Almost 170,000 hours a week of homecare could not be delivered in the first three months of 2022 due to a shortage of care workers, according to the latest Waiting for Care and Support report from the Association of Directors of Adult Social Services (ADASS), and the number of people waiting for assessments, reviews or care to begin is now at over half a million.

The first three months of the year saw a 671% increase in unmet hours compared to spring 2021, according to the survey, which also found a 16% increase in the number of hours of homecare that have been delivered compared to spring 2021.

The number of people waiting for assessments, reviews, and/or care support to begin as of February 2022 was 506,131, a significant increase from the 294,353 people reported as waiting in September 2021. The burden of care is increasingly being passed to friends and relatives. As the report notes:

“This means that people will be waiting without support and relying on unpaid/family carers….. Others will not be living a decent life and are likely to be deteriorating (becoming dehydrated or malnourished or falling for example). A proportion will need admission to hospital or will see their health and wellbeing deteriorate significantly.”

More than six in 10 councils that responded (61%) to the survey said that due to a lack of care workers they were having to prioritise assessments and were only able to respond to certain cases, such as where abuse or neglect had been highlighted, those due to be discharged from hospital or from a temporary period of residential care to support recovery and reablement.

ADASS received 94 responses to its Waiting for Care and Support survey, a 62% response rate and the results have been extrapolated to represent figures for 152 local authorities.

Sarah McClinton, ADASS president said: ‘We have not seen the bounce back in services after the pandemic in the way we had hoped. In fact, the situation is getting worse rather than better.’

The latest data from Skills for Care show that home care companies and local authorities are struggling to recruit staff, with the vacancy rate continuing to rise over the last year, with a new high of 13.5% for domiciliary care in April 2022 (8.3% in April 2021).

This is not a new situation, nor one created by the pandemic, care workers have suffered poor pay, terms and conditions for many years as a result of over a decade of cuts to local authority funding by the Conservative central government.

But now the lack of care workers has been made very much worse by the triple whammy of – immigration issues that are part of Brexit, the Covid-19 pandemic, and the cost of living crisis. The Independent reports figures from the Care Workers Charity that show a record number of care workers are facing homelessness as they struggle with low pay and rocketing costs for food and energy. Despite working full time many have to switch off heating in their homes, rely on Universal Credit or handouts from family.

It is no surprise that care workers are now leaving for better paid work outside the sector, including in the NHS, cleaning, and retail, where they can command higher hourly rates. With advice from government ministers on national TV (Rachel Maclean talking to Kay Burley on Sky News) being to find a better paid job if you are struggling or work more hours, there will soon be no care workers left.

As well as the high level of unmet need for many in the community, the problems in home care have a knock-on effect – NHS hospitals struggle to discharge patients back home, which in turn reduces beds available for patients from A&E and for elective care, which contributes to ambulance waits, cancelled clinics and cancelled operations, and makes it more difficult for hospital trusts to reduce waiting lists and respond to emergencies. Furthermore, prolonged stays in hospital can increase the risk of infection for the patient and a deterioration in physical and mental health.

HSJ has reported that nearly 600 patients waited 10 hours or more in the back of an ambulance to be transferred into emergency departments in April 2022, with one wait of 24 hours recorded.  At the end of March 2022, the waiting list for NHS hospital care in England reached another record high at almost 6.4 million. The data also reported that an average of 12,589 beds were filled with patients who were medically fit to be discharged during March, and this was a limit on hospitals’ ability to admit patients and perform planned surgery.

Inadequate provision of social care is one of the reasons why the NHS is struggling, noted Chris Hopson, the chief executive of hospitals body NHS Providers, along with a 10-year budget squeeze, lack of capacity in hospitals to treat the number of patients turning up, and major staff shortages.

Despite reforms to social care announced back in December 2021, which had a lukewarm reception, and promises of money from the health and social care levy (£5.4bn over the next three years) as part of the government’s reform plans, things are getting worse, not better.

Dr Jane Townson, the Homecare Association chief executive, said: ‘Far from fixing social care, the government’s policies are steadily weakening it. We continue to call on the government to invest properly in homecare so we can build capacity and reduce unmet need, take pressure off the NHS and help people live well at home and flourish in their communities.’

And Cathie Williams, ADASS Chief Executive, said:

“We need a funded plan so that we can ensure that everyone gets the care and support they need, with more of the Health and Social Care Levy being used to fund care and support in people’s homes and communities over the next two years.  People cannot wait for funding trickle into adult social care and wider community services”.

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