Background to the report
Adult social care covers social work, personal care and practical support for adults with a physical disability, a learning disability, or physical or mental illness, as well as support for their carers. In 2022-23, local authorities in England spent £23.7 billion on adult social care, supporting more than one million people with care needs.Jump to downloads
As people live longer and with more complex conditions more people are likely to need adult social care to support them to live the lives they want.
In 2019, the government promised to “fix the crisis in social care”. Following the COVID-19 pandemic, in September 2021 DHSC published Build Back Better: Our Plan for Health and Social Care.
Scope of the report
This report looks at how DHSC is responding to the challenges facing adult social care in England, and its progress with delivering the reforms set out in the 2021 white paper. This report examines:
- key pressures and challenges in adult social care in England
- DHSC’s response to increasing pressures in adult social care during 2022
- how DHSC is delivering reform and progress against its commitments
DHSC’s 10-year vision for adult social care reform was broadly welcomed by the sector as a step forward. But rising inflation compounded long-standing pressures and led DHSC to reprioritise money and activity to provide local authorities and care providers with some much-needed financial stability.
The sector remains challenged by chronic workforce shortages, long waiting lists for care and fragile provider and local authority finances. Although there are some early signs of improvement in some of these, it remains to be seen whether these trends will continue and at what cost.
Two years into its 10-year plan, DHSC has delayed its charging reforms, scaled back system reform, and is behind on some aspects of its revised plan. It has a long way to go if it is to deliver its ambitions. If DHSC is to successfully reform adult social care, it will need to manage some significant risks, including its own capacity and that of local government to resume charging reform activity alongside system reform.
To maximise its chances of succeeding, DHSC will need to make sure it understands how the different strands of its reforms relate to each other, and the cumulative impact on local authorities and other stakeholders. It must be clear what the critical steps are, manage delivery against those closely and put in place governance needed to manage delivery risks effectively.
Adult social care reform has been an intractable political challenge for decades, and in 2019 DHSC raised expectations that it would be addressed. Working with the sector, DHSC now needs to demonstrate how it is delivering on these plans.
- Report - Reforming adult social care in England (.pdf — 366 KB)
- Summary - Reforming adult social care in England (.pdf — 123 KB)
- ePub - Reforming adult social care in England (.epub — 1 MB)
- ISBN: 978-1-78604-515-7 [Buy a hard copy of this report]
- HC: 184, 2023-24
View press release (10 Nov 2023)