Rationing of Adult Social Care in the UK
Recently, there has been a noticeable decrease in the number of individuals receiving adult social care, coupled with a surge in requests for support, which has raised concerns about the allocation of these vital services. According to the Institute for Government (IFG), this decline is primarily attributed to the rationing of adult social care rather than the adoption of strengths-based practices aimed at promoting independence.
The IFG’s findings, presented in a recent report assessing the performance of adult social care, highlight a decline of 4.6%, or 30,090 fewer people receiving council-arranged long-term care as of March 2023 compared to eight years earlier. This drop is particularly pronounced among older individuals, with a 10% reduction in their access to care.
Concurrently, the number of annual requests for support has surged by 10.6%, exceeding two million in 2022-23. The IFG asserts that government failure to adjust the savings thresholds for accessing council-funded care since 2010, a decrease of 25%, has made it more challenging for people to access care. Furthermore, despite the Care Act 2014 having formally set a nationwide needs threshold, which remains unchanged since 2015, the IFG contends that local councils are employing “subjective judgments about need to further ration care to adults” due to reductions in government funding in the 2010s.
Regrettably, very few local authorities openly admit to rationing long-term care. Instead, they assert to follow a “strengths-based” approach, focusing on empowering individuals to live independently and contribute to their communities. However, confidential discussions with local authority leaders indicate that they have little choice but to ration services.
The IFG’s analysis of NHS England data indicates that the adoption of strengths-based practices has not resulted in a reduction in the number of people requiring care. The provision of short-term packages aimed at enhancing independence, such as reablement services, has fallen by 4% in 2022-23, and the number of requests for care and the adult population has grown more quickly during this period.
The support for carers has not seen an increase either. Requests for support from carers have decreased by 16% from 2014-15 to 2022-23, with the number of carers receiving support decreasing by an even larger margin of 30%. Similarly, the funding allocated for information and early prevention services, designed to delay, reduce, or prevent the development of care needs, has remained relatively unchanged in real terms.
The IFG’s report underscores that the key reason behind the declining rates of people accessing long-term support is the rationing of care. Unmet need has become a significant issue, which adds to the pressure on the NHS.
Although the government has increased funding for adult social care, further action is necessary. The Association of Directors of Adult Social Services (ADASS) stressed the importance of a long-term, fully funded plan to address the growing and ageing population, increasing inequalities, and the rising number of individuals living with disabilities. Such a plan would ensure that people receive the care and support they need in a way that suits their needs and circumstances. It would also involve collaboration with NHS primary, community, and mental health services to prioritise wellness and wellbeing over crisis management, sickness, and mere survival.
The IFG’s Report can be found here:
5th November 2023