Intended for healthcare professionals


Government must produce long term plan for adult social care in England this year, says watchdog

BMJ 2021; 372 doi: (Published 25 March 2021) Cite this as: BMJ 2021;372:n812
  1. Gareth Iacobucci
  1. The BMJ

Short term funding fixes and the failure to produce a long term vision for adult social care in England is hindering planning, innovation, and investment in the sector, the spending watchdog has concluded.

The National Audit Office (NAO) also warned that current accountability and supervision of the care system were ineffective for overseeing the market, in a report published on 25 March.1

The Department of Health and Social Care has increased its focus on adult social care in response to covid-19, the NAO found, but it has not fulfilled previous commitments to tackle recruitment and retention challenges for the 1.5 million people who work in care. Nor has it produced a workforce strategy since 2009 despite committing to do so in 2018.

And while the Care Quality Commission rates most adult social care in England as good, the health department lacks legal powers to intervene or hold individual local authorities to account for how they commission care and for the outcomes achieved, limiting its ability to assess how well money is spent or what additional funding is needed, the NAO said. Local authorities spent a net £16.5bn (€19.1bn; $22.6bn) in 2019-20 on commissioning adult social care from around 14 800 registered providers, mainly from the independent sector.

Cash starved authorities

The department must also bring forward a clear strategy for improving the “ad hoc and uncoordinated” investment in new accommodation or adapting existing accommodation for adults with care needs, the NAO added. The watchdog found that short term funding settlements had made it difficult for cash starved local authorities to plan how much care they could purchase beyond the current financial year.

It highlighted that many care providers were not financially resilient even before the destabilising impact of covid-19 and predicted that large increases in future demand for care would only lead to costs rising further.

After many government consultations and reviews that had not led to action, as well as further delays to reforms because of covid-19, the department must finally bring forward a long term plan for social care in 2021, the NAO urged. It must also develop a workforce strategy in line with its previous commitments to recruit, retain, and develop staff.

Gareth Davies, head of the NAO, said, “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.”

Danny Mortimer, chief executive of the NHS Confederation, said that the report’s findings highlighted the serious cracks in the foundations of the social care sector that urgently needed radical reform and significant investment.

“Without reform, and a clear and transparent timetable for delivery, both the NHS and social care will struggle to address the long term health and social care issues the pandemic will leave in its wake,” he said.

Meg Hillier, chair of the Commons Committee of Public Accounts, said, “Despite government’s repeated promises that it had a clear plan for tackling the social care crisis, today’s NAO report shows this is simply not the case. This unsustainable situation can’t go on—government must get a grip on the crisis in social care, and it must do it now.”


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