England’s adult social care sector is teetering on the brink of collapse as inadequate government funding and soaring costs push providers to their limits, according to a dire warning from the Nuffield Trust. The healthcare think tank cautions that large swaths of the care market are at risk of failure, jeopardizing the quality and availability of support for hundreds of thousands of vulnerable people.
A Decade of Cuts Takes Its Toll
The current crisis is the culmination of a brutal decade of austerity measures and funding shortfalls. Successive governments have slashed budgets for local authorities, who are responsible for commissioning social care services. This has left councils struggling to pay care providers enough to cover their costs, let alone invest in improving services.
An analysis by the BBC found that council spending on adult social care fell by 3% in real terms between 2010-11 and 2019-20, despite rapidly growing demand as the population ages. Over the same period, the number of adults receiving long-term support from their local council declined by a staggering 23%.
We’re beyond the point where these problems can be papered over with short-term fixes. Underfunding is now so deeply entrenched that we’re seeing care providers handing back contracts and closing down services because they simply can’t afford to operate.
– Natasha Curry, Deputy Director of Policy, Nuffield Trust
Spiraling Costs and Workforce Woes
On top of the long-term funding squeeze, care providers are now grappling with unprecedented cost pressures. The Nuffield Trust estimates that recent increases in the national insurance tax and the national living wage could drive up costs for private and non-profit providers by a staggering £2.8 billion.
Chronic underpayment and tough working conditions have also fueled a dire staffing shortage in the care sector. Skills for Care calculates that on any given day, there are around 165,000 vacant posts – a vacancy rate of over 10%. Remaining staff are overstretched and at high risk of burnout.
Working in care has always been challenging, but it’s getting harder and harder to deliver dignified, person-centered support with such limited resources. I regularly work 12 hour shifts without a proper break because we just don’t have enough staff. It’s not sustainable.
– Jessica, Care Worker, North London
A Shift to Unregulated Agencies
As regulated providers buckle under financial strain, there are signs of a concerning shift towards the use of unregulated “introductory” care agencies. These agencies face lower overhead costs as they are not subject to the same rigorous training, oversight, and quality assurance standards.
While this may seem like a tempting way for commissioners to stretch limited funds further, experts warn it is a dangerous false economy. Without robust safeguarding and monitoring measures in place, the risk of abuse or neglect rises sharply.
The growth in off-the-books care is a ticking time bomb. Regulators have no way to ensure staff are properly vetted and trained, or that people’s basic rights are upheld. Trying to cut corners like this undermines the whole integrity and safety of the system.
– Simon Bottery, Senior Fellow, The King’s Fund
A Drag on the NHS
The unraveling of the social care sector doesn’t occur in isolation – it places significant strain on the already overstretched NHS. When older and disabled people can’t access the care they need to live independently, they are more likely to suffer avoidable deteriorations in their health, leading to emergency hospital admissions.
Once in hospital, a lack of social care packages can make it unsafe to discharge recovering patients back home, leading to lengthy delays. In 2021-22, an estimated 2.2 million hospital bed days were lost due to delayed discharges, costing the NHS over £500 million.
Calls for Urgent Government Action
Campaigners argue the impending implosion of the care market is not inevitable, but will require urgent government action to reverse years of underfunding and neglect. Key priorities include delivering a substantial, sustained increase in funding, with the Health Foundation calculating an extra £7.7 billion a year is needed by 2024 just to stabilize the current system.
Improving pay, conditions, and career progression opportunities for care workers is also vital for building a sustainable workforce. The upcoming social care white paper is expected to include measures to enhance training and registration of care staff, but unions say investment in wages must come first.
We’ve heard endless promises of reform, but what’s needed now is cold, hard cash. Fixing social care won’t be cheap, but the cost of continuing to prop up a broken system is far greater – both in terms of the impact on the NHS and the suffering of the people caught in the fallout.
– Caroline Abrahams, Charity Director, Age UK
As the government prepares to unveil its long-awaited proposals for social care, the sector is holding its breath. Many fear that without a genuine commitment to transformative change, backed by adequate resources, the market will pass the point of no return – with devastating consequences for all who rely on it.
