More than £1 billion committed to reforming adult social care system has been diverted to other care priorities, NAO report finds

More than a billion pounds of the £1.7 billion committed to reforming the adult social care system in December 2021 has been “diverted to other care priorities”, a new National Audit Office (NAO) report has revealed.

Reforming adult social care in England found that only £729 million may now be spent between 2022 and 2025 on reforming the adult social care system, representing a 58% fall in the budget.

The report was carried out to review the Department for Health and Social Care (DHSC)’s progress with delivering the reforms set out in the 2021 white paper.

It was observed that rising inflation “compounded long-standing pressures” and led DHSC to reprioritise money and activity to provide local authorities and care providers with “much needed financial stability”.

The report notes that the sector remains challenged by “chronic workforce shortages, long waiting lists for care and fragile provider and local authority finances”.

The NAO warned that the care system remains under “significant pressure”, despite some recent signs of improvement.

In a June 2023 survey by ADASS, 17% of directors with responsibilities for social care responded that they were not confident that they could meet their statutory duties for care in 2024-25.

Further, vacancies in adult social care in England have increased by 173% in the past decade and stand at around 152,000 (a 10 per cent vacancy rate), the report revealed.

The NAO found that DHSC does not have a long-term funded plan for transforming adult social care.

“The department’s Next steps paper, published in April 2023 which contained high-level plans for system reform – does not go beyond the current spending review period”, said researchers.

Making recommendations for improvement, the NAO said the DHSC should:

• Assess the impact of its current and planned reform interventions on local authorities and seek stakeholder views to ensure its plans are manageable.
• Set out a costed plan for implementing charging reform from October 2025, and map the funding required to deliver its planned reform outcomes.

Head of the NAO, Gareth Davies said: “Adult social care reform has been an intractable political challenge for decades. Government has set out its ambition to meet this challenge and now needs to demonstrate how it is delivering on these plans.

“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.”

Responding to the report, Cllr David Fothergill, Chairman of the Local Government Association (LGA) Community Wellbeing Board said: “This report provides helpful insight into the current situation and framing of adult social care reforms.

“Adult social care remains in a precarious position, with overstretched budgets, significant unmet and under met need, and remaining instability within the provider market.

“We support NAO’s recommendation that DHSC must assess the impact of its current and planned reform interventions on local authorities and consult with stakeholders to ensure its plans are manageable.”

A Department of Health and Social Care spokesperson said: “We remain committed to reform and are investing up to £700 million over this year and next to make major improvements to the adult social care system. This includes £42.6 million to support innovation in care and increasing the Disabled Facilities Grant by £50 million.

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

Lottie Winson