, increased demand and future social care reform, the report challenges the UK Government to rethink funding and develop a long-term vision which fosters innovation, workforce development and a sustainable care provision.

Few, if any people involved in this sector will be surprised to hear the conclusions. The main point is that a lack of long-term vision and short-term funding reviews only have hampered councils’ ability to plan, invest and innovate for the long-term.

The Report highlights the impact of gaps in central government understanding of the adult care system and its changing needs. This, combined with a lack of funding and oversight has resulted in:

• An increase in unpaid-for care
• Many over 65-year-olds not receiving the care they need
• A fragile commercial market hit by ongoing below sustainable funding and reducing bed occupancy.

COVID-19 has brought into focus the perilous state of adult social care ‘as never before’. However, the evidence shows the pandemic is accelerating change (for example, the use of technology for GP assessments) and is demonstrating effective place-based collaboration between health and social care providers.

Systems thinking rather than silo provision is likely to be the blueprint for reform as the sector understands the impact of the Health and Social Care Bill on adult social care provision.

Key findings of the Report

The Report unearthed:

• A fast-growing need for care
• No long-term vision
• A fragile, financially vulnerable market
• Fragmented services with sometimes severe staff shortages
• Financial uncertainty, leaving both providers and commissioners unable to make any or any meaningful long-term plans, and a corresponding lack of investment.

Short and medium-term consequences for councils and their partners include:

• Senior leaders in councils should expect to be contacted by the DHSC. A recommendation has been made that the DHSC collaborates with councils to factor-in sector and user perspectives and views of people with lived experiences.
• Councils will be asked to collaborate with the DHSC to develop a workforce strategy with a focus on retaining and developing staff.
• Councils will feed into a cross-government strategy for a range of accommodation and housing needs for people with care needs. The strategy should be realistic about potential costs to the sector, and data will have to support policy.

• Councils may be called on to produce financial information about the sustainability of local providers. The Report’s recommendations include a proposal that the DHSC, with local authorities and the Care Quality Commission (CQC), explore how best to increase visibility of and transparency over providers financial sustainability and costs.

Councils’ pandemic experience and knowledge of the changing face of adult social care can feed into discussions on how long-term funding can support a long-term vision.

Councils should invest in data analytics and gather the most experienced and persuasive teams for the spending review this autumn. This is an opportunity for councils to have their say on the future of adult social care provision.

Sarah Erwin-Jones (sarah.erwin-jones@brownejacobson.com) and Bridget Tatham (bridget.tatham@brownejacobson.com) are Partners at Browne Jacobson.