Government must show how it is delivering on adult social care reform plans – NAO
The Government must demonstrate how it is delivering on its plans to meet challenges in a social care system which remains under “significant pressure”, a report has warned.
The National Audit Office (NAO) said the Department of Health and Social Care (DHSC) has not established an overarching programme to co-ordinate its promised reforms, meaning it is difficult to track progress.
The report also described achieving the 10-year vision for adult social care, set out in December 2021, as a “costly and ambitious endeavour”, and warned of “significant risks” the department must manage along the way.
Last year, Chancellor Jeremy Hunt confirmed that social care charging reforms which had been promised by Boris Johnson’s government would be delayed for two years to 2025, including an £86,000 cap on personal care cost contributions, as well as an expanded means test that is more generous than the existing one, which had been due to come into effect from October this year.
The NAO said the department needs to be mindful that to deliver charging reform by October 2025, “work will need to begin soon and will increase workload for DHSC and local government staff, alongside the system reforms underway”.
While the department has a history of implementing projects and programmes in the NHS and an established delivery body, it does not have the same for adult social care, the report noted.
It also pointed out the absence of a long-term plan for achieving its vision, with no funding certainty beyond the current spending review period, therefore the department is unable to plan “every step in detail now”.
It stated: “Without a long-term plan for achieving its 10-year vision, DHSC may not understand which interventions it is likely to need and when, so that it, and the sector, can factor them into their plans and carry out necessary preparatory work.”
To date, the NAO said the department is delivering on two of its eight workforce projects, supporting international recruitment and adult social care volunteering, while the other six are in development.
The report recommended that the department assesses the impact of its current and planned reform on local authorities, sets out a costed plan for implementing charging reform from October 2025, and maps the funding needed to deliver its planned reforms.
Gareth Davies (pictured), head of the NAO, 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.”
Meg Hillier, chairwoman of the Public Accounts Committee, said the report shows the department “still has a long way to go” in its 10-year plan.
She said: “It has made some progress but that has largely stalled, with charging reform delayed and wider improvements scaled back. The sector is still struggling with long waiting lists, staffing shortages and both local authorities and providers under significant financial pressure.
“DHSC needs a long-term plan to deliver its vision. It must understand if it is on track and whether its activities are actually improving people’s lives.”
David Fothergill, chairman of the Local Government Association community wellbeing board, said the report gives “helpful insight into the current situation and framing of adult social care reforms”.
He added: “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.”
The County Councils Network, which represents county councils and unitary authorities across England, recognised a “clear rationale” for introducing charging reforms but warned “they cannot be delivered on a shoestring”.
Martin Tett, the network’s adult social care spokesperson, said its own previous research had suggested their costs could be at least £10 billion more than estimated, adding: “The next government must ensure that these reforms do not fall at the first hurdle by ensuring there is enough resource and workforce capacity in the social care system.”
Andrew Gwynne, Labour’s shadow minister for social care, said the report makes “clear that the Conservatives will break their promise to ‘fix the crisis in social care once and for all’ by the next election.
“Delays and watered-down workforce reforms will leave the sector without the care workers it needs. People will wait longer and longer for care, as there simply aren’t enough staff.”
A DHSC 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.”
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