Source · Select Committees · Public Accounts Committee
Twenty-Second Report - Reforming adult social care in England
Public Accounts Committee
HC 427
Published 20 March 2024
Recommendations
3
Acknowledged
Set out spending review preparations and long-term funding certainty for local authorities.
Recommendation
Local authorities are having to plan and commission adult social care services against a backdrop of fragmented and uncertain funding. We have long voiced our frustration at the short-term and multiple funding pots provided to local government and recommended that …
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Government Response Summary
The government agrees, stating it is learning from the first phase of reform and monitoring current funding impacts to inform preparations for the next spending review. It will work with HM Treasury and DLUHC to deliver a sustainable funding package, aiming to provide as much certainty as possible for local authorities.
HM Treasury
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6
Rejected
Set out and publish a roadmap with KPIs for delivering the adult social care vision.
Recommendation
The Department faces significant challenges in delivering its ‘vision’ for adult social care reform, and Parliament and the sector must be able to hold it to account for its progress. It is worrying that the Department has no roadmap for …
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Government Response Summary
The government disagrees with the recommendation to publish a roadmap with KPIs and six-monthly updates, stating it cannot commit to this approach. It will set out details of the next phase of reform following the next spending review and will consider the value of publishing regular progress reports.
HM Treasury
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8
Accepted
Data on health and social care outcomes lacks clear strategy and public accessibility.
Recommendation
We asked the Department about how it was measuring the effectiveness of joint working between health and social care in delivering better outcomes for the people they served. We heard that CQC inspections, which were now measuring systems as well …
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Government Response Summary
The government accepts the recommendation, stating CQC assessments of ICSs and local authorities will be published by Summer 2024 to enable public understanding and comparison of outcomes. They are also improving adult social care data through a new strategy, including better outcomes data collection and a strengthened outcomes framework.
HM Treasury
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10
Accepted
Autumn Statement funding impact on adult social care remains unquantified and unclear.
Recommendation
When we asked what the Autumn Statement funding had delivered, the Department told us it had achieved “an awful lot” but acknowledged this was not as much as it had wanted and there was more to come. The Department did …
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Government Response Summary
The government states the recommendation is implemented, providing figures for £8.6 billion in additional funding that supported an 8.9% average increase in provider fee rates and a 10% increase in supported discharges. They are undertaking significant assurance of grant funding, requiring reporting on performance and spending plans, and engaging CQC to monitor profit margins.
HM Treasury
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11
Accepted
Profiteering risk in social care considered low due to falling profits and commissioning.
Recommendation
We asked about the risk of profiteering and how the Department was ensuring that the money it was putting into the system was going to the right places. The Department explained that was mainly down to the quality of commissioning …
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Government Response Summary
The government states the recommendation is implemented, referring to £8.6 billion in funding and describing ongoing measures to ensure money goes to the right places and prevent profiteering. These include significant assurance processes for new grant funding, requiring detailed spending plans, and ongoing engagement with CQC to monitor provider profit margins.
HM Treasury
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12
Accepted
Short-term hospital discharge funding shows positive impact but avoids systemic issues.
Recommendation
With regard to additional funding for hospital discharge—£600 million in 2023– 24 and £1 billion in 2024–25—the Department told us that delayed discharges had been consistently lower over the last 6 months than the previous year despite an increase in …
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Government Response Summary
The government states the recommendation is implemented, highlighting £8.6 billion in additional funding for adult social care and discharge over 2023-25, which has supported increased provider fee rates and supported discharges. They are also implementing significant assurance processes for new grant funding and enhancing transparency and accountability through various bodies.
HM Treasury
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15
Deferred
Fragmented, uncertain short-term funding stifles long-term planning and investment in adult social care.
Recommendation
We have reported before on the prevalence of short-term, one-off funding for local authorities and recommended that government explore ways to provide greater confidence over long-term funding.31 With regard to adult social care, this lack of financial certainty has constrained …
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Government Response Summary
The government states the recommendation is implemented, explaining they are learning from reforms and monitoring funding impact to inform future spending review preparations. They commit to working with HM Treasury and DLUHC to ensure the next spending review delivers a sustainable funding package for Adult Social Care, while seeking to provide as much certainty as possible.
HM Treasury
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16
Deferred
Delayed local government finance settlement omits minimum wage provisions for councils.
Recommendation
We asked about the local government finance settlement for 2024–25, noting that the longer the settlement is delayed, the more difficult it is for local authorities to prepare their budgets. DLUHC told us that in 2022 it had set out …
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Government Response Summary
The government states the recommendation is implemented, affirming its commitment to providing as much certainty as possible for local authorities through future spending reviews. They are learning from current reforms and monitoring funding to inform preparations for the next spending review, aiming to deliver a sustainable funding package for Adult Social Care.
HM Treasury
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20
Accepted
Department's workforce plan lacks long-term strategy and fails to address low pay
Recommendation
Given the significant workforce challenges facing the sector, we asked the Department why it had not produced a workforce strategy, despite repeated calls from the sector and our previous recommendations.46 It told us that it considered the workforce chapter of …
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Government Response Summary
The government states the recommendation is implemented, asserting that its 2021 white paper and 2023 'Next Steps' plan serve as its workforce strategy. They highlight ongoing investments in recruitment, retention, professionalisation, workforce training, pay, and international recruitment initiatives, citing a decrease in the overall vacancy rate.
HM Treasury
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22
Accepted
Limited progress on workforce reforms, dependent on delayed new payments platform
Recommendation
We welcomed the Department’s introduction of a new framework aimed at providing consistent career progression for the social care workforce (the Care Workforce Pathway) in January this year.54 However, we challenged the Department on why it had made so little …
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Government Response Summary
The government accepts the recommendation and expects the new payments system to begin making payments from the end of June 2024, enabling employers to claim funding for training courses and the new Level 2 Adult Social Care Certificate qualification. The department will update the Committee on Fund take-up before the end of the 2024-25 financial year.
HM Treasury
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23
Accepted
Department selected complex new payments system to directly fund social care providers
Recommendation
The Department explained that it had chosen a new payments system because it would be making payments on a scale not dealt with before and had wanted a proper way 47 Q 47 48 Department Health and Social Care, People …
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Government Response Summary
The government accepts the recommendation, stating the new payments system is on track to start making payments from the end of June 2024 for training courses and the Level 2 Adult Social Care Certificate. The department will provide updates on progress and fund take-up by the end of the 2024-25 financial year.
HM Treasury
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25
Deferred
Department lacks long-term funded plan and milestones for its social care vision
Recommendation
The NAO reported that the 2021 white paper set a 10-year ‘vision’ for transforming adult social care, but that the Department had no long-term funded plan for achieving it and no milestones beyond the end of the current Spending Review period, March
Government Response Summary
The government states the recommendation is implemented, highlighting progress towards the 10-year vision and learning from reforms to inform future plans. They commit to working with HM Treasury and DLUHC to ensure the next spending review delivers a sustainable long-term funding package for Adult Social Care.
HM Treasury
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Conclusions (15)
2
Conclusion
Accepted
We remain unconvinced as to whether the Department knows if it is achieving value for money from the additional funding going to adult social care. Recent funding for adult social care includes short-term, top-up pots of money in response to crises. In response to emerging pressures in 2022, government awarded …
Government Response Summary
The government agrees and states it is undertaking significant assurance of new grant funding by requiring local authorities to report on performance and submit detailed spending plans. It cites increases in fee rates and supported discharges, and ongoing engagement with the CQC regarding provider profit margins.
4
Conclusion
Accepted
Notwithstanding its recent efforts to make adult social care a more attractive career, the Department has still not produced a convincing plan to address the chronic staff shortages in the long-term. Workforce vacancies in adult social remain worryingly high with some places, such as rural areas, particularly affected. In 2022–23, …
Government Response Summary
The government agrees but states it has already published its workforce strategy in 2021 and an updated plan in 2023. It reports a decrease in vacancy rates and highlights existing investments in recruitment, retention, workforce training, and support for ethical international recruitment initiatives.
5
Conclusion
Accepted
Long-awaited workforce reforms are way behind schedule and too dependent on a ‘novel’ payment system. We welcome the Department’s launch of the care workforce pathway, which aims to provide consistent career progression for those working in the sector, but we are concerned at the lack of progress on other workforce …
Government Response Summary
The government agrees and confirms the payment system is on track to start making payments from the end of June 2024 with a phased approach. It will enable claims for qualifications and training from June and commits to update the Committee on fund take-up by the end of the 2024-25 financial year.
1
Conclusion
Accepted
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health and Social Care (the Department) and from the Department for Levelling Up, Housing and Communities (DLUHC) about progress in reforming adult social care in England.1
Government Response Summary
The government agrees and details ongoing work, including new Care Quality Commission assurance of Integrated Care Systems and local authorities, and efforts to improve adult social care data quality, timeliness, and availability through a new data strategy and collection methods.
7
Conclusion
Accepted in Part
When we pointed out that it was not always the case that social care got the right weighting in ICS structures because they are health-led, the Department acknowledged that the system was not working everywhere.10 The National Care Forum called for the appointment of adult social care leads on all …
Government Response Summary
The government agrees with the committee's observation regarding social care weighting in ICSs and commits to new CQC assurance of ICSs and local authorities to assess how well partners meet population needs. It also plans to improve adult social care data quality and availability, though it does not commit to appointing social care leads on all Integrated Care Boards as suggested by external bodies.
9
Conclusion
Accepted
In recent years, there have been multiple short-term, top-up funding announcements for adult social care in response to crises. In response to emerging pressures in 2022, in the November 2022 Autumn Statement government announced funding of up to £7.5 billion over two years (up to £2.8 billion in 2023–24 and …
Government Response Summary
The government agrees and states the recommendation has been implemented, detailing the up to £8.6 billion in additional funding made available over two financial years and its impact. It also describes ongoing assurance and scrutiny of new grant funding to local authorities.
13
Conclusion
Other evidence we received put forward alternative ways of taking pressure off the NHS and other parts of the public sector, that might offer better value for money. For example, the National Care Forum suggested that measures to enable a shift towards prevention and early intervention, rather than a narrower …
14
Conclusion
We noted that reform funding, including the £300 million budget to integrate housing into local and care strategies, had been redirected to support the system and asked what the consequences of that reprioritisation had been.29 Both the Department and DLUHC acknowledged the redirection of money from supported housing, and the …
17
Conclusion
Deferred
We challenged the Department on whether we were ever going to see a multi-year funding settlement for local government and if the extra money for adult social care in 2023–24 and 2024–25 would continue into future years. Both the Department and DLUHC acknowledged the benefits of multi-year funding but also …
Government Response Summary
The government agrees and recognizes the value of multi-year funding, noting the 2021 Spending Review provided three years of funding. However, it defers the decision on future multi-year settlements for adult social care, committing to work with relevant departments to ensure the next spending review delivers a sustainable funding package.
18
Conclusion
Accepted
We have repeatedly raised concerns about care workforce shortages. When we reported in 2018, vacancy rates for 2016–17 were 6.6%.38 The vacancy rate has increased since then and, as the NAO reported, in 2022–23 vacancies were 152,000, a rate of 9.9%, despite the recruitment of 70,000 staff from overseas. We …
Government Response Summary
The government agrees and states the recommendation has been implemented, referring to its 2021 workforce strategy and 2023 plan. It highlights ongoing investment in recruitment and retention reforms, including workforce training, pay, and a £15 million investment in 2023-24 for international recruitment initiatives.
19
Conclusion
Accepted
In its 2021 white paper, the Department said it expected the number of jobs in adult social care to increase by almost one-third by 2035.42 Given its reliance on overseas workers to date, we asked what percentage of the workforce it expected to come from overseas in future. The Department …
Government Response Summary
The government agrees and states the recommendation has been implemented, referring to its 2021 workforce strategy and 2023 plan. It details investments in recruitment, retention, and international recruitment, including £15 million in 2023-24 for local initiatives, alongside adherence to ethical standards in international recruitment.
21
Conclusion
Accepted
Care England said there was a widespread sense within the sector that careers in adult social care did not enjoy parity of esteem with the NHS and care workers were not afforded the same level of respect from the Government or across wider society.52 Pay for equivalent roles in adult …
Government Response Summary
The government agrees and states the recommendation is implemented, outlining existing and ongoing actions such as published workforce strategies, investment in recruitment/retention reforms, workforce training, the Market Sustainability and Improvement Fund (focused on pay), and £15 million for international recruitment initiatives.
24
Conclusion
Accepted
When asked when the payments system would be ready, the Department told us that it was aiming for summer 2024 but that delivery was “at risk”. The Department described the system as “difficult”, “complex” and “novel” which, we noted, sent “chills down our spine”.61 The Department has since confirmed that …
Government Response Summary
The government agrees and confirms the payments system is on track to begin making payments from the end of June 2024, with a phased approach for specific funds and qualifications. It commits to updating the Committee on fund take-up before the end of the 2024-25 financial year.
26
Conclusion
We challenged the Department on how it was applying lessons from its earlier attempt at charging reform to meet the revised implementation date of October 2025. The Department told us that charging reform was “not a delivery challenge; it was a money challenge”, and that was why it delayed it …
27
Conclusion
We asked the Department and DLUHC what they were doing to ensure that local authorities could deliver charging reform alongside system reform, with all the other pressures on them. The Department told us one of the reasons for delaying charging reform had been local authority capacity given other pressures on …