Rationing, not strengths-based practice, likely to explain fall in numbers receiving care, finds study

King's Fund probes reasons behind demand for adults' services reaching record high as the number of people receiving long-term care

Jigsaw puzzle showing supply demand gap
Photo: IQoncept/Adobe Stock

Rationing by councils, rather than the impact of strengths-based practice in reducing need, is the most likely explanation for falling numbers of people receiving adult social care amid record demand.

That was the message from the King’s Fund’s annual social care 360, its analysis of the latest data on the state of adult social care in England, published last week.

The number of requests for support councils received rose by 3.3% rise from 2020-21 to 2021-22, to 1,978,550, which was a 9.3% rise on the level in 2015-16, when contemporary records began, showed NHS Digital figures issued last year.

However, there was a fall of 4.3% (7,255) in the number of requests resulting in the person receiving long-term care, to 162,590. This contributed to a fall of 2.8% (23,325) in the overall number of people receiving long-term care, to 817,915, the lowest number since 2015-16. This was almost entirely driven by falls in the number of older people receiving long-term care, which fell by 4% to 529,010.

‘Rationing in response to financial pressures’

In its analysis of the data, the King’s Fund said the likeliest explanation was that councils were rationing care in response to financial pressures.

The same NHS Digital figures showed that councils’ spending on adult social care had grown year on year in real terms since 2015-16, from about £19.5bn to £22bn in 2021-22.

However, the King’s Fund pointed out that much of the increase from 2019-20 to 2021-22 had been in Covid-related funding, designed to help providers meet additional costs, rather than directly finance care for individuals.

The increase in funding since 2015-16 was also driven in part by growth in the unit costs of services. Over that time, the amount councils paid per hour of home care grew by 13.8%, while the weekly cost of a residential and nursing care bed rose by 21% for older people and by 7% for those of working-age.

The think-tank said an alternative explanation for the falling number of people receiving long-term care, besides financial pressures, was increased use of strengths-based, or enabling approaches by authorities.

These “seek to focus on support that might be available from an individual’s wider support network and
community, rather than through the provision of formal long-term care and support”.

‘No significant rise in evidence of strengths-based approaches’

However, it said there has been “no significant change” in indicators that suggest such an approach had been taken. For example, there had been falls in both the number of carers supported by councils, and in their funding for voluntary sector organisations, since 2015-16. In addition, there had only been a modest increase in the number of people receiving short-term care to maximise independence, such as reablement packages designed to help people regain skills.

It said its view that rationing was the source of the drop in the numbers receiving long-term care was supported by watchdog Local Government and Social Care Ombudsman in its annual review of adult social care complaints, published in October 2022. The ombudsman said it was “seeing more cases where councils are failing to provide care, or are limiting care, while using cost as the justification”.

Tighter means-testing and less personalisation

Among the King’s Fund’s other findings included:

Reflecting on the report’s findings, lead author Simon Bottery said: “It’s likely that local authorities will see the number of new requests for adult social care pass the two million mark for the first time this year but, on current trends, fewer people will end up receiving long-term support.

Adult social care ‘going in wrong direction’

“That means that more people will have to pay themselves, rely on family and friends – or go without care entirely.”

He added: “The report shows that many of the critical indicators for adult social care are going in the wrong direction yet the government’s main reforms, such as the introduction of a cap on lifetime care costs, have now been postponed until 2025 and there is little action so far on critical issues such as workforce and carers. The government has an opportunity to move from words to action in its reform plan, promised for the spring.”

The Association of Directors of Adult Social Services said the King’s Fund report painted an accurate picture of an adult social care system that was in a crisis that had been years in the making.

“Successive governments have underfunded the system over decades even though we knew with an ageing population many more people would need social care support,” said joint chief executive Cathie Williams.

Fully-funded, long-term plan needed – ADASS

“The government needs to act decisively now: a long-term, fully funded plan that provides the right support for older and disabled people, and unpaid carers. And a workforce plan for adult social care, like the one promised for the NHS, that solves the vacancy crisis in social care and ensures workers are paid a fair wage for the vital care they provide.”

The government has said it is allocating an additional up to £2.8bn in 2023-24 and £4.7bn in 2024-25 to social care. However, sector leaders have questioned these figures as some of the funding is meant for children’s services and another chunk is dependent on authorities increasing council tax by the maximum amount – 5% for most authorities – in each year.

For the Local Government Association (LGA), community wellbeing board chairman David Fothergill said the funding fell far short of the £13bn annual boost it has argued was needed to meet pressures and deliver on councils’ statutory duties. This included £3bn for an increase in care worker pay, to overcome recruitment and retention challenges.

“Councils and providers always strive to reflect, learn and improve, but it is becoming increasingly hard to fund even statutory services,” he added. “We need to see urgent investment in adult social care that will ensure the best possible care for those that need it.”

One Response to Rationing, not strengths-based practice, likely to explain fall in numbers receiving care, finds study

  1. Chris Sterry March 6, 2023 at 3:03 pm #

    While the funding appears to be substantial, it is far from it and the lack of social care continues to escalate and is and will lead to many more deaths.

    The current figures will include those, pertaining or being assumed to be from COVID, but the figures will continue to increase while the element from COVID reduces.

    The real problems are lack of resources of which staff is a major reason and the reason for this is down mainly to funding and then also the poor working terms and conditions.

    For many are reluctant to enter the care profession and many others are leaving to get better paid work in other sectors with far less responsibilities and this can only get worse.

    Substantial funding is required from Local Authorities, but for them to achieve this they in turn also need much more funding themselves, which can’t be obtained from any increases to Council Tax to anywhere near the required level. The government needs to, urgently, find the funds to provide this much needed funding and it has to be now. To wait another year will be way to late and many more deaths with occur.

    Safeguarding is and always will be a major concern and the incidents of safeguarding will continue to escalate.

    These are serious matters relating to Human Rights, which are not being respected and adhered to.

    But is this government concerned, I regretfully believe that they aren’t and are not understanding the real extent of the problem, if they have any understanding of the problem at all.

    Hopefully this is due to their ignorance on the subject, but is that really correct or is it that they really don’t care.