The government must provide stronger leadership, long-term financial support and a clear workforce strategy to address shortfalls in the adult social care sector, according to a report published by the Public Accounts Committee (PAC).
The parliamentary body noted that workforce vacancies in the sector, which employs around 1.6 million people, exceeded 152,000 in March 2023 – a vacancy rate of almost 10%.
The PAC reiterated concerns over the lack of a long-term workforce plan to address the shortfall, and said that the government’s social care white paper, published two years ago, was ‘woefully insufficient to the scale of the task’.
In 2021, the Department of Health and Social Care (DHSC) set out a 10-year vision for adult social care, and the government committed £5.4bn funding over three years, on top of existing budgets, to reform the sector.
However, in April 2023, plans for system reform were revised, scaling back short-term plans to £729m over the period 2022-23 to 2024-25.
‘Two years on from its long-awaited white paper People at the heart of care – a 10-year ‘vision’ for adult social care – plans for reform have once again gone awry,’ the PAC report said.
It added: ‘We asked the [DHSC] why it had not produced a workforce strategy, despite repeated calls from the sector and our previous recommendations.
‘It told us that it considered the workforce chapter of its white paper to be its workforce strategy, and that it would not be possible to create a strategy similar to that produced for the NHS, as the [DHSC] is not the employer of the adult social care workforce.’
The select committee also questioned the government’s ‘future reliance on overseas staff’ in light of proposed visa restrictions and risks of exploitation.
And it also raised concerns over demand for adult social care services in rural areas, as it is ‘set to rise against a backdrop of chronic understaffing in these communities’.
Overarchingly, the report said the DHSC was ‘not providing the leadership needed to deliver a social care sector that is sufficient to meet the country’s future needs, particularly in relation to the workforce’.
The PAC expressed worries that the government ‘has no roadmap for achieving its vision, or any targets or milestones beyond 2025, with nothing meaningful in place to demonstrate progress’.
Dame Meg Hillier MP, chair of the committee, said: ‘Years of fragmented funding and the absence of a clear roadmap has brought the adult social care sector to its knees.
‘Waiting lists are rising, the sector is short of tens of thousands of essential staff, and local authority finances are being placed under an unsustainable amount of pressure.’
Dame Meg added that the committee welcomed the increase in funding, but ‘fear[s] this will do little to address the key challenges faced by the sector in the absence of a well-funded multi-year strategy’.
The PAC report contains recommendations for the DHSC to write to the committee, setting out how it will lead the sector and identify and address workforce challenges, including:
- achieving a sustained reduction in the number of vacancies in the sector (beyond 2025)
- addressing the challenges and risks associated with international recruitment
- tackling local variations in vacancy rates
- addressing issues around disparity with NHS pay
- assessing which workforce initiatives are most effective for recruiting and retaining staff.
Dame Meg said: ‘While an NHS-style workforce strategy for social care may not be feasible, the DHSC must set out how it will provide leadership across the sector to identify and address workforce challenges.’
Responding to the report, Royal College of Nursing transformational lead for the independent health and social care sector Claire Sutton, said: ‘Social care is gripped by devastating workforce shortages whilst staff working in the sector take home up to a third less pay than their colleagues in the NHS.
‘As demand for social care services continues to increase, the government has serious questions to answer as to why there is no social care workforce strategy to speak of.’
She added: ‘The lack of a workforce plan and leadership from government means services cannot recruit and retain the nursing staff they need.
‘This has led to a hypocritical approach of relying on overseas recruitment, while also placing heavy, unjustified visa restrictions on overseas care workers who are keeping social care afloat.’
Saffron Cordery, deputy chief executive at NHS Providers, said it ‘shines a much-needed light on the urgent need to reform adult social care, which has been severely under-resourced for years’.
‘National action is needed to address the growing levels of unmet and under-met need, improve quality of care and fix the 150,000-plus workforce shortages,’ she added.
‘The prolonged absence of meaningful reform of adult social care is taking a huge toll on those who give and receive care, the economy and the wider health and care system.
‘The NHS and social care are two sides of the same coin. As such, an NHS fit for the future needs a healthy social care sector alongside it.’
