Skip to main content

National Audit Office report: The adult social care market in England

The adult social care market in England

This report examines the current care market and the Department of Health & Social Care’s role in overseeing it.

Background to the report

The Department of Health & Social Care (the Department) is responsible for setting national policy and the legal framework. It is accountable to Parliament and the public for the performance of the care system as a whole. The Ministry of Housing, Communities & Local Government oversees the distribution of funding to local government and the financial framework within which local authorities operate. As set out in the Care Act 2014, local authorities are responsible for commissioning care, mostly from independent providers which are autonomous enterprises. Around 14,800 registered organisations across 25,800 locations provide care. The Care Quality Commission regulates care providers for quality and also provides oversight of the financial resilience of the largest and potentially most difficult-to-replace care providers.

In 2019-20, local authorities spent a net £16.5 billion on care. Current demographic trends suggest a greater demand for care and increasingly complex care needs in the future, resulting in care forming an ever-increasing proportion of public expenditure. Future reforms, promised for several years, will need to tackle these growing challenges.


Scope of the report

This report examines the current care market and the Department’s role in overseeing the market now and in the future, with the aim of offering insights and recommendations ahead of future social care reforms. It builds on a significant body of past National Audit Office (NAO) work on care, including on the care workforce; personalised commissioning; and the interface between health and care.

In Part One, we provide an overview of the market. In Part Two, we assess market oversight. In Part Three, we assess plans for future demand and reform.


Report conclusions

High-quality care is critical to the well-being of some of the most vulnerable adults in society. Yet levels of unpaid care remain high, too many adults have unmet needs and forecasts predict growing demand for care. The lack of a long-term vision for care and short-term funding has hampered local authorities’ ability to innovate and plan for the long term, and constrained investment in accommodation and much-needed workforce development. In a vast and diverse social care market, the current accountability and oversight arrangements do not work. The Department currently lacks visibility of the effectiveness of care commissioned and significant data gaps remain. As such, it cannot assess the outcomes achieved across the system and whether these are value for money.

COVID-19 has focused attention on social care as never before. It has highlighted existing problems with social care and emphasised significant gaps in the Department’s understanding of the market. However, we have also seen substantial efforts from those across the sector to deliver these essential services in such challenging circumstances. The Department has recently taken steps to increase the capacity of its teams; address data gaps, with local government and care providers; and strengthen system accountability and assurance. This renewed focus, impetus and collaborative approach must be capitalised upon when government finally focuses on the long-awaited social care reforms.


Publication details:

ISBN: 9781786043672 [Buy a hard copy of this report]

HC: 1244, 2019-21

Published date: March 25, 2021