Adult social care and the NHS: two sides of the same coin
22 September 2023
An overview of total capacity and national trends across the health and care sector.
Social care
Key points
- Understanding how trends in the social care market shape demand for integrated health and care services across the country is a key challenge for emerging integrated care systems. Social care is, and will continue to be, a critical partner in developing sustainable services, therefore understanding the care provider market and trends in provision is essential. This analysis brings together demographic trends with data on workforce, Care Quality Commission-registered services and funding, to provide an overview of total capacity and national trends across the health and care sector, as well as significant variation across the country.
- This report focuses on demand for and provision of state-funded social care for older people as the largest cohort drawing on care and support, but in considering workforce and market capacity trends, it is important to note need for care and support is also increasing among both working-age adults and children.
- Over the last five years we have seen demand increase, with around 4 per cent more people in England aged 65 and over. Within the state funded sector, requests for care have increased at broadly the same rate with requests per capita remaining broadly consistent. However, nationally, rather than expanding to meet the needs of growing numbers of older people, fewer people are being supported by state-funded social care.
- As a result, large numbers of people aged over 65 are living with unmet needs, relying on informal care or self-funding access to care services. Self-funders make up around 46 per cent of care home residents and account for an estimated £1 in £4 spend on home care provision. Although these individuals do not qualify for state funded care services, they represent a significant proportion of NHS patients living with complex needs.
- Social care can enable people to live independent and fulfilling lives, but too few people have access to it as a result of recent trends. In many areas, there are too few effective, joined up health and care services capable of identifying older people at risk and intervening to help avoid it. We see more urgent care demand, admissions and longer hospital stays. Lack of care availability is also having a significant impact on the ability to discharge older people from hospital. This creates not only poorer outcomes and greater reliance on services, but less acute capacity overall.
- Recent trends in funding, changes in the market and workforce constraints are key drivers impacting social care capacity. Despite some investment in the sector, this has not been consistent or sufficient and due to rising costs has not resulted in increased service provision. Churn in the market has seen residential care home bed numbers falling and increases in home care providers, but not commensurate increases in capacity. Filled posts have failed to keep pace with expanding roles and one in ten posts are vacant, becoming significantly more acute post-pandemic. More recent improvements have been highly reliant on international recruitment.
- The national picture is moving in the wrong direction, however, in some areas this is acutely felt. Unpacking the data by region demonstrates the extent of the variation and individual systems working in very different workforce and market conditions - particularly around constraints to services such as unit cost inflation, workforce capacity proportional to older populations, and overall funding.
- Given its knock-on effect for other factors, the shortfall in social care workforce capacity is a pressing priority. The government should publish an equivalent to the recently released long-term workforce plan for the NHS for social care, setting out how the sector will address existing vacancies and meet future challenges through exploring measures such as a fully funded minimum care wage. While it potentially offers additional workforce resource, overreliance on overseas recruitment will not fix the problem. These actions should sit alongside a long-term settlement, which would give providers, local authorities and the wider sector the clarity and security it needs to focus on long-term planning.
- It is important for individual ICSs to understand need and demand for social care and ageing services in the overall context of the health and ageing profile of the populations they serve. ICSs must prioritise engagement with the adult social care sector, including providers in the private and voluntary sectors to develop a shared and deep understanding of their population and tailored solutions to ensure that all systems are equipped to deliver the right care at the right time.