Dedicated funding for adult social care in England will rise by just over £1bn next year, according to government plans.

However, this falls far short of the estimated £1.8bn in extra costs facing councils, chiefly driven by rises in employers’ national insurance contributions (NICs) and the national living wage(NLW), the Association of Directors of Adult Social Services has warned.

The funding was set out in a Ministry of Housing, Communities and Local Government (MHCLG) policy statement on the local government finance settlement for 2025-26, published last week. This provided further detail on announcements made in the October 2024 Budget.

£1bn in extra funding

The extra money is made up of projected increases in the adult social care precept (£650m) – the element of council tax that is ring-fenced for the sector – and adults’ services’ share of a £680m rise in the existing social care grant, which amounts to about £400m.

Though local authorities will have further funding they can use on adult social care in 2025-26, the sector will need to compete with other services for this, several of which – including children’s services – are also under severe pressure.

Responding to the news, ADASS chief executive Sally Burlington said: “Whilst the additional funding is welcome, the 2025-26 budget doesn’t provide local councils with enough to cover the increase in the cost of care due to the recent national living wage (NLW) and employer national insurance rise and the growing numbers of us needing more complex care and support.”

Minimum wage and tax increases

The NLW is due to rise from £11.44 to £12.21 an hour in April 2025, benefiting many thousands of low-paid care workers, but costing independent providers an estimated £1.85bn next year, according to think-tank the Nuffield Trust.

The trust has also calculated that the rise in employers’ NICs would cost providers a further £940m in 2025-26. It said all but the 2% of the largest providers would have to pass on these costs on to funders – who are mostly councils – but warned that authorities were not being sufficiently resourced to pick up the tab.

A survey by the Care Provider Alliance (CPA), an umbrella group for provider representative bodies, found that most services would have to cut jobs and care on the back of the changes, without further government funding.

Councils ‘will be forced to ration care’

Burlington echoed these warnings on the back of the MHCLG figures, adding: “Without addressing this funding gap, local councils will be forced to further ration care and support, focusing on those people with the greatest needs.

“People waiting for care are likely to face further delays, risking their health deteriorating further and those paying for their own care may be forced to cut back on support due to increasing costs, making their lives more difficult.”

The government has pledged to cover councils for the increased direct costs they will face from the rise in NICs and will provide further information later this month when it sets out the provisional local government finance settlement for 2025-26 in detail.

Call for further funding

However, it has not pledged any funding to cover authorities for the knock-on impact on providers they commission.

Burlington urged ministers to address this in the settlement, adding: “ADASS along with care providers across the sector are calling on the government to provide additional funding to mitigate the shortfall in funding, or risk further destabilising local care markets at the detriment of those of us drawing on care and support”

Her message was echoed by Local Government Association chair Louise Gittens, who warned: “Without action, councils will be forced to make further cuts to statutory services, and risk not fulfilling some of their most important duties.”

Targeting funding at deprived areas

Alongside last week’s statement, the MHCLG announced plans to consult on reforming the way government funding for councils is distributed to ensure it better targets need.

As a first step, it will provide authorities with a £600m ‘recovery grant’ in 2025-26, which will “allocate funding where the numbers of vulnerable people who rely on council services are highest, and the ability to fund need locally is weakest”.

It will go to places where, weighted by population, deprivation outweighs council tax-raising ability, with some areas getting nothing at all.

Concerns over impact on county councils

The news sparked concern from the County Councils Network (CCN), which warned that deprivation was only one indicator of demand facing councils and the recovery grant risked ignoring the pressures on shire authorities.

“Considering that increases in the minimum wage and national insurance contributions will more than wipe out extra funds for social care, it is possible most CCN member councils – and many more across the country – will receive nothing from the ‘recovery grant’ which will be heavily targeted and weighted exclusively by deprivation,” said CCN Tim Oliver.

“As we have argued over the last few weeks, whilst deprivation is a key indicator of a councils’ need, it is not the only indictor nor the most important measure of financial distress. The reality is that it is demand and market failure across adult and children’s social care and special educational needs services that are pushing councils to the brink.”

He said CCN members deserved “an appropriate share of the recovery grant”.

Overhaul of funding system ‘long overdue’

However, London Councils, which represents the capital’s boroughs, welcomed the government’s plans to reform the distribution of local government funding, citing a report last year from think-tank the Institute for Fiscal Studies (IFS) that found London was under-funded relative to need.

For the IFS, head of devolved and local government finance David Phillips said the planned reform of the funding system was “long overdue”, with existing allocations based on “a range of ad-hoc decisions and data from back as far as the 1990s”.

Phillips also stressed that more deprived areas “bore the brunt” of local government funding cuts in the 2010s, though added that whether redistributing resource to them was fair “will be in the eye of the beholder”.

Councils were already planning to make £1.4bn in adult social care savings next year before learning of the added pressures on the sector brought about by the government’s Budget.

That was one of the messages from the Association of Directors of Adult Social Services’ (ADASS) autumn survey, released today, which also revealed that councils were having to make over £1bn in savings in the current financial year.

ADASS’s survey, answered by 131 of the 153 English authorities, was conducted from 12 September to 9 October 2024, before Rachel Reeves delivered her Budget, setting out government spending plans for 2025-26.

Budget impact on social care

Reeves said that councils’ available resource would increase by 3.2% next year, with at least £600m in additional grant earmarked for social care.

However, at the same time, she announced  a 6.7% rise in the national living wage, which will benefit many thousands of care workers, and a significant increase in employers’ national insurance contributions, which will likewise kick in April 2025.

The rate employers pay per employee will rise from 13.8% to 15%, while the salary threshold at which they start paying the tax will fall from £9,100 to £5,000, bringing many more part-time workers, who make up 45% of the adult social care workforce in England, within its scope.

‘£600m risks being swallowed up by tax and wage rises’

Several sector bodies said the impact of the wage and tax rises on adult care providers would swallow up the £600m in additional grant, despite this expected to be available for the severely-stretched children’s social care sector as well.

They also warned that providers risked becoming financially unsustainable as a result of the measures.

However, ADASS’s survey revealed that authorities were already predicting severe pressures on adults’ services before learning of the Budget’s impact.

£1.4bn in planned savings

It found that authorities were planning to make £1.4bn in savings in 2025-26, based on extrapolating responses to the full complement of 153 authorities, a 55% increase on the £903m budgeted for 2024-25, as revealed by ADASS’s spring survey this year.

However, the latter figure had been topped up by £156m of in-year savings that councils responding to the autumn survey reported having had to find, taking the total for 2024-25 to over £1bn.

In addition, 81% of respondents said they were on course to overspend their budgets this year. Based on their responses, ADASS estimated that the 153 authorities were on course to overspend their allotted funding by £564m in 2024-25 – about 3% of total net budgets – a similar figure to 2023-24.

This is despite councils having budgeted to increase spending on adult social care by 9.2% in real terms in 2024-25 on the back of a significant boost in government funding. A 7.5% real-terms rise in 2023-24 helped councils increase the numbers of people receiving long-term, as well as reablement, packages of care.

Commenting on the results of its survey, ADASS said: “These are not the conditions for adult social care to thrive. These are not the conditions under which the new government’s proposed national care service can hope to succeed.”

A national care service is the government’s long-term ambition for the sector – however, it is yet to set out what this means in practice.

Budget ‘risks pushing providers over the edge’

Following the ADASS survey results, the Homecare Association reiterated warnings that the Budget would threaten provider sustainability.

“ADASS reports 81% of councils are already overspending and face unprecedented savings targets,” said chief executive Jane Townson.

“This means council fee rates are unlikely to rise enough to cover increases in provider costs. The Autumn Budget’s changes to employers’ national insurance contributions (NICs) and the minimum wage risk pushing many homecare providers over the edge.

“This perfect storm of council underfunding and increased employment costs will force providers to make impossible choices. We’re already seeing evidence of care visits being shortened; non-compliance with the minimum wage; providers exiting contracts; and providers ceasing to trade.”

She called on the government to exempt home care providers from the NICs increase and fully fund the increase to the NLW.

More people are receiving adult social care in England following years of decline, official data shows.

Councils funded long-term care packages for 858,720 people during 2023-24, up 2.8% on the year before, which in turn followed a 2.1% rise in 2022-23, according to NHS England’s annual adult social care activity and finance report.

This took the number receiving care back up to levels last seen in 2017-18 and follows a 6.3% fall in recipients, from 872,520 to 817,915, between in 2015-16 and 2021-22.

As of 31 March 2024, 650,085 people were receiving long-term care, up from a low of 613,510 in March 2022 and the highest year-end total since 2017.

Alongside this, councils boosted the number of short-term care packages they delivered to maximise people’s independence, often known as reablement services. The number of these grew by 12.2% last year, from 251,255 to 281,850.

The increases in provision came on the back of a 4.2% increase in the number of requests for care, from 2,002,055 in 2022-23 to 2,085,720 to 2023-24.

Unmet need concerns

The decline in the numbers receiving long-term care from 2015-16 to 2021-22 came despite a 9.3% rise in the number of annual requests for care during that time, leading to significant concerns about unmet need having increased and councils rationing care in response to financial pressures.

While councils increased real-terms spending year-on-year during this time, these increases were not substantial, while think-tank the King’s Fund has pointed out that much of this was absorbed by Covid-related pressures or increases in the unit costs of services.

The NHS England report showed that real-terms funding grew much more quickly in 2023-24 (7.5%) than in previous years, with gross expenditure increasing by £3.4bn, in cash terms, to £27.1bn. This was driven by funding on long-term care, which grew by £3bn between 2022-23 and 2023-24, to £21.4bn.

As well as providing more people with care, the increased spending also went into significant rises in provider fees.

The average weekly fee paid to care home providers rose by 11.6% in cash terms, from £992.80 in 2022-23 to £1,108.40 in 2023-24. This was likely driven by high rates of inflation and a 9.7% rise in the national living wage in April 2023.

Injection of government cash

The increased spending in 2023-24 came on the back of the then government making significantly more resource available to councils in 2023-24, including by diverting funds earmarked for the overhaul of the adult social care charging system. This included:

• A £1.36bn real-terms boost to the social care grant, which can be used on both adults’ and children’s services.
• A £475m rise in the market sustainability and fair cost of care fund, designed to help councils increase fees to adult social care providers, cut waiting lists for services and tackle recruitment and retention issues.
• £307m through a new adult social care discharge fund, designed to help speed up hospital discharges.
• Permitting authorities to increase the adult social care council tax precept – whose proceeds are ring-fenced for the sector – by 2% in 2023-24, up from 1% in 2022-23.
• Allowing councils to raise general levels of council tax by 3% without the need for a local referendum, up from 2% the year before.

Highest overspend in a decade and Budget concerns

However, despite their increased funding, councils overspent their budgets by £586m, the highest level in a decade, in 2023-24, according to the Association of Directors of Adult Social Services’ spring survey, carried out earlier this year.

And while councils have budgeted to increase adult social care spending by a further 9.1% in 2024-25 – on the back of another government funding boost – ADASS found that authorities were having to make £903m in savings this year, the highest annual level since 2016-17.

There are also huge concerns across the sector about the impact of last week’s Budget on funding levels for 2025-26. The government said councils’ overall resource would increase by about 3.2% next year, with an extra £600m earmarked for social care, a fund that is expected to be available for adults’ and children’s services.

However, adult sector leaders have warned that the £600m will be entirely swallowed up by the increased costs for adult social care providers of delivering a 6.7% rise in the national living wage – which will benefit many thousands of care workers – and an increase in employers’ national insurance contributions.

Improvement in timeliness of reviews

Alongside the growing number of people receiving care, councils also improved the timeliness of reviews of care and support plans in 2023-24, which are expected to take place every 12 months.

Of people who had been receiving long-term care for more than a year, 58.8% received a review during 2023-24, up from 57.1% in 2022-23.

This follows significant concerns about councils running long waiting lists for assessments, reviews and care packages in recent years.

But less funding for carer support

However, there was little improvement in provision for carers, with a 1.3% increase in the number receiving a service in 2023-24, from 356,235 to 360,815, which followed an 8.4% fall in numbers supported over the two preceding years.

Funding for carer support fell, meanwhile, from £195m in 2022-23 to £183m in 2023-24.

“These alarming figures show state funded support for carers in England has nosedived in recent years,” said charity the Carers Trust’s director of policy and public affairs, Dominic Carter.

“This is a travesty at a time when carers are taking on ever more responsibility and facing burnout as they prop up a health and social care system that’s been starved of funding.”

The next government should take forward reform of the Mental Health Act 1983 (MHA) and implementation of the Liberty Protection Safeguards (LPS) in its first 100 days in office, the incoming Association of Directors of Adult Social Services (ADASS) president has said.

However, Melanie Williams said she was not expecting either major party to implement the cap on care costs and associated reforms to the adult social care charging system should they win the next election.

Williams took over as ADASS president from Beverley Tarka at its annual spring seminar last week, meaning she will see the association through and beyond the election, which is widely expected to take place by November 2024.

MHA reform, the replacement of the Deprivation of Liberty Safeguards (DoLS) with the LPS and the introduction of the charging reforms are three policies that the current government has pledged to introduce but that will not be implemented before the election.

Cap on care costs ‘too politically risky’

In an interview with Community Care, Williams said see could not see the next government – whether Conservative or Labour – implementing the adult social care charging reforms “because of the price tag” and the fact that it was “too politically risky”.

The current government allocated £3.6bn over three years to the changes, but then reallocated this money to fund day-to-day adult social care services. While Labour’s shadow care minister, Andrew Gwynne, told last week’s spring seminar that Labour remained committed to the reform, the party has not set out how it will pay for it within the constraints of its tight fiscal policy.

In her speech to the spring seminar, Williams referenced repeated past promises from politicians to reform adult social care that failed to come to fruition.

“Politicians make promises about reforming social care and then don’t fulfil them,” she said. “To build sustained political backing to transform care and support in England, we not only need the trust of decision-makers in Government and their confidence that the solutions we’re proposing will work. We need to the change the way the public thinks about social care.”

MHA reform and LPS ‘priority for new government’

However, she was clear that MHA reform and the LPS should be an early priority for the next government.

“In the first 100 days of a new minister, one of the things I’d like them to do is implement Mental Health Act reform and Liberty Protection Safeguards,” she told Community Care.

The LPS is designed to tackle councils’ substantial backlogs of DoLS cases, which mean that many thousands of people are likely being deprived of their liberty unlawfully.

And reform to the MHA has the objectives of reducing the number of people subject to compulsory treatment, tackling the disproportionate use of the act in relation to black people and preventing the detention of people simply on the grounds of autism or learning disability.

“They’re really important [reforms] and make a real difference to people’s lives, particularly Mental Health Act reform because it tackles [issues such as] people with autism admitted to hospitals.”

Background in youth work

Williams has been director of adult social care and health at Nottinghamshire council since 2019, having previously held management roles across various councils, mental health charities and the NHS, after having started her career in care work and youth work.

“I felt quite troubled as a teenager and the youth worker I had was really important so that’s what got me into it because I wanted to give something back,” she said.

“And then I met a friend who worked in social care full-time, so she said, ‘why don’t you give it a go full-time?’. So, it was a very accidental start to the career. And then I just started progressing through management. I’m not sure how I did it. There was no secret or formula.”

Tribute to predecessor

Tarka was ADASS’s first black president and highlighted her position as a role model for black women who aspire to leadership roles.

Beverley Tarka, ADASS president, 2023-24

Williams paid tribute to her predecessor in her speech to the spring seminar, saying she was “an inspiration for inclusive leadership and has set an expectation for ADASS for how we will work into the future, which I fully intend to mirror”.

She then referenced the results of the social care workforce race equality standard (SC-WRES), assessing the performance of 23 councils against a series of race equality measures.

‘Shock, anger and shame’ at workforce race inequality

It found that black, Asian and minority ethnic social care staff faced disproportionately high levels of workplace bullying, disciplinary action and fitness to practise referrals, while also being less likely than white counterparts to be appointed to jobs from shortlists.

“Reading the recent report on learning from the SC-WRES was an emotional rollercoaster for me through shock, anger, shame and then a determination to act,” she said. “These experiences within our own workforce are simply not good enough.”

Nottinghamshire was one of the councils to take part and Williams told Community Care she would like to see the SC-WRES rolled out nationally and also applied to other protected characteristics beyond race.

She also referenced Tarka’s championing of the role of informal carers, through her carers’ challenge, designed to identify good practice with the group.

“Carers will remain a priority for us,” she told the spring seminar “91% of directors stated in the spring survey that unpaid carers are coming forward with an increased level of need. That carer burnout is the main driver of family breakdown. Enabling carers to care through carers leave, support when it is needed most, and navigating our systems with digitally enabled access, are core to our priorities this coming year.”

By Beverley Tarka, president, ADASS

When ADASS and carers’ organisations launched the Carers Challenge in October, our goal was to unearth the gold standard work social care teams and voluntary organisations are doing to support unpaid carers.

The response has been great, with lots of stories about how organisations are working with carers to co-produce services and place them at the heart of decision making.

One example was from the London Borough of Waltham Forest. There, the council has established a residents’ panel for unpaid carers who are looking after someone with dementia, so they can meet with social care team managers and other senior staff, face to face, once a month.

Giving carers the chance to shape services

“Unpaid carers told us that their voices weren’t being heard and they felt opportunities were being missed to improve services here in Waltham Forest,” said Matthew Mint, the council’s dementia and service development manager.

“The panel gives them the chance to offer feedback about the services they are using every day and iron out issues they are personally experiencing.

“In doing this, we as managers are then able to take this feedback and make the changes that are needed to the way we work, which benefits all unpaid carers in our borough.”

Matthew said this had influenced service delivery in the borough; for example, the council was reviewing dementia training for adult social care as a result of concerns raised by carers at these meetings.

Liz, a carer to her husband, who has dementia and Parkinson’s, said she found the panel meetings useful in understanding how processes such as hospital discharge and safeguarding worked.

“It allowed me to feel comfortable airing my concerns,” she added. “I’m really pleased that telling my story about the everyday struggles I face can help managers make the changes we all want to see.  By speaking up, together we make someone else’s life a little easier in the future.”

A carers’ good practice ‘storehouse’

Over the next few months, ADASS, alongside people with lived experience, will be finding out more about projects like this one and gathering them together to create the Carers Challenge ‘storehouse of great ideas’.

We hope this will be an inspirational tool for people working with unpaid carers, where they can find out more about different approaches other organisations have taken and how they can transfer this learning to their own practice.

So, watch this space for more information about the launch of the storehouse in early spring.

The government has increased funding for adult social care to help tackle NHS pressures this winter by £10m.

Councils will be able to bid from a pot of £40m – up from £30m – for cash to help prevent hospital admissions and speed up discharges from wards. The funding will be allocated to areas deemed to have the greatest urgent and emergency care challenges this winter.

The Department of Health and Social Care suggested that councils use the funding to purchase more home care packages, to enable people to leave hospital more quickly, and specialist dementia support to prevent admissions, among other things.

“It will improve social care capacity, boost discharge rates and avoid unnecessary admissions, freeing up hospital beds and reducing waits for care,” said care minister Helen Whately.

The DHSC announced the funding, along with £200m for the NHS, following a winter planning summit this week between prime minister Rishi Sunak, health and social care secretary Steve Barclay and leaders from both sectors.

Extra funding ‘welcome but not enough’

Council leaders welcomed the funding but said it did not go far enough.

“There is no doubt that this winter will be extremely challenging for those needing or working in social care with increased needs and an increasingly unhealthy population,” said Association of Directors of Adult Social Services president Beverley Tarka. “Every bit of extra funding helps.”

“But to solve pressures in the long term we need to provide more care at home to prevent more people getting ill and needing hospital in the first place as well as decent pay for the care workforce and support for unpaid carers. That will take a long-term plan, with long term increases in funding to provide the care and support older and disabled people need and to support us all to live and work and care.”

Her comments were echoed by NHS Providers’ director of policy and strategy, Miriam Deakin, who said: “The £40m for local authorities to boost social care capacity, reduce admissions and to tackle delayed discharges will similarly be welcomed but the government must also take a long, hard look at the fundamental long-term challenges facing social care rather than trying to get by through short-term quick fixes.”

By Mithran Samuel and Dan Parton

Adults’ services teams have cut care and assessment waiting lists by 60,000 since last summer and are arranging more home care, but continue to struggle with mounting need.

That was the message from the Association of Directors of Adult Social Services (ADASS) today as it released the results of its spring survey of member councils.

Directors reported that 434,243 people were waiting for assessments, care packages, direct payments or reviews as of 31 March 2023, down 12% on the 491,663 ADASS recorded for the end of August 2022*.

Councils also commissioned 30% more home care hours from January to March 2023 (54.5 million) than April to June 2022 (42.1 million).

This was amid a halving in the number of hours not delivered due to a lack of staffing capacity, to just over half a million.

Increase in care ‘not keeping pace with need’

ADASS hailed the improvements as a testament to the hard work of adults’ services teams as well as the consequence of £700m in short-term government winter money to fund care packages for people so they could leave hospital.

However, the association warned that the increases in care being delivered were not keeping pace with rising levels of need.

Despite the fall in waiting lists, the number waiting more than six months for an assessment remained stubbornly high, at 82,087 as of the end of March, up 1% on August 2022.

Most directors reported rises in the number of referrals from hospital (81%) and the community (70%), during 2022-23, with large majorities seeing increases in those presenting with mental ill health (81%) or in relation to domestic abuse (64%).

Increased complexity of need

At the same time, three-quarters said the average size of care packages for people discharged from hospital had risen over the previous year, while two-thirds said the same about those referred from the community.

This was reflected in the fact that the three biggest cost pressures directors said they faced in 2023 were increases in the unit price of care packages due to the complexity of people’s needs, unspecified other reasons and staffing costs, respectively.

The latter has been driven by the 9.7% rise in the national living wage (NLW), from £9.50 to £10.42 an hour in April, which ADASS said would load almost £1.8bn in direct and indirect costs on council adults’ services departments in 2023-24.

Though the association said it supported a higher wage floor than this for care staff, it stressed the government needed to fully fund it.

Councils overspent and requiring more in savings

While councils budgeted to increase spending from £16.5bn to £17.7bn in 2022-23, they still overspent overall by £74m, ADASS found.

And though authorities have significantly increased budgeted spend in 2023-24, to £18.9bn, directed reported that they would have to make more savings this year – £806m, up from £597m in 2022-23.

The survey also uncovered evidence of costs being passed from the health service to local authorities due to reductions in people qualifying for NHS continuing healthcare.

ADASS said 79% of directors reported a trend in the NHS reviewing CHC recipients’ needs and finding they no longer qualified, resulting in councils having to fund their care.

As of the end of March 2023, 50,650 people were eligible for CHC in England, down 6% on a year previously, according to official figures from NHS Digital.

Adults’ teams’ hard work praised

“Our findings show that a short-term funding boost from the government and the hard work social care teams have done to rebuild services after the pandemic is making a difference to thousands of people needing support and care, but we’re not out of the woods yet,” said ADASS president Beverley Tarka. “Leaders tell us they are paddling hard to keep up against a tide of increasing and complex needs.”

Tarka said that adult social care needed “a long-term plan for investment” along the lines set out by the ADASS-commissioned roadmap for reform published in April.

That called for care worker pay to be raised, charges for services cut and people to be provided with clear rights to support as part of a shift to a more personalised, accessible and fair system.

Government hails cut in waits

In response to the ADASS survey, a Department of Health and Social Care spokesperson hailed the cut in waiting lists, adding: “We have reduced waiting times, as the survey shows, and this comes despite challenges posed by the pandemic and rising inflation.

“We’re going further by providing up to £7.5bn for social care over the next two years to put the system on a stronger financial footing and help local authorities address waiting lists, low fee rates and workforce pressures.”

While the government is investing more in adult social care from 2023-25, some in the sector have criticised the “up to £7.5bn” figure as misleading on the grounds that:

• £3.14bn has been recycled from the delay to the two-year delay to the social care charging reforms – including the cap on care costs – the government announced last year.
• Some of this £3.14bn is to be shared with children’s social care.
• £1.6bn is reliant on how much authorities can raise through council tax.

The spokesperson also said the DHSC remained committed to its 10-year reform plan for the sector set out in its 2021 white paper, People at the heart of care.

This pledged £1.7bn, from 2022-25, to invest in the workforce, technology, carers’ breaks and housing with care, among other things.

However, the DHSC was heavily criticised after a follow-up paper, published in April this year, cut in half the £500m allocated to the workforce and said that £600m of the £1.7bn remained unallocated.

In its report today, ADASS said this money needed to be ploughed into the sector now.

*The March 2023 figure is based on a more complete sample of councils (142 of the 153), whereas the August 2022 figure was based on responses from 115 authorities.

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Beverley Tarka this week became the first black president of the Association of Directors of Adult Social Services (ADASS) since its establishment in 2007.

Taking the helm at ADASS at its annual spring seminar this week, the importance of her appointment – and her position as a role model for others – was not lost on Tarka.

Three in ten of the social workers whom Tarka and her colleagues lead are black, Asian or from an ethnic minority, but this diversity is not reflected in adults’ services’ leadership cadre.

Being a role model

“I think it’s very important,” she tells Community Care. “I want to have a focus on inclusion and diversity. That visible leadership role acts as  a role model for people in the field and even people outside the field of social care. If you see black women in leadership positions people understand they can do that.”

Tarka’s appointment also stands out for another reason. Director at Haringey council for the past eight years, she has been with the London borough, where she also lives, for 30 years, the length of her social care career.

This is rare among adults’ or children’s services leaders, who often move between authorities as they climb the leadership ladder. So why has Tarka stayed put?

“If I was being flippant, I would say I hate commuting,” she jokes before referring to the “vibrancy and diversity of the community”, 43% of which is non-white, according to the 2021 census.

Beyond that, she feels a debt of gratitude to an authority she says has invested significantly in her career since she joined as a residential social worker three decades ago.

“I started at a time when there was quite significant investment from local authorities,” she says. “I was fortunate to qualify as a social worker and then did a masters in strategic leadership. Before austerity, there was much more financing available for learning and development.”

Family inspiration

Much of her career was spent working with adults with learning disabilities, a reflection of the fact that her career in social care was inspired by her own experience caring for her brother, who has profound and multiple learning disabilities.

She had been working in Nigeria writing feasibility studies about agricultural finance but was called back to the UK after her mother – her brother’s main carer – fell ill.

Tarka referred to the formative nature of this experience in her presidential speech at the spring seminar.

“These personal experiences were my introduction to seeing the world through the lens of my mother, an “informal carer” and this has undoubtedly influenced my choice to pursue a career in social care,” she said.

It has also influenced one of her top priorities for her presidential year, improving support for carers.

“As a society we have asked a huge amount of carers, and during the pandemic we asked more again,” she said. “They rose to the challenge – as they always do – but they are now utterly exhausted. We owe them not just our thanks, not just our respect, but real, meaningful support that will help them carry on and will give caring the status it deserves.”

Roadmap for change

ADASS has long advocated improving funding and support for carers, and for the social care system more generally. But it has now been provided by a clear blueprint for how to do this, in an independent report – known as the roadmap – published for the association this week.

While ADASS is not signed up to every dot and comma of the report – produced by policy consultants Anna Dixon and Kate Jopling – it supports the broad thrust of its agenda of a shift to a more personalised, accessible and fair adult social care system.

This will be the basis of the case it will be making to government for how it invests in, and reforms, the system over the coming years.

It is an optimistic vision – based significantly on that articulated by Social Care Future: “We all want to live in a place we call home, with the people and things we love, in communities where we look after each other, doing things that matter.”

Ongoing challenges

But it comes with the sector in as challenging a position as it has been in many years, the legacy of austerity, Covid and the cost of living crisis, set against the backdrop of an ageing population and the increased lifespan of many disabled people.

Low pay and challenging working conditions have made it increasingly difficult for providers to recruit and retain staff. Councils – with rising vacancies for social workers and occupational therapists – have struggled to manage pressures at their front door, leaving about 500,000 people waiting for assessments, reviews or care. And, as Tarka articulated, carers are under severe pressures, leaving many on the brink of being unable to do their job.

While the government has hailed record funding for adult social care from 2023-25, it has, at the same time, cut – at least for the time being – that available for reforming services and investing in the sector.

At the same time, much of the resource it has provided is directed towards clearing hospital beds, rather than the vision of social care as a vehicle for better lives.

Glass half-full

Tarka appears to be taking a glass half-full approach to this issue.

On taking up the presidency, she says: “It’s daunting – but exciting at the same time. The roadmap gives us a tool, a resource to support a narrative with government. We want a shift from the dominant narrative around hospital discharge. It’s helpful to have a resource to frame that narrative and have a platform to take forward the work we’ve done.”

However, she says that, with the many pressures and priorities facing the government, ADASS and the social care sector more widely needs to make their case to the public if it is to succeed.

While a recent ADASS survey found members did not see this as important, Tarka says this is the best way to influence government, particularly with a general election due in the next 18 months.

Making social care’s case to the public

“Social care touches all of our lives, whether you’re a person with care needs or you have a relative with care needs,” she says.

“I’m not sure we’re doing enough to articulate how important it is in the public perspective. The government will listen to the public. And stories are rich and tell a thousand words.”

ADASS will continue to make the case for more funding and she is also focused on improving the wellbeing of the workforce that it is the beating heart of the sector, including social workers.

This was one of the areas that the government has cut planned support for in its scaling back of its reform plans.

“We’ve been through a tough time through Covid and have significant workforce challenges in terms of recruitment and retention,” she adds. “I think there’s something for me in having a really well-developed social workforce strategies and supporting the health and wellbeing of our workforce.”

Hospital social workers should be reinstated onto wards to support people to achieve better outcomes on discharge, amid the current severe pressures on the NHS and social care.

That was the message today from the Adult Principal Social Worker Network in an open letter to health and social care secretary Steve Barclay.

The letter, which has been backed by the British Association of Social Workers (BASW) England, warned that a lack of social work assessments prior to discharge was leading to people ending up in the wrong place, reduced independence and lower quality of life.

The PSW network’s intervention comes on the back of  the number of medically fit people awaiting discharge reaching 14,000 in early January – the highest level on record – due to a lack of social care, community health and other services to support them on their return home.

In an effort to clear beds, the government has provided £700m from December 2022 until March 2023, mostly for the NHS, though chiefly to fund social care services, with the latest £200m tranche of this – announced last week – reserved for care home provision.

Risks of ‘poor or potentially illegal practice

This has prompted criticism from other social care leaders, with the Association of Directors of Adult Social Services (ADASS) warning this week that it risked “poor or potentially illegal practice” through people ending up permanently placed in care homes without informed consent.

The PSW Network raised similar concerns in its letter, saying people were being discharged to care homes when they recovered best at home, supported by their networks and communities.

“We are concerned that people leaving hospital are ending up in the wrong places, with the wrong support, away from the people and things that are important to them which means they are at increased risk of a slower recovery and a potential unnecessary return to hospital,” network co-chairs Hannah Scaife and Sarah Range told Barclay.

“We know that people are able to remain independent for longer and have a better quality of life when they can return to their own homes.”

Hospital social work assessments ‘key to right outcomes’

On behalf of the network, Scaife and Range wrote that a social work assessment in hospital was “key to ensuring that a person gets to the right place for them, with the support that they need”.

However, hospital social work assessments have become much less prevalent since the national rollout of the discharge to assess (D2A) model in 2020, at the start of the pandemic.

The model is designed to ensure people are discharged when medically fit, mostly to their own homes, though in some cases to bed-based services, where any short-term needs will be met and their independence maximised pending an assessment of any longer-term social care needs.

Department of Health and Social Care (DHSC) guidance on discharge states that hospital social workers have a “vital role as members of a multi-disciplinary team, ensuring a person-centred and strengths-based approach is adopted during pre-admission, hospital stays and planned safe discharge”. This was particularly so for people with complex social circumstances.

The DHSC has also said that social workers and other social care staff should carry out “limited assessments” on wards prior to discharge.

Impact of reduced social work involvement

However, the PSW network’s letter stated: “We know that the absence of social work assessments is increasing stress for care providers who have inadequate information for their care plans, causing trauma for carers and families who are not involved as they should be in decision-making and who end up picking up the pieces from our broken system.”

For BASW England, professional officer Denise Monks said: “BASW wholeheartedly agrees that social workers in hospitals needs to be revived.

“Historically, social workers based in hospitals helped prevent people being readmitted to hospital by timely interventions to review existing care packages or mobilise support from families and others in the person’s network, meaning a person can be safe to return home from hospital directly from A&E to receive community health.

“We need to get back to this multi-disciplined approach and sharing of knowledge to avoid overuse of the medical model. Quite simply, social workers need to be able to work with people before they are discharged from hospital and assess their social care needs going forward ensuring the move is very much ‘person centred’ and not one size fits all.”

Practitioners on wards ‘essential’

For ADASS, chief executive Cathie Williams said: “Social workers in hospitals are essential to ensure that, at the very least, safeguarding and mental capacity issues are addressed properly and to ensure that discussions are held about the options and implications of different places for care and if needed longer term time for assessment and planning.

“Without social workers in hospital to do this, there is a high risk that too many people will be persuaded, deceived or led to believe there is no option but to move into residential care where there are shortages for care at home.  There is evidence that such discussions – setting out options and listening to what matters to people  – result in less or less expensive care options.”

She added that D2A could work so long as there was “sufficient staffing capacity in local systems for people to be discharged to recover, rehabilitate, and then, if longer term care is needed, to talk with social workers to assess and plan for their futures, weighing up the benefits, risks and costs of different options”.

Leaders urge recovery focus

The focus of the PSW network’s letter was reflected in a paper published yesterday by ADASS, the Local Government Association and the NHS Confederation, which represents health leaders.

This called on the government to fund the full implementation of a “recovery model” in health and social care, designed to maximise independence and quality of life and thereby prevent hospital admissions.

This stated that adult social care and NHS staff should “jointly review all people being discharged from hospital to make sure that they have the information to make informed choices about the risks and benefits of different options and ensure that any ongoing treatment, care and support is appropriate, with the aim of regaining independence, confidence and connectedness”.

The DHSC has been approached for comment.

“Things have never been so bad,” for people needing care, carers and staff, the president of the Association of Directors of Adult Social Services has warned.

In a speech to the National Children and Adult Services (NCAS) Conference yesterday, Sarah McClinton said the sector had been left with “no certainty, no plan and increasingly little time”, as it entered a challenging winter.

This was in the context of councils running waiting lists of 542,000 for assessments, personal budgets or reviews, as of April this year, according to ADASS figures, and the wider sector having lost 50,000 care staff during 2021-22.

‘Staggering’ level of unmet need

“The scale of how many people are either not getting the care and support they need, or are getting the wrong kind of help, at the wrong time and in the wrong place is staggering,” McClinton told fellow sector leaders.

“It is also adding to the endless pressures we see with ambulances and hospitals, and adding to the pressures we see in our communities, [including] more people requesting help with mental health and domestic abuse, [and] 2.2 million hours of home care [that] couldn’t be delivered in the first quarter of this year. We see unpaid carers at breaking point and people unable to afford the support they need.”

In September, the government announced £500m for adult social care to help speed up hospital discharges – to relieve NHS pressures – and bolster the care workforce.

However, it is yet to decide how the funding will be distributed – including how far it will be allocated through councils or NHS integrated care boards – let alone provide it to local leaders.

£500m the latest ‘sticking plaster’

McClinton said the money needed to be provided urgently.

However, echoing the language of other sector leaders, she said it was latest of a number of “sticking plasters” that the sector had received over many years, leaving fundamental problems unaddressed.

“If we added together all the sticking plasters, we have seen over the past 10 winters, we could at least have invested in one proper bandage, and we might have started to heal the wound,” she added.

As the government considers delaying its proposed reforms to the adult social care charging system – including the cap on care costs and a more generous means-test – McClinton said there were “sound reasons” for this.

However, while the government sees the measure as saving money, with the reforms costing £771m in 2023-24, ADASS, like the Local Government Association and the County Councils Network, have said the money should be retained to invest in the sector.

Reform funding ‘should be retained and increased’ 

In a recent statement, ADASS chief executive Cathie Williams said: “By guaranteeing funding already allocated for reforms next year, and indeed increasing it significantly, the government could facilitate further investment in care workers’ pay and conditions, enable more people to receive care at home, improve support for unpaid carers and initiate more intermediate care schemes to avoid people going into hospital or staying there longer than necessary.

“These are the priorities if we are to avoid a spiralling rise this winter in the numbers of people going without the care and support that they need or having too little of it.”

McClinton also highlighted the risks in delaying the reforms, suggesting it would leave the question of the balance of responsibility for paying for care between the state and the individual unresolved.

“But if we don’t get to the starting line of resolving who’s paying for care, we’re never going to get to the first hurdle – let alone get over it,” she added. “As I said earlier, it’s all about the long term, and the scale of the challenge needs long term plans with long term investment.”

Social care ‘a top priority’

In response to McClinton’s speech, a DHSC spokesperson said: “Social care is a top priority and we are committed to bolstering the workforce and protecting people from unpredictable care costs.”

The latter is a reference to the objective of the cap on care costs – which will limit people’s liability for personal care costs deemed eligible by their local authority to £86,000 over their lifetime.

To implement the reforms, a related measure to ensure councils pay providers a fair cost of care and wider improvements to the sector, the government has allocated £5.4bn from 2022-25.

The spokesperson said this funding would be retained, alongside the £500m for the winter for hospital discharges, which local health and social care leaders would be able to use flexibly.