Why are we calling for changes to social care? - Healthwatch England

In 2024, Healthwatch is launching a campaign calling for social care reform. We'll start by looking at how people access social care, and where people aren't getting their needs met. 

Throughout the year, we'll make sure the urgent need to reform social care and the potential solutions are at the forefront of policymakers' minds. 

Here, we look at what social care is, why it needs reforming, and what challenges those reforms must address. 

What is adult social care?

Adult Social Care is practical support for older and disabled adults that helps them live as independently as possible.  

Over one million people in England had some kind of social care support from their local council in 2022. 

Your local authority is responsible for managing social care services in your area. Councils might provide some services themselves, or outsource these services to meet the needs of their community. 

You also may buy support for yourself, whether you pay for this privately or with help from your local council. 

Many people also get care from unpaid carers, often family members. 

Social care services can include support for daily living in your home, care homes and community support such as daycare opportunities. This support can be short-term, or it may be lifelong.

Why does social care need reform?

Advances in healthcare mean many people are living longer, and the number of people living with complex health conditions has also increased. This has led to big rises in demand for social care, but without any significant change in how it is organised and funded.

In 2021, the government proposed reforms to adult social care. This included a policy to cap the social care costs a person would pay over their lifetime, funded by a rise in National Insurance. But this and other reforms were later paused or scrapped.

This means the social care system is under significant financial pressure, and struggles to consistently deliver high-quality care to those who need it.

The impact on individuals

In 2022, we asked people about their awareness of social care support. We found that less than half of adults would know to go to their council if they needed social care support.

Recently, we worked with local Healthwatch to talk to people using or waiting for social care services for themselves or their family members. Through these interviews, we heard compelling evidence of people's struggles with local social care services.

These obstacles include:

• Challenges finding the right information about complicated services.
• Long waits for care assessments, financial assessments and social care reviews.
• People not getting the support they need, due to poor communications, staff shortages, and the cost of care.

The impact on unpaid carers

Unpaid carers, like family members and close friends, provide the equivalent of £164 billion in caring costs each year. 

On top of that, the burden of providing unpaid care doesn't fall evenly on different parts of the population. There's a higher proportion of unpaid carers in the most deprived areas of England and Wales. And 59% of unpaid carers are women.

If councils can’t give unpaid carers the support they need, many unpaid carers won't be able to keep providing this essential support.

Similarly, if councils can't deliver the right social care, unpaid carers may struggle under an unmanageable burden, harming their health and the health of those they care for.

The impact on councils

Councils are facing severe budget pressures. In England, they spent around £27 billion on social care in 2022. But most councils are facing increasing gaps in their social care funding.

According to ADASS, the reasons for this include central government funding cuts, high inflation, increasing complexity of need, struggles to recruit care workers, the higher National Living Wage and extra care costs during the pandemic.

ADASS also estimates that councils will face a four billion pound funding gap over the next two years.

The social care pressures councils face also add significant costs to the NHS, with the costs of inappropriate hospital admissions and delayed hospital discharges estimated at £1.5 billion.

The impact on social care staff and providers

Workers delivering social care have tough jobs, but are often paid at or only slightly above the minimum wage due to financial pressures. Care worker teams are often understaffed, and turnover rates are extremely high at around thirty percent a year.

Providers, often in the private sector, also need help with the underfunded system, which often offers lower care rates than ‘fair cost of care’ exercises calculate.

The providers who care primarily for self-funding clients have more flexibility around costs, but face many similar challenges.