Social care in England: Current situation, case for a strategy and further support for unpaid carers

Approximate read time: 15 minutes

The House of Lords will debate the following motion on 10 October 2024:

Baroness Tyler of Enfield (Liberal Democrat) to move that this House takes note of the state of social care in England, and the case for a comprehensive social care strategy and further support for unpaid carers.

1. Overview of social care in England

1.1 What is social care?

Social care services help people living with illness or disability. Social care support can include:^[1]

• help at home with daily tasks such as dressing and eating
• home adaptations, household gadgets and equipment
• supported living and care homes
• meal delivery

This briefing focuses on adult social care. For more on the children’s sector, read:

• Community Care, ‘Law to bolster child protection announced in Labour’s first King’s Speech’, 17 July 2024
• House of Lords Library, ‘Children looked after by local authorities in England’, 26 March 2024; and ‘Reforming children’s social care: Public Services Committee inquiry’, 14 September 2023
• House of Commons Library, ‘Reform of children’s social care in England’, 21 March 2024
• Institute for Government, ‘Performance tracker: Children’s social care’, 30 October 2023

1.2 Challenges facing the social care sector

In March 2024, the House of Commons Public Accounts Committee set out its assessment of the pressures on the sector, including:^[2]

• chronic underfunding
• ‘patchwork’ funding and the lack of a long-term funding settlement hindering planning
• workforce vacancies
• rising waiting lists

The Association of Directors of Adult Social Services (ADASS) has conducted regular surveys on waiting times in recent years. These have estimated that between 400,000 and 500,000 people have been waiting for an assessment, review, direct payment or care package at any one time since 2021.^[3]

1.3 Independent investigation of the NHS in England: Social care conclusions

Lord Darzi of Denham’s ‘Independent investigation of the NHS in England’, published on 12 September 2024, described the state of social care as ‘dire’. The new Labour government had commissioned Lord Darzi (non-affiliated) to undertake this rapid review two months earlier. Lord Darzi is a surgeon and served as a parliamentary under secretary of state at the Department of Health under the last Labour government.

The report highlighted that 13% of NHS beds were occupied by people who could have been discharged from hospital.

Figure 1 shows how much longer people who were not discharged on the day they first could have been stayed in hospital. The numbers have remained similar across 2023 and 2024. In July 2024, 32% of patients were in hospital one extra day, 25% an extra two or three days, 18% four to six days, and 26% over a week.

Figure 1. Delayed discharges: How much longer are people staying in hospital than they need to?

Not all delayed discharges can be attributed to challenges in the social care sector. Other reasons include waiting for patient transport or medications, or families raising concerns about whether a person is ready to come home.^[4]

Lord Darzi’s report described the impact of delayed discharges on NHS activity:

The result is there are 7% fewer daily outpatient appointments for each consultant, 12% less surgical activity for each surgeon, and 18% less activity for each clinician working in emergency medicine.^[5]

The report recommended “hardwiring” funding for a multidisciplinary model of care services. It advocated better integrated care as well as preventative intervention in the community.^[6]

1.4 Demand

For the year 2022/23, the NHS reported 835,335 people received support from long-term support services.^[7] This increased by 17,415 people (2.1%) from 2021/22. Gross current expenditure on adult social care by local authorities was £23.7bn. This was an increase of £1.7bn (7.9%) from the previous year.

Local authorities received over 2mn requests for adult social care support for the first time ever in 2022/23. This is equivalent to 5,485 requests for local authority support received per day in England by local authorities (up 65 requests per day on the previous year).

Statistics for 2023/24 are expected at the end of October 2024.^[8]

NHS England and care providers use a digital tool called the ‘capacity tracker’ to share and see care home vacancies in real time. A statistical bulletin updated from the capacity tracker showed that as of the week ending 14 August 2024, 86.4% of beds in care homes were occupied.^[9] Of vacant beds, 10.7% were ready for someone to be admitted to them.

Social care is needs and means tested.^[10] According to the King’s Fund, the gap has been growing between the number of applications being made and the number of people who ultimately receive local authority support.

1.5 Workforce

Skills for Care, the strategic workforce development and planning body for adult social care in England, publishes sector workforce statistics.^[11]

In 2023/24 there were around 131,000 vacant posts and 1.7mn filled posts. There was a vacancy rate of 8.1% and a turnover rate of 24.4%.

The most recent published monthly statistics, for August 2024, showed:

• 1% of jobs were vacant
• the turnover rate was 25.4%

Skills for Care attributes turnover and vacancies in the sector to a range of factors including low pay, zero-hours contracts and difficulty accessing full time work.^[12]

2. Unpaid care

The 2021 census found that approximately 4.7 million people were providing unpaid care in England.^[13] This represented around 9% of the entire population, including children.

Table 1 also presents data from the 2021 census. It illustrates that over 1.9 million people were providing 35 or more hours of care every week.

Table 1. How many hours of care are unpaid carers providing?

(Government Statistical Service, ‘UK adult social care statistics: Four nations carers and workforce matrix’, 28 August 2024)

Some organisations, such as the campaigning charity Carers UK, estimate that the number of unpaid carers could be higher, at around 10.6 million.^[14]

Carers UK set out the impacts of caring, including:

• Financial impacts: Many carers have additional costs as well as limits on their ability to work. It estimates 44% of working-age adults who are caring for 35 hours or more a week are in poverty.
• Health and wellbeing impacts: 60% of carers report having disability or long-term health conditions. Carers can also be isolated and under stress.

Carers UK research found that minority ethnic people with caring responsibilities were more likely to experience financial stresses (59% compared to 37%). LGBT+ carers were found to be more likely to be lonely or isolated (45% compared to 33%). 59% of carers are women.

Lord Darzi’s report noted the “huge contribution” of unpaid carers.^[15] It called for a “fresh approach” so that the NHS can provide unpaid carers with support and treat them as “equal partners” when working on care plans.

Financial support is available to some carers.^[16] Carer’s allowance is available to people who provide at least 35 hours a week of care for a person in receipt of certain benefits. The allowance is currently £81.90 per week.

Depending on individual circumstances, carers may also be eligible for a council tax reduction, universal credit, pension credit, or carer’s credit (which helps with gaps in national insurance contributions).

3. Previous Conservative governments’ social care policies

Previous Conservative governments implemented measures relating to the social care sector. For example, they allowed local authorities to raise council tax and charge an adult social care precept to increase funding to the sector.^[17] In its 2022 report on ‘Long-term funding of adult social care’, the House of Commons Levelling Up, Housing and Communities Committee highlighted some benefits of raising funds through council tax. However, the committee noted that social care remained systemically underfunded. It also noted the ability to raise revenue locally does not correlate to an area’s need. The government response to the committee pointed to the degree of rebalance based on need provided through the social care grant’s equalisation funding.^[18]

The Health and Care Act 2022 established integrated care systems (ICSs), which aim to improve links between health and social care.^[19] In 2023, the House of Lords Integration of Primary and Community Care Committee assessed that there were signs that new ICSs were engendering a “collaborative ethos”, but needed time to develop.^[20] The government responded that a review of the 2022 act would conclude in October 2026.^[21]

Ten years ago, the Care Act 2014 introduced by the coalition government aimed to modernise social care law. The legislation focused on preventing, reducing and delaying service need, as well as supporting carers. However, some aspects of the act were not implemented.

In its 2021 white paper ‘People at the heart of care: Adult social care reform’, the government then led by Boris Johnson concluded that the spirit of the Care Act 2014 had not been realised. A 2022 report by the House of Lords Adult Social Care Committee went further and called the legislation a failure.^[22]

The 2021 white paper followed increased focus on the social care sector due to its experiences during the Covid-19 pandemic. The pandemic had significant impacts on the sector, including over 43,000 deaths of care home residents as well as over 1,200 deaths of social care workers from Covid-19.^[23]

Lockdowns impacted the support available to unpaid carers, and there were delays in access to services, including safeguarding.^[24]

In September 2021, the government published ‘Build back better: Our plan for health and social care’. The reforms would have introduced a lifetime cap on care costs and an extended means test.

The government explained that it would raise taxes to fund these proposals. It set out plans to introduce a UK-wide 1.25% health and social care levy based on national insurance contributions that would be ringfenced. In September 2022, the government under Liz Truss announced that the health and social care levy would be reversed.^[25] However, it said that funding for health and social care would be protected and remain at the same level as if the levy were in place.

Ultimately, in response to concerns from local authorities, at the autumn statement 2022 the then chancellor, Jeremy Hunt, announced that the reforms would be delayed.^[26] They were initially proposed to be implemented from October 2023, and the new date set was October 2025. The funding originally allocated to the reforms was given to councils to pay for more care.

The new Labour government has announced that it will not implement the reforms, calling them ‘unfunded’.^[27]

4. What has the new Labour government said it will do about social care?

In a speech on 12 September 2024, following the publication of Lord Darzi’s report on the NHS, Prime Minister Keir Starmer announced the government was building a “10-year plan” for healthcare reform.^[28] One of the areas for “fundamental” reform, Mr Starmer said, would be shifting care “from hospitals to communities” and integrating health and social care. The plan is expected in spring 2025 after consultation this autumn.^[29]

For the adult social care workforce, the Labour manifesto pledged a ‘fair pay agreement’ with terms for pay, conditions and training standards.^[30] The King’s Speech 2024 included the fair pay agreement as part of an Employment Rights Bill, which has not yet been introduced.^[31] Health think tank the King’s Fund commented: “Unless that increase in pay is matched with commensurate increases in local government funding, it will further squeeze already strained care provider and local council budgets”.^[32]

The Labour manifesto included an aim to create a ‘National Care Service’ “underpinned by national standards, delivering consistency of care across the country”.^[33] It would prioritise people being cared for at home “for as long as possible”. Labour also pledged a “new legal right” for people in residential care to see their families.^[34]

Health Secretary Wes Streeting has also said that NHS trusts should buy beds in care homes to reduce delayed discharges from hospitals and increase treatment capacity.^[35]

The King’s Fund and the Nuffield Trust noted a lack of detail in Labour’s plans for social care reform and called for urgent action.^[36] Labour has indicated it will consult, and consider future areas of development, including:^[37]

• tasking regulators with assessing the role social care workers can play in basic health treatment and monitoring
• investigating integration with the NHS
• considering how to best support working age disabled adults
• exploring how to support an ageing population and move to a more preventative system

On 17 September 2024, Stephen Kinnock, minister of state for care, wrote to chief executives and directors of adult social services ahead of winter’s seasonal pressures.^[38] Mr Kinnock said the government was embarking on “an ambitious long-term programme of reform with a view to creating a National Care Service”. He said in the short term the priorities should be:

• a ‘home first’ approach that supports people to live independently for as long as possible
• a relentless focus on ensuring high-quality care
• close involvement of people receiving care and their families and carers

On 18 September 2024, Health Secretary Wes Streeting told the New Statesman:

If I look back on my time in this office not having grasped the nettle of social care reform, I will have considered my time here a failure, and I’m not prepared to fail.^[39]

5. Read more

• Institute for Public Policy Research, ‘Our greatest asset: The final report of the IPPR Commission on Health and Prosperity’, 17 September 2024
• The Carer, ‘Sector responds to devastating Darzi report’, 12 September 2024
• House of Commons Library, ‘Informal carers: Health and wellbeing’, 9 September 2024; and ‘Funding for adult social care in England’, 21 February 2024
• Oral question on ‘Social care reform’, HL Hansard, 2 September 2024, cols 960–3
• Skills for Care, ‘A workforce strategy for adult social care in England’, 18 July 2024
• House of Commons Public Accounts Committee, ‘Reforming adult social care in England’, 20 March 2024, HC 427 of session 2023–24
• House of Lords Adult Social Care Committee, ‘A “gloriously ordinary life”: Spotlight on adult social care’, 8 December 2022, HL Paper 99 of session 2022–23; and House of Lords Library, ‘Reforming adult social care: House of Lords committee report’, 28 September 2023

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Cover image by Freepik.