Reflections on ADASS Spring Survey

Even for a sector used to depressing news, the ADASS Spring Survey of adult social care directors is a difficult read. Only 10% of directors are fully confident they can meet statutory duties to provide social care: this is the stuff that keeps people alive, let alone living well. More people are coming to services with more complex needs, including from hospitals.

The things that could change that trajectory are not happening in most areas: prevention is being cut in many areas, as is support for families to avoid carer breakdown, and backlogs of assessments and reviews are growing. The deficit of £900m this year is the highest since 2016/17, but that was early on in the austerity period: councils now have spent years making deep cuts.

The new government quickly made bold statements about saving the ‘broken’ NHS. If there have been similar commitments to social care, I’ve not been able to find them.

Social care is vital in its own right: it’s the promise of being able to live well and with dignity if we develop long-term support needs, which for some people can be lifelong but, for most of us, will affect us at some point in our lifetimes. Governments by now also surely understand that there is no ‘saving the NHS’ without also fixing social care.

The Spring Survey brings this home: 99% of directors think NHS pressures will increase pressure this year. 84% say frontline adult social care staff are undertaking tasks previously delivered by NHS staff (up from 70% just six months ago), and in 67% of cases, doing so without training, supervision and/or funding from the NHS. The most rapidly-increasing NHS pressures are coming from hospital discharge and reductions in NHS funding for long-term care (Continuing Health Care or CHC), which is being transferred into adult social care budgets/funding. The welcome discharge of people with learning disabilities and autistic people from hospitals, where too many spend too much of their lives, is also resulting in greater use of adult social care.

Clearly significant multi-year funding is needed to address this, but it’s not only funding that will make a difference. The NHS and social care are inextricably linked. Wes Streeting has an opportunity to be the first Secretary of State for Health and Social Care who takes both sides of that job title equally seriously. This would mean serious investment in improvement: we consistently find that councils which know what good would look like cannot create space to innovate and – crucially – then scale and embed that innovation, without outside input. The Better Care Fund is a vital source of shared NHS and social care resource, but in many areas it has been used just to keep the ship afloat, and never had a clear enough theory of change and implementation methodology to make the strategic shift the sector desperately needs.

We see councils doing extraordinary things, despite the extraordinary pressures. There are strengths-based and capacity-building ways to develop systems, practice and commissioning, which work both for people and for budgets. Our new Valuing Good Lives programme is demonstrating that sustainable, person-led change with young and working age adults. We are excited by the work that Social Care Future and councils are doing to make person-led care a reality through fixing the Plumbing and Wiring issues. People who use services and their families are often the most creative of all.

We need government and its partners to provide not just the resourcing, but also the leadership, that can make those successes a possibility for every area, and everyone who draws on care and support.