Watchdog slams government delays over key social care reforms

The National Audit Office (NAO) has warned that, two-years into its 10-year plan to overhaul adult social care, the government has delayed major workforce reforms.

“If government is to successfully reform adult social care, it will need to manage some significant risks”

Gareth Davies

These delays included plans to develop training opportunities and support the wellbeing of staff, noted the NAO in a report looking at reforming adult social care in England, which was published today.

The NAO report warned that workforce shortages and growing waiting lists were making it harder to deliver on key promises for adult social care.

In September 2021, the Department of Health and Social Care (DHSC) committed £5.4bn funding for adult social care over three years, from 2022-23 and 2024-25. Of this, 1.7bn was for system reforms.

The government went on to publish its People at the Heart of Care white paper in December 2021, which set out a 10-year vision for adult social care and provided more detail on how the money would be spent.

But the NAO report noted that, during 2022, rising inflation and concerns over delayed discharge had forced DHSC to reprioritise and focus on easing immediate pressures and stabilising the sector.

It revealed that, after finalising its budgets, the DHSC had reallocated over a billion pounds of its initial £1.7bn to other care priorities.

The report noted that now, only £729m may be spent between 2022 and 2025 on reforming the adult social care system – representing a 58% fall in the budget.

The NAO analysis follows a DHSC announcement earlier this year, which revealed the government had halved the allocations for workforce reforms set out in the white paper, down from £500m to £250m.

This money was originally supposed to go towards initiatives around training, qualifications and the wellbeing of social care staff, including social care nurses.

The NAO warned that, since the publication of the white paper and revisions made to it in the Autumn Statement 2022, the DHSC had “made less progress than it expected on system reform” of social care.

In addition, it said that the DHSC had failed to establish a programme to ensure that it could measure its progress, and see whether it was on track to deliver objectives.

The report found only two out of eight promised workforce projects had been delivered – supporting international recruitment and adult social care volunteering. The remaining six were in development.

The report comes as figures suggest there are currently 152,000 vacancies in the adult social care sector in England.

Meanwhile, the NAO said the government had delayed the delivery of its most expensive reform – to fund enhanced training and development of the workforce through care providers – because it had not yet been able to set up a system to administer payments to providers.

It noted that the DHSC had also not made any policy commitments about the number of people who may be supported by this additional funding, which is now expected to be launched in spring 2024.

Additionally, the development of the care workforce pathway, which includes a new career structure for the sector, has been delayed, according to the report.

The NAO also warned that the government did not have a long-term funded plan for transforming adult social care.

It said that the DHSC’s Next steps paper, published in April this year and which contained revised plans for system reforms, did not go beyond the current spending review period.

As such, the watchdog concluded that the government had much to do if it was to achieve its 10-year ambition for reforming adult social care.

The NAO called on the DHSC to assess the impact of its current and planned reform interventions, and seek stakeholder views to ensure its plans are manageable.

In addition, it urged the department to ensure that it has the resources to deliver reform, and called for it to publish a long-term plan mapping its activity and the funding it will need to achieve these outcomes.

Head of the NAO, Gareth Davies, said: “If government is to successfully reform adult social care, it will need to manage some significant risks, including its own capacity and that of local government to resume charging reform activity alongside system reform.

“To maximise its chances of succeeding, government will need to ensure it understands the impact of its ambitions on local authorities and other stakeholders and establish a costed plan which ensures delivery of its long-term goals.”

“Despite bold promises, we have seen social care yet again deprioritised”

Natasha Curry

Responding to the report, many health and care leaders noted how it laid bare the reality of chronic underfunding facing the adult social care sector.

The Royal College of Nursing’s director for England, Patricia Marquis, said: “Yet another report shows our health and care system buckling under the pressures brought about by years of neglect.

“Now we’re seeing the government backtrack on previous pledges meaning more people forced to pay privately for longer,” she said.

She warned that, just a day after NHS data revealed that the NHS waiting list had hit a 7.8m high, health and care leaders have had to learn of the “catastrophic failure” to invest in a social care system.

“Government must grasp the nettle, deliver the promised reform of social care funding, raise standards, and recognise the value of the professionals working in it,” she added.

Meanwhile, the deputy director of research at the Nuffield Trust, Natasha Curry, said: “The NAO report paints a bleak picture of the state of reform in the adult social care sector.

“[It] is a damning indictment of the government’s progress towards delivering change,” she said. ”Despite bold promises, we have seen social care yet again deprioritised.”

Ms Curry warned that unstable and sporadic funding had created a pattern of “short-termism” that had “undermined any attempts at long-term strategic planning”.

“We have repeatedly called for a long-term vision for adult social care, backed with a clear strategy for how to get there, and crucially, the funding certainty that moves away from short-term pots and gives the sector the stability it so desperately needs,” she said. “Today’s report adds further weight to that call.”

A Department of Health and Social Care spokesperson said: “We remain committed to reform and are investing up to £700m over this year and next to make major improvements to the adult social care system.

“This includes £42.6m to support innovation in care and increasing the Disabled Facilities Grant by £50m.

“Additionally, we have made up to £8.1bn available to help local authorities tackle waiting lists, low fee rates, and workforce pressures, £570m of which will help local authorities improve adult social care provision, in particular by boosting the workforce.”