Social care reform plans have once again gone awry, MPs say

Initiatives to support the workforce have so far only been short-term, while a long-term and comprehensive workforce plan is lacking, the Public Accounts Committee said.

Its report, published on Wednesday, stated that MPs “remain unconvinced” about whether the department knows if it is achieving value for money from additional funding going to adult social care.

They criticised “patchwork funding and short-notice announcements” which they said “hinder the sector’s ability to plan for the long-term and risks undermining delivery of the department’s 10-year vision for adult social care”.

In 2019, then-prime minister Boris Johnson promised to “fix the crisis in social care once and for all”.

But the committee noted that the department has delayed charging reform – changing the way people pay for care – from October 2023 to October 2025, and scaled back short-term system reform plans – improvements to the wider adult social care system – having, by October last year, slashed the budget from £1.7 billion to £729 million for 2022–23 to 2024–25.

The report said: “Two years on from its long-awaited white paper People at the heart of care – a 10-year ‘vision’ for adult social care – plans for reform have once again gone awry.

“Charging reform is delayed, system reform scaled back and funding for both has been diverted, including from areas such as supported housing, towards addressing urgent pressures.

“Meanwhile, waiting lists are rising, workforce vacancies exceed 150,000 and local authority finances are under sustained pressure.”

Among their six recommendations, MPs on the committee said the department must set out how it is assuring itself that funding such as £1.6 billion to help speed up hospital discharge through the Better Care Fund and £1.1 billion new grant funding to local authorities through the Market Sustainability and Improvement Fund (MSIF) “is achieving value for money, including on benefits in relation to costs”.

It also urged the department to set out what it is doing to prepare for the next spending review and make the case for more stable funding, as well as what it can do to give local authorities greater certainty over funding to allow them to plan for the longer term.

MPs said local authorities are currently having to plan and commission adult social care services “against a backdrop of fragmented and uncertain funding”.

The committee said the department had “still not produced a convincing plan to address the chronic staff shortages (in social care) in the long-term” and requested that it must set out “how it will lead the sector to identify and address workforce challenges”.

MPs said they welcomed plans previously announced to professionalise the workforce, but that this “falls short on providing leadership on pay and ensuring parity of esteem with equivalent NHS roles”.

MPs accused the department of having “no roadmap for achieving its 10-year vision for adult social care, or any targets or milestones beyond 2025”.

It said a road-map must be set out “pulling together all its reform activity (system reform and charging reform), and the risks to delivery with key performance indicators and should publish six-monthly updates on progress to time and budget”.

Calling for the department to bring together its performance and inspection data relating to adult social care, MPs said they “remain concerned about under-representation of adult social care in health-dominated systems and are deeply sceptical about the feasibility of integrating health and care when they are funded so differently”.

Committee chairwoman Dame Meg Hillier said: “While an NHS-style workforce strategy for social care may not be feasible, the DHSC (Department of Health and Social Care) must set out how it will provide leadership across the sector to identify and address workforce challenges.

“Whilst we welcome the increase in funding, we fear this will do little to address the key challenges faced by the sector in the absence of a well-funded multi-year strategy.

“A 10-year vision is all well and good, but this alone is not enough to bring about the fundamental changes this sector so desperately needs.”

The Local Government Association (LGA) said it strongly supports the call for long-term financial support and certainty, as it described the sector being in “a precarious position, with overstretched budgets, significant unmet and under-met need, and remaining instability within the provider market”.

The Nuffield Trust health think tank said the committee had delivered “a scathing judgment on the Government’s progress” and backed a call for the department to “provide clarity on how it intends to deliver change”.

Care England, which represents providers, said the Spring Budget this month had “made it clear adult social care is not high on the Government’s agenda” and added that “the gauntlet has been thrown by this report”.

Its chief executive Professor Martin Green said: “We need accountability and responsibility to rise to the challenge.”

Caroline Abrahams, charity director at Age UK, suggested that “rather than painting an overly gloomy picture, the Public Accounts Committee’s report may actually be understating the challenges facing older people in need of care, and those whose job it is to commission and provide it”.

A DHSC spokesperson said: “We are committed to reforming adult social care and have invested up to an additional £8.6 billion over two years to meet the pressures facing the sector, grow the workforce and improve hospital discharge.

“The report rightly acknowledges progress to boost care workers’ career progression and training to improve retention, including through a new accredited qualification.

“To drive forward our vision for reform, we are also investing up to £700 million on a major transformation of the adult social care system, which includes investing in technology and adapting people’s homes to allow them to live independently.”