The Adult Social Care Market in England - Latest report by National Audit Office

Friday, March 26, 2021

The National Audit Office have released their latest report about the Adult Social Care Market in England. The report examines the current care market and the Department of Health and Social Care’s role in overseeing the market now and in the future, with the aim of offering insights and recommendations ahead of future social care reforms. It builds on a significant body of past National Audit Office (NAO) work on care, including on the care workforce; personalised commissioning; and the interface between health and care.

The report provides an overview of the adult social care market, assess market oversight and assess plans for future demand and reform.

Adult Social Care Market in England Key Facts

839,000 number of adults receiving long-term support at some point during 2019-20, arranged by local authorities

£16.5bn net local authority expenditure on adult social care in 2019-20

25,800 estimated number of regulated adult social care locations as at March 2020

30% of the overall care market by number of beds, subject to Care Quality Commission (CQC) market oversight of the financial sustainability of most difficult-to-replace care providers

1.5 million estimated number of people working in adult social care in 2019-20

29% projected forecast increase in adults aged 18 to 64 requiring care by 2038 compared with 2018

90% projected forecast increase in costs of care for adults aged 18 to 64 by 2038 compared with 2018

57% projected forecast increase in adults aged 65 and over requiring care by 2038 compared with 2018

106% projected forecast increase in total costs of care for adults aged 65 and over by 2038 compared with 2018

Report Conclusions

High-quality care is critical to the well-being of some of the most vulnerable adults in society. Yet levels of unpaid care remain high, too many adults have unmet needs and forecasts predict growing demand for care. The lack of a long-term vision for care and short-term funding has hampered local authorities’ ability to innovate and plan for the long term, and constrained investment in accommodation and much-needed workforce development. In a vast and diverse social care market, the current accountability and oversight arrangements do not work. The Department currently lacks visibility of the effectiveness of care commissioned and significant data gaps remain. As such, it cannot assess the outcomes achieved across the system and whether these are value for money.

COVID-19 has focused attention on social care as never before. It has highlighted existing problems with social care and emphasised significant gaps in the Department’s understanding of the market. However, we have also seen substantial efforts from those across the sector to deliver these essential services in such challenging circumstances. The Department has recently taken steps to increase the capacity of its teams; address data gaps, with local government and care providers; and strengthen system accountability and assurance. This renewed focus, impetus and collaborative approach must be capitalised upon when government finally focuses on the long-awaited social care reforms.

National Audit Office Recommendations

The Department of Health & Social Care should:

  • As a priority, set out a cross-government, long-term, funded vision for care. It should collaborate with the Ministry and local government in particular; factoring in sector and user perspectives, such as people with lived experience;
  • Develop a workforce strategy, in line with its previous commitments, to recruit, retain and develop staff, aligned with the NHS People plan where appropriate;
  • In conjunction with the Ministry, Department for Work & Pensions and local government, develop a cross-government strategy for the range of accommodation and housing needed for people with care needs, and how to fund it;
  • Assess the performance and cost data it needs to gain assurance over the system’s performance as a whole and the potential costs to the sector of providing these data, bearing in mind its current proposals for enhanced accountability and oversight.
  • Address significant gaps in the performance and cost data it collects on care, particularly on self-funders and unmet need. In doing so, it should be mindful of, and assess, the potential burden on local authorities and care providers;
  • consult on options for enhancing support for local commissioners which promotes an integrated approach and incentivises commissioning for outcomes; and
  • Explore with CQC how best to increase visibility of and transparency over providers’ financial sustainability and costs, bearing in mind operational and legal practicalities.

“The lack of a long-term vision for adult social care coupled with ineffective oversight of the system means people may not get the care that best supports them.

"The Department of Health and Social Care has increased its focus on adult social care in response to the COVID-19 pandemic. It needs to build on this to ensure that its long-awaited reforms deliver affordable, high quality and sustainable adult social care for the future.”

Gareth Davies, the head of the NAO

You can read the full report on the National Audit Office’s website here.