Care delivered not keeping pace with increased needs, say social care leaders

New findings from a survey of social care leaders shows short-term funding boosts from Government has helped reduce the number of people waiting for care and increased support for people at home. But increases in care delivered are not keeping pace with increased needs, according to a report by the Association of Directors of Adult Social Services (ADASS).

Care waiting lists have dipped from a high watermark of 542,000 in April 2022 to 430,000 at the end of March 2023. However, leaders say that still means the health and wellbeing of many thousands of people continues to deteriorate while they wait for assessments, care or direct payments. They say many will end up having to go to hospital or a care home instead, undermining their independence, costing the NHS and councils much more in the long run.

Leaders estimate this winter waiting lists will still be higher than in 2021 with the potential to rise further without more staff.

Amidst a record NHS backlog, rising mental health needs, support around domestic abuse of people with care and support needs, and carer breakdown means most councils are not confident they can offer the minimum social care support in their communities required by law.

The survey shows that in the battle to free up NHS acute beds, council social care teams are needing to support more people coming out of hospital with complex health and support needs. Three quarters of councils say the size of care packages for people being discharged from hospital – the number of hours and number of carers they need – has increased. Over half say they’ve seen an increase in the numbers of people needing social care due to delays to hospital admissions or not being admitted at all. Eight in ten (81%) of directors of adult social services either strongly agreed or agreed that increased NHS pressures will lead to adult social care taking responsibility for services which previously the NHS would have arranged or delivered.

Social care leaders also reported a growing need for social care support to help people with poor mental health, homelessness and domestic abuse in communities. Eight in ten (81%) directors reported an increase in the number of people approaching their council with mental ill health, and more than half (51%) have seen a rise in rough sleepers needing help. Nearly two thirds (64%) report a rise in domestic abuse relating to people with care and support needs.

Findings reveal recruitment and retention of care staff remains a challenge and continues to undermine progress. This is despite some difference being made through recruitment of care workers from other countries which, though welcome, is unsustainable.

Directors say they are caught in a vicious cycle as the survey reveals that more councils overspent on their adult social care budget last year and there was a worrying increase in those relying on reserves to fund these pressures. Directors have had to identify an increased level of savings from their social care budgets for 2023/24, putting further pressure on the support they can offer people.


Carer burnout was the number one reason Directors gave for breakdown in unpaid carer arrangements, as family and unpaid carers are bearing the brunt of an under-resourced and over-stretched system. They say it is likely that as more people reach crisis point, there will also be a rise in carers forced to reduce hours or leave work. Once again, this data demonstrates the importance of social care in supporting people to continue working, which has the potential to further boost the economy.

To improve social care, boost our economy and enable carers to continue working, social care leaders are calling on the Government to increase support to carers and improve workforce pay and provide a fully-funded, long-term plan to transform social care. ADASS is also calling on the Government to commit to invest in support that helps people avoid the need to go to hospital or a care home in the first place and support for people to recover.

Beverley Tarka, President of ADASS said that although the number of people waiting for care was dropping, we are not out of the woods yet.

“While the focus on people coming out of hospital is important, we need to focus more funds on keeping people independent and out of hospital in the first place so that they don’t end up needing more costly and complex medical care, which is bad for them and for the public purse.”

Responding to the publication, Professor Martin Green OBE, Chief Executive of Care England said local authorities have been set up to fail by the government.

“[…]Local Authorities are starting from a £400m deficit, before they even look to address staffing, inflation and wider cost pressures.

“Whilst it is incredibly welcome that 94% of Local Authorities chose to take up adult social care precept for 2023/24, Local Authorities are operating on a shoestring and require significant investment from central government. Without intervention, we face an uncertain future. The survey highlights the increasing number of providers closing, ceasing trading or handing back council contracts. The warning lights have never been brighter for the government.”