This change is due to increasing local authority spending power – the total amount that councils have to spend, both from money they raise themselves (for example, from council tax and business rates) and from central government grants.  

However, councils still do not have the resources to meet all the demands on them and their overall financial position is worsening. As a result, local authorities are increasing fees below the increase in costs faced by social care providers. This has potential implications for market stability, quality, and particularly private-paying clients, who are being charged much more for their care so that providers can balance their books.  

Taken together, the picture for social care remains precarious, then, with significant pressure on the government to ensure stability in the sector in the medium term, and on the Casey Commission to identify coherent proposals for reform in the long term.

• 2 million people aged 65+ and 1.5 million people of working-age are not getting the care they need, leading to lives led at the bare minimum rather than to their fullest.
• Individuals face unknowable, and potentially life-changing, charges for care, including 1 in 7 older people with care costs over £100,000.
• The care individuals do receive can be inadequate, or neither the right care nor in the right place, leaving people unable to work or take part in other meaningful activities and risking the worsening of existing conditions.
• 1.5 million unpaid carers are providing over 50 hours of care per week to loved ones, and many of these withdraw partially or wholly from employment as a result, and who themselves suffer adverse outcomes as a consequence of putting the needs of their loved ones before their own.
• Due to the current funding model, local authorities’ budgets are buckling under the pressure of adult social care, with more councils seeking emergency funding and increasing proportions of budgets being spent on adult social care to the detriment of other services, leading to the perception of a democratic deficit in local government with people paying more and more for fewer and fewer services.
• The care provider market is in distress, struggling to cover existing costs via fees and facing underfunded increases in the National Living Wage and National Insurance.
• Care workers continue to be underpaid, driving high turnover and vacancy rates, and are twice as likely to be claiming benefits;
• The NHS struggles to divert admissions from the community and to discharge medically fit patients, causing knock-on costs of at least £1.89 billion, putting at risk the mission to build an NHS fit for the future.
• The economy is missing out on the sector’s potential to drive growth and regional rebalancing, as well as on tax receipts from unpaid carers and people in receipt of care, who are unable to work as much as they would like.

You don’t have to be a doctor to recognise that Rosy urgently needs 24/7 specialist home care. Instead, a hospice she had used suggested she apply for continuing healthcare (CHC) – the NHS-funded service that provides care workers for people with “primary health needs” outside hospital – and wait for however long it took for swamped assessors to get to her application. In the meantime, the local council had given her a couple of hours of social care a day: a slot with a well-meaning but untrained agency worker to help her get up and another to get to bed.

Without a carer overnight, Rosy can’t use her ventilator; if she were to choke from the secretions in her lungs, she wouldn’t be able to get the vent mask off herself. On the nights she struggled to breathe, she was forced to stay awake and hold the mask to her face in the dark. The NHS’s solution? Rosy said one assessor suggested her 14-year-old daughter fill in as a child carer, including being on call for the ventilator throughout the night.

In recent weeks, the government has launched NHS reforms and a social care consultation to considerable fanfare. There has been no mention of CHC, or the tens of thousands of people like Rosy who rely on it.

• Over a quarter of carers (28%) said their mental health is bad or very bad, rising to 37% for carers on Carer’s Allowance.
• A third (36%) of carers said that they had thoughts related to self-harm or suicide.
• Over half (54%) of carers said that their physical health had suffered because of their caring role, with one in five (20%) suffering a physical injury from caring.  

The results of a survey of over 1,700 Scottish unpaid carers shows the ongoing struggle that they are facing to access the services and support they need to care and manage their health and wellbeing. Despite their huge contribution to the Scottish economy, to our communities and to the lives of the people they care for, carers are facing deteriorating physical and mental health, loneliness and isolation with too many driven to deep mental despair as they are denied the support they need to maintain a healthy life. 

Only a third (38%) of carers are receiving support from formal social care services and over a third (35%) have not had any break from caring in the last year. There is lack of involvement of carers on hospital discharge with 60% not engaged by health services, despite being expected to provide care to someone at home. Only 18% were provided with sufficient support on discharge to protect their health or the health of the person they care for. 

Caring, particularly with such insufficient support, is damaging carers mental health. Carers shared in detail the impact that caring had on their mental health, with the majority (88%) having difficulty sleeping, continuous low mood (85%) and feelings of hopelessness (82%) including regularly feeling tearful (71%). This has led a shocking level of carers saying that they have thoughts of self-harm or suicide. 

And, concerningly, this lack of support from both health and social care services leaves little time for carers to look after their own health, with four in 10 (41%) saying that they have had to put off receiving healthcare treatment because of their caring role. 

Key findings

1. To better support unpaid carers locally, commissioners and services need to develop and maintain a good understanding of their populations. This can be facilitated by supporting local professionals to identify and point carers to available services, meaningfully measuring the impact of support and engaging with local carers.
2. Local support offers should be built on this understanding. Commissioners and providers of services for unpaid carers need to actively develop awareness of their local support offers among unpaid carers, at the same time ensuring support is appropriate and accessible, as well as inclusive of diverse populations. Carers are a hugely diverse group, both in terms of who they are and who they care for, but policy and services don’t always reflect this diversity.
3. Awareness of carers needs to be embedded in strategic level and commissioning decisions. Professionals who ‘get it’ and advocate consistently are vital. But the work can’t just rely on a few committed individuals—system-level carers’ partnerships and strategies have a key role in advocating and embedding the carers agenda.
4. The impact of wider health and care issues on carers cannot be ignored. The impacts of ongoing funding issues and the health and social care workforce crises on carers and local support services were highlighted multiple times in our research. Workforce shortages in particular are directly impacting on carers health and wellbeing because they are the ones left to fill in the gaps. 

1. Requests: More people, particularly working-age adults, are requesting support.
2. Receipt of care: The number of people receiving long-term care has fallen again.
3. Eligibility: Financial eligibility is tighter and reform has been put back.
4. Spending: Total expenditure has increased due to the Covid-19 pandemic and is now higher than in 2010/11. 
5. Costs: Local authorities are paying more for care home places and home care. 
6. Capacity: The total number of care home places has declined slightly.
7. Vacancies: The staff vacancy rate is the highest since records began.
8. Pay: Care-worker pay continues to rise but struggles to compete with other sectors. 
9. Carers: Fewer unpaid carers now receive paid support and respite care has also fallen. 
10. Quality: Quality is largely stable but fewer ratings were published during Covid-19. 
11. Personalisation: Fewer people receive direct payments.
12. Satisfaction: Satisfaction of people using services is edging downward.

Workforce and sector size

• An estimated 17,900 organisations were involved in providing or organising adult social care in England as at 2021/22. Those services were delivered in an estimated 39,000 establishments. There were also 65,000 individuals employing their own staff.
• The total number of adult social care posts in 2021/22 was 1.79m. 1.62m of these posts were filled by a person (filled posts) and 165,000 were posts that employers were actively seeking to recruit somebody to (vacancies).
• The adult social care sector was estimated to contribute £51.5 billion gross value added (GVA) per annum to the economy in England (up 2% from 2020/21).

Recent trends – workforce supply and demand

• The total number of posts in adult social care in England as at 2021/22 was 1.79 million (up 0.3% from 2020/21). Of these posts, 1.62m were currently filled by a person (filled posts) and 165,000 were posts that employers were actively seeking to recruit somebody to (vacancies).
• Skills for Care workforce estimates show a decrease in the number of filled posts in 2021/22. Overall, the decrease was around 3% (50,000 posts).
• The vacancy rate has risen over the same period to the highest rate since records began in 2012/13. The number of vacancies increased by 52% in 2021/22 by 55,000 to 165,000 vacant posts. The vacancy rate in 2021/22 was 10.7%.
• This shows that the decrease in filled posts is due to recruitment and retention difficulties in the sector rather than a decrease in demand. Employers have not been able to recruit and keep all the staff they need. As a result, an increasing number of posts remain vacant.
• The starter rate has fallen from 37.3% in 2018/19 to 30.8% in 2021/22. The turnover rate these periods remained at a similar level (29% in 2021/22). Therefore, around the same proportion of people are leaving their roles, but there are fewer people replacing them.
• The UK vacancy rate has increased rapidly in the past year. This increase has created competition for staff and contributed to the increase in the adult social care vacancy rate over the same period.
• During 2022, following the relaxation of rules regarding testing and isolation, sickness rates have begun to decrease towards pre-pandemic levels (6.2 days as at August 2022 compared to 4.6 days in 2019/20).

 Workforce characteristics

• The adult social care workforce continued to be made up of around 82% female workers, the average age was 45 (with 28% aged 55 and over), 23% of the workforce had black, Asian and minority ethnicity and 16% had a non-British nationality.
• Data collected in the ASC-WDS since care workers were added to the shortage occupation list showed more people were arriving in the UK to take up adult social care jobs. In 2022, between February and August, 11% of workers new to their role within the year had also arrived in the UK within the year. This was greater than the equivalent period in 2021 (4%) and 2020 (2%).
• Almost a quarter of the adult social care workforce (24%, or 358,000 filled posts) were employed on zero-hours contracts.
• In April 2021, the NLW rose from £8.72 to £8.91 (2.2% in nominal terms). This increase contributed to a 5.4% increase in the median nominal care worker hourly rate from March 2021 to March 2022. This was the second highest increase over the recorded period.
• The median hourly rate for care workers decreased, in real terms, by 1.5% between March 2021 and March 2022. This compares to an average increase of 1.8% per year since September 2012. This decrease was driven by the high cost of living in 2021/22 with inflation rising to 7.0%.
• Analysis of workforce data from the ASC-WDS shows that there were differences in diversity between job roles. Notably, there were proportionally more males and more white people in senior roles than front line roles. The root cause of this difference can’t be ascertained from ASC-WDS data alone.
• Our forecasts show that if the number of adult social care posts grows proportionally to the projected number of people aged 65 and over in the population between 2021 and 2035, an increase of 27% (480,000 extra posts) would be required by 2035.
• Employers with favourable workforce metrics (such as high levels of learning and development), on average, had better outcomes (lower staff turnover and/or high CQC ratings).

• There is unsustainable pressure on health and care services, driven strongly but not exclusively by the severe capacity challenges affecting social care. Like the NHS, the sector faces steep vacancies and is struggling to recruit and retain staff desperately needed to keep people well at home and support them to leave hospital safely.
• 99 per cent of healthcare leaders responding to our latest survey agreed that there is a social care workforce crisis in their local area. Almost all agreed it is worse than a year ago and expect it to deteriorate into this winter.
• These pressures are impacting the whole health and care system’s ability to deliver care across community and acute settings. For instance, 85 per cent of those surveyed agreed that the absence of a social care pathway is the primary cause of delayed discharge of medically fit patients.
• Almost three-quarters (73 per cent) said a lack of adequate social care capacity is having a significant or very significant impact on their ability to tackle the elective care backlog. Over 80 per cent said it is driving urgent care demand.
• Although health and care are inextricably linked and interdependent, social care is not just about helping to alleviate pressure on the NHS. The care delivered by social care services is critical to the wellbeing of the nation. However, patients will continue to face long delays for treatment unless the government invests in social care to boost capacity. Healthcare leaders stand in support of their colleagues in social care and are calling for urgent government action to tackle this capacity crunch.
• Healthcare leaders are calling on the government to back social care with a fully funded pay rise to boost recruitment and retention, alongside providing greater overall investment and improved career progression opportunities. This will help to stop the exodus of staff leaving for better paid and less stressful roles in other industries like hospitality. There is no time to waste, and action must be immediate to not only ensure people do not have their health outcomes further threatened, but to also ensure capacity gaps are not worsened.
• Healthcare leaders are clear that the NHS and social care will sink or swim together. New integrated care systems (ICSs) encompass both health and care and are acutely aware that both need sufficient resourcing if ICSs are to succeed in their essential task of improving health and sustainability.
• So, what now? Healthcare leaders are asking for a ‘realism reset’ on the state of health and care. This needs to properly acknowledge where the ten years of austerity in the 2010s have left health and care services. It also needs to include an acknowledgement that social care is not ‘fixed’ as the government continues to insist. The priority must be to close the gulf between demand and capacity – particularly in the face of continued COVID-19 spikes, a cost-of-living crisis and what we expect to be another gruelling winter.