About a quarter of a million vulnerable people in England are languishing on adult social care “waiting lists” for up to six months, at risk of physical deterioration, abuse or neglect while they wait to be assessed by social workers, council care leaders have revealed.
At least 75,000 people are waiting for an initial assessment of their care needs after contacting a local authority for help. And an estimated 159,000 people already getting care are facing long delays for their annual care review, which checks on recipients’ physical and mental state.
The Association of Directors of Adult Social Services (Adass) described the emergence of what were, in effect, waiting lists for care assessments as unacceptable and a reflection of the parlous financial situation facing councils after a decade of cuts and a pandemic that had created staff shortages in care services.
Stephen Chandler, the Adass president, said: “I don’t think a waiting list is acceptable in the NHS, and I certainly don’t think it is acceptable in adult social care. If we are going to have a system that we are proud of for our nearest and dearest we should be creating one that does not rely on waiting lists as a way of managing the level of need in the system.”
Chandler, who is the director of adult social care at Oxfordshire county council, called on the government to urgently publish its promised but long-delayed plans for the reform of social care funding. Failure to do so would ensure “a grinding continuation of decline” in council services. He added: “We do not have time on our side.”
All but those with the most urgent cases, in contact with councils and asking for help, wait weeks to be assessed. About 7,000 waited for more than six months. The total number waiting was likely to be an underestimate, said Chandler. All callers were triaged, usually by a social worker, and placed on a waiting list, which was reviewed weekly or fortnightly.
“Whilst social work teams do their best to prioritise based on the information they glean, it is inevitable that many people will deteriorate, become mentally or physically unwell, lose confidence, fall – or that unreported or concealed abuse or neglect will worsen,” said Chandler.
Heads of care said they believed the emergence of the waiting lists reflected a deluge of requests for support as the UK opened up after the pandemic, and followed the 10 years of financial cuts that had taken £8bn from care budgets and left care departments overstretched.
This year adult social care departments face £600m of cuts and a funding shortfall of £204m. Vulnerable people have not only waited longer to be assessed, but often have subsequently received less care than they needed, an Adass survey report said. Councils were increasingly forced to ration services, thereby ratcheting up the pressure on unpaid family carers, who were increasingly finding it hard to cope.
The survey found that the financial crisis facing councils meant the unmet and inadequate care for vulnerable people would increase. Four-fifths of local care directors reported that they were not fully confident they had the resources to meet their legal obligations to provide sufficient care and support.
Boris Johnson said he had a “clear plan” to reform social care when he became prime minister in 2019, but has yet to deliver and so has added to 20 years of unmet promises from successive government’s to overhaul care funding. Proposals are not expected until the autumn spending review.
Despite the pandemic highlighting the crucial support role of local charities and voluntary groups in helping vulnerable adults, the Adass survey revealed that many councils were being forced, due to funding cutbacks, to reduce grant funding to local voluntary groups.
The Adass spring survey was carried out in May and June and about 147 in 157 local authorities answered the questions.
The Department for Health and Social care was approached for comment.
Case study: ‘The system is teetering on the brink’
Marie, a care manager for a local authority on the south coast of England, says: “All councils have a front door call centre. They deal with inquiries from people wanting a care assessment. Their role is to filter and get rid of as many as possible. If they can give it to the NHS or to other people they will do that. If something is really super urgent we’ll visit and do an assessment. But what normally happens is somebody is booked into a diary appointment.
“We have what are called priority appointments, where people won’t have to wait longer than two weeks. If there isn’t a massive risk, people will be booked into a normal appointment. The current wait for a normal appointment is about eight weeks.
“I’ve been a worker in adult social care for 20 years. Things have got a lot tighter over that time. Finances are very tight. Are we too focused on money? In our team we really work hard not to to lose sight of the bigger picture. We are very focused on the person and on continuing to give a really good service. It’s very hard. Staff get burnt out very easily. I wouldn’t say it isn’t a challenge but I would say, with good support and supervision, it is possible to retain a focus on the person.
“It feels like it is on a knife edge all the time. The system is teetering on the brink. In one case recently relatives were complaining because they were only given one choice of nursing home for their relative to go into. I had to explain that there was only one home locally that was willing to accept a local authority rate.
“There needs to be much more investment, definitely. For older people, especially, our offer can be very basic and limited. It isn’t about quality of life. It’s about making sure somebody is clean and making sure they are fed. That takes the joy out of care work. It’s hard for people to do that job. It is not a valued job.”