Adult social care

Funding gap

Since 2015, the government has relied on a “cash-crisis-repeat” model to fund adult social care, while long-term reform is repeatedly abandoned or pared back. Despite announcing an additional 10.4% real-terms rise in spending for 2023/24 – the largest increase for 14 years – the extensive challenges in adult social care mean it’s unlikely to be enough to meet the government’s objectives or address the rising levels of unmet need.

Increased costs and demand

We estimate that spending on adult social care by local authorities and the NHS will rise by £2.8bn in 2023/24 compared to the previous year. However, the 9.7% increase in the National Living Wage, which covers over 60% of care workers, is expected to cost providers an extra £1bn in 2023/24. The rising prices of fuel, food and utilities are also expected to add a further £0.3bn to providers’ costs, while increasing demand for care from both an ageing population and working age adults will add an additional £0.4bn. This leaves just £0.9bn to meet the government’s objectives, including stabilising the provider market, expanding provision of care and supporting hospitals to improve discharge during the winter. It is unlikely that this amount of funding will be able to meet all these objectives. 

Staff turnover

Vacancy rates across adult social care marginally declined from 11% in 2021/22 – the highest annual rate on record – to 10% in 2022/23 (the second highest on record). This was largely down to international recruitment, with care workers placed on a shortage occupation list for immigration, leading to a 150% increase in visas granted to senior care workers. However, annual staff turnover is still incredibly high at 28.3%, rising to 36% for care workers and 44% for nurses, and due in part to poor pay and conditions. An important caveat of this is that 59% of recruitment comes from within the care sector, meaning that a lot of leavers are remaining in the system. There is no long-term workforce plan for adult social care, unlike for the NHS, with estimates that an annual growth rate of 4.9% will be required to meet demand by 2030/31. The annual growth rate between 2012/13 and 2022/23 was just 1.3%. 

Increase in demand

There is also significant evidence of barriers to accessing long-term care in local authorities because of funding pressures, with rates of those receiving it dropping by 6.2% between 2015/16 and 2022/23. This is despite estimates that up to 2.6 million people over 50 in England are living with some form of unmet care need.

The government’s failure on many of these issues leads to worse outcomes for people with care needs, and it’s particularly concerning in the context of expected increases in demand.