The British Social Attitudes (BSA) survey shows just how far satisfaction in the NHS has fallen – it is now at an all-time low of just 24%; in 2010 it stood at 70%. Figures for social care services were even worse – just 13% of respondents were satisfied with social care and 57% were very or quite dissatisfied.

Dissatisfaction was higher among respondents who had used or had contact with social care services (for either themselves or someone else) in the past 12 months at 64%, compared to those who had not (49%.)

The top reason for dissatisfaction with social care was pay, working conditions and training for social care workers not being adequate (57%), closely followed by people not getting all the social care they need (56%) and there not being enough support for unpaid carers (49%).

The BSA survey is viewed as a gold standard measure of public attitudes in Britain. The King’s Fund and the Nuffield Trust sponsor the health and social care questions of the National Centre for Social Research’s (NatCen) BSA survey.

Simon Bottery, Senior Fellow in social care at The King’s Fund, said: 

“These are awful results, but they are sadly unsurprising. For many years governments have taken too little action on social care and this is now seriously affecting those who draw on services, the families who support them and the staff who work in the sector. People realise that too many people fail to receive the social care support they need, putting an unfair requirement on unpaid carers, and that staff are overworked and underpaid.

“The results demonstrate the need for immediate action to stabilise the social care system, backed by long-term reform and investment. The next government must take a strong step forward and prioritise social care.”  

There were more bad figures for social care this week, when the HSJ published waiting time figures for local authorities around England. 

In the BSA survey waiting time to receive social care was not included as one of the reasons for dissatisfaction. Unlike the NHS, where waiting times are a key metric of how well the NHS is performing and continually covered by the media, waiting times for social care are not publicly available and not logged centrally by the DHSC, but held by individual local authorities.

However, last year for the first time in a decade, the DHSC collected the data on social care waiting times from councils, but it was not made public. Now HSJ via a freedom of information request has obtained the data.

What they found was that older people were often waiting many months to get essential care and support. HSJ reports that the longest average waits of up to 149 days (about five months) were in Bath and North East Somerset, with 25 councils (30% of the 85 councils which supplied this information) reporting waits of two months or more. 

What was also clear from the data was that it was incomplete and lacked clarity. The DHSC requested councils provide the total time from a person’s first request to be assessed for eligibility, through to the service beginning if they were eligible. Not all councils could provide this information. 

Some figures are publicly available for social care, such as vacancy rates, expenditure by councils and the number of people being funded, but wait times are not, so unlike in the NHS, they can not provide a measure of service that is easily assessed by the public.

The reason for dissatisfaction with social care and the long waits is clear from how little reform of the sector has taken place despite calls for this for well over three decades or more. And the wait continues.

In its recently released report ‘Reforming adult social care in England’, the House of Commons Public Accounts Committee, noted that two years on from the Government’s long-awaited white paper ‘People at the heart of care: adult care reform’ , plans for reform have “once again gone awry. Charging reform is delayed, system reform scaled back and funding for both has been diverted, including from areas such as supported housing, towards addressing urgent pressures. Meanwhile, waiting lists are rising, workforce vacancies exceed 150,000 and local authority finances are under sustained pressure.”

The committee criticised the DHSC for not providing the leadership needed to deliver a social care sector that is sufficient to meet the country’s future needs, particularly in relation to the workforce. Initiatives that have been taken, such as to ‘professionalise’ the workforce, are taking place too slowly and are too reliant on a ‘novel’ payments system.

Care England, which represents independent care providers, welcomed the call for a long-term funding settlement and a move away from short-term, sporadic Government funding measures. This, they note, would allow care providers to address financial and workforce challenges, whereas at present the funding only gives a temporary relief, often attached to conditions and difficult to access.

The PAC committee once again called for a long-term, comprehensive workforce plan, such as in the NHS.  It recommended the DHSC sets out how it will identify and address workforce challenges in the absence of an NHS-style workforce plan. At present the vacancy rate in the care sector is around 9.9% (152,000 vacancies on any given day) but would be much higher if it weren’t for international recruitment.   

Such recruitment was only made possible by intense lobbying by the industry for a change in immigration rules, that means care workers were added to the Shortage Occupation List in February 2022. 

As a result of the government ignoring calls for a workforce plan for social care, in October 2024, Skills for Care began work on a 15 year workforce strategy in an effort to address the ongoing crisis in the workforce. The plan, which will be similar to that unveiled for the NHS in June 2023, will be developed in collaboration with several other organisations, including the King’s Fund, but NOT with the Department of Health and Social Care (DHSC).

The King’s Fund’s annual analysis of social care produced this month, also paints a difficult picture of social care, concluding that there is little to suggest that social care has “turned a corner”.  Although there was a 2% increase in people who received social care support in 2022/23 compared to 2021/22, this was unlikely to be a trend in more people getting support, but rather a ‘correction’ after the extraordinary circumstances of the Covid-19 pandemic.

In 2022/23, 2% fewer people were receiving support than in 2015/16, despite 11% more people requesting it. 

The annual review concluded that all the data points to a social care sector that is still under intense pressure. The cost to councils of commissioning care has increased at a faster rate than inflation, less and less people are eligible to receive care as financial thresholds have not changed since 2010/11; the social care workforce vacancy rate still at its second highest-ever level, despite the arrival of around 70,000 overseas workers; fewer unpaid carers receiving direct support, and fewer people receiving respite care, than in 2015/16.

Despite the crisis in social care, there was no additional money for local government in the 2023 Autumn Statement, but in January 2024 the government announced an additional £600 million for local authorities in 2023/24, of which £500 million was for children’s and adults’ social care.

This is not nearly enough, however, as local councils finances go from bad to worse and bankruptcy beckons.  As the cross-party House of Commons Levelling Up, Housing and Communities Committee noted, in February 2024, ‘local authorities are increasingly reporting concerns about their financial positions and their ability to maintain delivery of their services’ and ‘the Government must act now if local authorities are to survive the severe crisis and financial distress that they face’.


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