Inequalities in access to adult social care are deepening due to the cost of living crisis, staff shortages and squeezed council budgets.

That was the message today from the Care Quality Commission in its annual State of health care and adult social care report.

The regulator said council funding for care was not keeping up with need, with requests for care per 100,000 population up 4.9% from 2017-18 to 2021-22, while the numbers receiving care as a result fell by 2.2%.

It found that a quarter of providers surveyed in July 2023 had considered quitting the sector over the past year, as council funding failed to keep pace with their rising food, energy and staffing costs.

Reduced service capacity

Workforce shortages had resulted in reduced service capacity. The number of registered care home beds shrank by 0.6% in the year to July 2023, and home care providers deemed hard to replace delivered almost 15% fewer hours’ care in the first three months of 2023 compared to the same period in 2021.

Care home profitability was at historic lows, and with council-funded care being less profitable than the private market, the CQC found a greater proportion of fees had come from private sources in the past year.

This risked leaving people in deprived areas, who are more dependent on state services, going without care, it warned.

Specialist services for people with learning disabilities and autistic people, including supported living, saw a sharp fall in their profit margins from 2021-23, driven by rising staff costs.

However, with a much smaller private market, they were less able to subsidise state-funded provision through self-funder fees, meaning that it was “vital” for them to receive increased funding.

People going without care due to cost of living

At the same time, the CQC found that some self-funders were going without some of the home care they needed because of the cost of living crisis and increased provider fees.

Staffing shortages resulted in providers deprioritising less urgent visits, sending one carer for calls that required two, overloading staff rotas, giving workers overlapping calls and leaving too little travel time between visits.

And despite the number of vacancies across social care falling in 2022-23, mainly due to international recruitment, 54% of providers surveyed reported recruitment difficulties and 31% retention challenges.

While the CQC welcomed Skills for Care’s decision to develop a sector-led social care workforce strategy, the regulator said it was vital that the government produced its own staffing plan.

“The work that Skills for Care do will be positive, but it will need to have an outcome which is why we are calling for a national workforce strategy,” said James Bullion, the regulator’s chief inspector of adult social care and integrated care. “The sector alone cannot solve those problems.”

State of social care ‘unremittingly grim’

Charity coalition the Care and Support Alliance said the 2022-23 State of care report was “without doubt the worst we have ever seen and within it, the picture painted of how social care is currently performing is unremittingly grim”.

The CSA’s chairs, Caroline Abrahams (Age UK), Emily Holzhausen (Carers UK) and Jackie O’Sullivan (Mencap), added: “In particular, the growing inequality in people’s ability to access social care, and the vanishingly small options for those with little money, living in poor areas, is a source of huge concern to us.”

For the Association of Directors of Adult Social Services, president Beverley Tarka said: “Funding is not keeping up with people’s needs, so fewer can access care and people who can’t afford to pay for care themselves are more likely to be going without the support they need.

“And it’s left care staff overworked, stressed, and poorly paid, meaning many leave their jobs and we have difficulty recruiting people to replace them.”

People in deprived areas ‘unable to access care they need’

Nuffield Trust senior policy analyst Sally Gainsbury said: “Local authorities were already struggling to meet growing need for care services before rising cost pressures hit, so inevitably this means more people unable to access care they need, particularly in more deprived areas.

“Financial pressures as well as repeated failed reforms have left social care services fragile and seen council-funded care packages shrinking with increasing numbers of people shut out from publicly funded care.”

The situation prompted widespread calls for the government to not only find more money for the sector in next month’s autumn statement but also provide long-term investment in social care.

Call for more money

“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,” said the Local Government Association (LGA)’s community wellbeing board chair, David Fothergill.

“Local authorities need a good funding settlement this autumn to avoid further cuts to care, and a government commitment to a fully funded social care workforce strategy is long overdue,” added the CSA’s chairs.

Provider representative body Care England’s chief executive, Martin Green, said: “Social care must be seen as an essential part of national infrastructure. The social care sector is brimming with talent and provides essential support for our citizens.

“We need a government that understands the importance of social care and sets about creating an environment where it flourishes, rather than struggles.”

DHSC defends record on investment

A Department of Health and Social Care spokesperson defended the government’s record, saying the sector had access to an additional £8.1bn from 2023-25 “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”.

This comprises:

• £3.2bn extra through the existing social care grant, though this is for both adults’ and children’s services, with an expected 40% due to be spent on the latter.
• £1.6bn to tackle delayed discharges, with the funding split between councils and NHS integrated care boards.
• £1.6bn through increasing the adult social care council tax precept by 2% and raising standard council tax by 3% in each year.
• £1.08bn through the market sustainability and improvement fund, designed to help councils increase provider fees, tackle waiting lists and boost recruitment and retention.
• £570m through a separate market sustainability and improvement fund – workforce fund, which has the same objectives but is particularly focused on tackling staff shortages.

However, Gainsbury, for the Nuffield Trust, added: “Continued short-term funding injections into social care are fuelling uncertainty and leaving the sector susceptible to shocks, unable to invest in the workforce and infrastructure needed for the future.”

Extra funding for social care is needed to help the sector meet a proposed 3% increase in the minimum wage, the Low Pay Commission has recommended.

The commission has recommended increasing the minimum wage by 19p to £6.50 per hour from 1 October 2014 but warns that government action is still needed to ensure that social care employers comply.

The commission said that despite an HMRC investigation finding that non-compliance with the minimum wage was higher than average in the social care sector, government action has been slow to materialise.

It said that the government should stump up more money to help fund a minimum wage rise in the sector and ensure forthcoming statutory guidance on commissioning requires councils to take the costs of care into account when purchasing services.

“We urge the government to take further action, including that promised statutory guidance on commissioning should include a requirement for local authorities to take into account the actual costs of care, including the national minimum wage,” said the commission’s summary of its 2014 report.

The call was welcome by the United Kingdom Homecare Association (UKHCA).

“We all want to see the homecare workers properly rewarded for the demanding and essential work they do. However, local authorities persistently failed to recognise these cost pressures,” said UKHCA chair Mike Padgham.

“It is imperative that a government which acts on the Low Pay Commission’s recommendations to increase the minimum wage also heeds the commission’s urge for a requirement for councils to take account of the full costs of care in the statutory guidance it is currently preparing on commissioning of social care.”

The commission said that the real value of the minimum wage has fallen slightly in recent years and now that the labour market is improving the wage should rise to restore its value. It added that a further increase should follow in 2015.

The commission’s full 2014 report is due to be published in the next few weeks.