National Audit Office, London
National Audit Office, London

Short-term funding and the lack of a long-term vision has hampered planning, innovation and investment in adult social care, according to a report published today by the National Audit Office.

The NAO found current accountability and oversight arrangements for overseeing the care market to be ineffective, stating that, although the CQC rates most care as good, the Department of Health and Social Care lacks visibility of how effectively local authorities commission care and the outcomes achieved. It has no legal powers to intervene or hold individual authorities to account, which limits the its ability to assess how well money is being spent, or what additional funding is needed to support care users.

The report notes that the DHSC has increased its focus on adult social care in response to Covid-19 and taken steps to increase its capacity and address data gaps, acknowledging last month’s White Paper with its proposals to improve data collection and oversight of local authority delivery of social care.

The NAO noted the DHSC failed to meet previous commitments to tackle recruitment and retention challenges for the 1.5 million people who work in care, and hasn’t produced a workforce strategy since 2009, despite committing to do so in 2018. However, the NAO said it has been told by the DHSC that a workforce strategy would be dependent on the next spending review and wider reforms committed to in the White Paper.

The report goes on to say the DHSC has no clear strategy to develop accommodation for adults with care needs and doesn’t monitor the condition of current accommodation itself. Uncertainty about future funding and care policy mean providers are reluctant to invest in accommodation, and funding for new investment is ad hoc with no coordinated, long-term vision across government about how new accommodation will be developed or existing accommodation adapted to meet care needs.

The NAO said short-term funding settlements have hampered long-term planning for adult social care, and that it has previously emphasised the importance of clarity over funding beyond the end of a spending review. Uncertainty has made it difficult for strapped local authorities to plan how much care they can purchase beyond the current financial year, constraining much-needed innovation and investment. For 2019-20, the DHSC assessed that most local authorities pay care providers below a sustainable rate for care.

The report maintains that stakeholders lack visibility of provider finances across the care market. Pre-Covid-19, many care providers were not financially resilient, and the impact of the pandemic could have further consequences. Analysis by CQC of the large providers indicates that government support has helped to stabilise the market, but falls in occupancy from around 90% pre-pandemic to 80% last month, raises concerns that ongoing support may be required.

Despite many years of government papers, consultations and reviews, the NAO notes the DHSC has not produced a long-term plan for care, however the NAO said it recognises the pandemic has delayed promised reforms affecting government priorities and noted the DHSC is leading reform plans and has committed to bringing forward proposals this year. Noting that reforming the sector will be a significant challenge, the report said they will require a whole system, cross-government approach.

Gareth Davies, head of the NAO, said: “The lack of a long-term vision for adult social care coupled with ineffective oversight of the system means people may not get the care that best supports them. The Department of Health and Social Care has increased its focus on adult social care in response to the Covid-19 pandemic. It needs to build on this to ensure that its long-awaited reforms deliver affordable, high-quality and sustainable adult social care for the future.”

Care England, the representative body of independent adult social care providers, welcomed the report. Its chief executive Professor Martin Green said: “The NAO report gives clear evidence that the social care system is fragile and in urgent need of reform. The Covid-19 pandemic has shown the importance of social care and the need to regard it as part of the national infrastructure. Care England, stands ready to support the government in developing a new vision for social care, that is properly funded, understood, and respected by everyone.”

Date published: March 25, 2021

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