The State of Care: The Government Must Listen to People’s Experiences and Act Now

In the aftermath of the PM’s resignation, the National Care Forum (NCF) is continuing its call for urgent government intervention to tackle the deepening adult social care workforce crisis, and a commitment to previous pledges and funding, as outlined in our letter to the Chancellor earlier this week.

The renewed call comes after the Care Quality Commission (CQC) published its annual State of healthcare and adult social care in England report which makes grim reading. The CQC report describes a health and care system in gridlock at every point and shows how the failures in different parts of the system are impacting upon one another leading to the deterioration of people’s access to and experience of care – in turn resulting in a deterioration of people’s health and wellbeing. In particular, according to the report, ‘many of the challenges services are now facing are linked to historical underinvestment and lack of sustained recognition and reward for the social care workforce’.

The report states:
– The workforce crisis in social care is greater than that of the NHS, with 165,000 vacancies.
– Around 500,000 people are waiting for an adult social care assessment, for care or a direct payment to begin, or for a review of their care.
– In the first 3 months of 2022, 2.2m hours of homecare could not be delivered because of insufficient workforce capacity, leading to unmet need and under-met needs.
– Only 2 in 5 people are able to leave hospital when they are ready to so.
– CQC commissioned a survey of more than 4000 people aged 65 and over who had used health or social care services in previous 6 months:
o Over 1 in 5 people (22%) said they were currently on a waiting list for healthcare services.
o 37% on a health waiting list did not feel well supported by health and care services
o 41% said their ability to carry out day-to-day activities had got worse while waiting
o Of those waiting for a care needs assessment, 57% said they felt very or fairly well supported while waiting but 36% said they felt they were not very well or not at all supported.
o 40% of those waiting for a care needs assessment said that their ability to carry out day-to-day activities was now worse than when the assessment was required, while 15% said it was better.
– There is unequal access to health and care services for ethnic minorities and people with learning disabilities and autistic people.

Professor Vic Rayner OBE, CEO of the National Care Forum said:
“This report, like so many others, highlights starkly the real impact on people when social care is underfunded and under resourced. Recognition of the heroic efforts, dedication and hard work of the care workforce to continue to support people in very difficult circumstances despite all the pressures is welcome. However, despite the backdrop of the current political turmoil, the government cannot continue to ignore the very real human impact on the millions of people who need care and support and the people working relentlessly every day to provide it.

“The possibility that the Chancellor is planning to delay social care reform and impose spending cuts is disastrous, especially given current pressure on the NHS and the looming winter pressures. This will impact on the already ‘gridlocked system’ CQC identified. Equally, failing to increase public spending on social care in line with rising costs and ignoring the urgent need to inject funding into the workforce is unthinkable.

“Good quality and well-resourced social care is essential if local health and care systems want to unlock the current gridlock we are facing across hospitals, and the ambulance service and across communities, health and care services. As Healthwatch say, people are losing confidence that the health and care system will be there to support them when they need it most.

“Even more importantly, good quality and well-resourced social care is also preventative in nature, supporting people to retain their independence for longer and reducing demand on the wider health system.

“It is imperative that any new PM guarantees the reforms contained within People at the Heart of Care, as well as bring forward the necessary funding.

“The CQC report also outlines the role Integrated Care Systems (ICS) have in dealing with the gridlock in the system. We call on the CQC and government to ensure that the voices of adult social care providers, and those accessing their services, are given a role on the Integrated Care Boards and Integrated Care Partnerships to avoid everything being seen through a clinical lens, and shift the focus to prevention and what people actually want from their health and care system.

At this pivotal time in our nation, the NCF has a number of asks:
• For the Chancellor to make good on his convictions and guarantee additional funding for adult social care in line with the findings of the Health and Social Care Select Committee’s recommendations and the Prime Minister’s pledge of £13bn
• For the new PM to commit to the reform of adult social care as outlined in People at the Heart of Care, and provide the funding to fully realise this to ensure people are able to access high quality services when they need them.
• Bring forward a fully funded, workforce plan, with pay progression in line with the NHS, making provision for better terms and conditions, training and career structures.
• Guarantee that adult social care providers are defined as a vulnerable sector as part of the Energy Bill Relief Scheme following April 2023
• Guarantee that those people accessing adult social care support will still be able to access a version of the Energy Price Guarantee following April 2023
• Ensure adult social care providers, and those they support, are given a formal role at the strategic levels of the Integrated Care Systems.