The Association of Directors of Adults Social Services (ADASS) has published its Spring Survey 2023: compiling the results of a survey which questioned 153 directors of adult social care across all the English regions. We draw out some of the key messages below.

Homecare

The number of homecare hours that have been delivered has continued to increase by just over 30 minutes per week per person to 13.99 hours. However, 564,584 hours could not be delivered due to a lack of staff. This is equivalent to £14,650,954.8 using the Homecare Association’s calculation for the minimum price for homecare (£25.95 per hour). 

Average hourly rates for homecare were requested for each council area. At the time of completing the survey, the national average hourly rate for homecare was £21.30 (based on 139 responses).

Residential and nursing care

85% of directors either strongly agreed or agreed that funding from the NHS which supports people in care homes with nursing is insufficient to attract and retain sufficient numbers of qualified nursing staff. 

There are a number of consequences for people who use social care services. ADASS suggests the most obvious is that the quality of care homes with nursing perform substantially worse in CQC inspections than any other form of social care, despite making up the smallest part of the regulated social care market. The report also recognises individuals suffer, falling through the gaps where disputes arise between health and social care commissioners.

Unpaid carers

Unpaid carers are being left to pick up the pieces of shortages in health and social care support to the detriment of their own health and wellbeing. Directors are clear that unpaid carers are presenting with increasing levels of need and this is compounded by a reduced ability to meet the needs of carers at this time.

Over two-thirds of directors (68%) reported an increase in referrals relating to carer breakdown. For 2023/24 just under two-fifths of directors (36%) reported that their council is taking a positive investment strategy for carers support, with 63% indicating that they are maintaining investment levels from 2022/23.

Assessments and personal assistants

The number of people waiting for an assessment of their needs, care and support or a direct payment to begin, or for a review of their care plan has increased by 10% from November 2021 to the end of March 2023. Of those people waiting for an assessment of any kind, 82,087 or 36% of people have been waiting for six months or more.

Whilst not asked or reported in the report, difficulties in recruiting personal assistants by people who draw on direct payments from councils to manage their own support are also reported as increasing.

Market sustainability

Care market instability remains a major concern for directors, just as much for providers. Uncertainty about fuel, other costs and availability of staff due to pay rates and career progression is having a direct impact on provider capacity. Overheads are of particular concern for care homes, which is likely to be a direct consequence of spiralling costs for energy, fuel and food. 

The proportion of directors indicating that they’ve experienced closures of care homes or homecare providers has significantly increased over the past year, demonstrating the fragility of the market. In the past six months, a total of 8,334 people have been directly impacted by provider closures, cessation of trading or contract hand backs (an average of 1,389 people per month). Some 3,113 people have been impacted by contract hand-backs by homecare providers in the past six months alone.

Future investment

Whilst some councils are investing in preventative services in adult social care, the focus on meeting the care and support needs of those people with the most complex needs remains the priority within limited resources. In cash terms, £692m of additional funding is required in 2023/24 to meet the same level as the previous financial year.

Directors were asked how they would make savings in 2023/24. Overall, councils are trying to manage the financial challenges by working more efficiently and there is a continued shift towards the use of asset-based approaches (working with older and disabled people to identify their strengths, networks and communities that could support them). 29% of councils (15% more than 2022/23) said that they would be using non-recurrent funding, such as council reserves, to fund their adult social care base budgets. The use of reserves is a one-off and an unsustainable way to fund budget pressures going forward.

The types of accommodation where directors indicated that their councils are making the greatest levels of investment are supported living (45%), people with learning disabilities (43%) and extra care housing (38%). The areas where the largest proportion of directors indicated that their councils are disinvesting are shared lives (17%), extra care housing (15%), and younger adults with mental ill health (14%). Overall, this suggests that demand for extra care housing is more closely tied to local strategy when compared with other types of social care and accommodation.

The report acknowledges the need for the right kinds of support for people at home and in their communities: more social care, and more ‘prevention’, accompanied by investment in community, primary and social care. The report also claims directors know where investment would have the biggest impact on enabling people to live healthier, more independent and connected lives, even if their budgetary pressures are preventing them from funding those areas of delivery.

What this is likely to mean for providers, is that local preferences for certain types of care services will become more entrenched. Whether that's a desire to invest in asset-based and self-help approaches, digital and technology, housing-based models of care or complex health needs, councils will continue to focus on individuals in the greatest need and providers who shout the loudest. Providers who are able to support individuals with more complex needs will be in the strongest bargaining position, whilst others may find themselves inheriting staff and customers as a result of competitors exiting the market.

For a discussion on how to best navigate the upcoming challenges and prepare for winter pressures, please contact our health & social care or local government teams.