The government has no long-term funded plan for social care reform and is behind schedule on its revised plans, the National Audit Office (NAO) has said.

In its Reforming adult social care in England report, the NAO said the DHSC has much to do if it is to achieve its 10-year ambition for reforming adult social care and must manage significant risks.

The report reveals over £1 billion of the £1.7 billion committed to adult social care reform in December 2021 has been diverted to stabilising the sector.

Only £729 million may now be spent between 2022 and 2025 on reform, representing a 58% fall in budget, the report says.

At last year’s Autumn Statement, the government postponed its £3.6 billion charging reform initiative and committed up to £7.5 billion to the sector, including £2.7 billion of new central government funding, to help ease immediate pressures, which has provided some welcome relief for local authorities. 

Despite this, however, the NAO estimates around a quarter of local authorities may not spend enough to keep up with the cost pressures they face this year, while one in six expects demand for adult social care to exceed capacity this winter.

Social care waiting lists, meanwhile, increased by 37% between November 2021 and April 2022, with the number of people waiting more than six months in March 2023 for a care assessment almost double – at around 82,000 – what it was at the end of 2021. 

Additionally, vacancies in adult social care in England have increased by 173% in the past decade and, despite a recent fall, stand at around 152,000 (a 10% vacancy rate) with around 70,000 staff having been recruited from outside the UK in the past year.

The report calls on the DHSC to set out a costed plan for implementing charging reform from October 2025, and to map the funding required to deliver its planned reform outcomes.  

Gareth Davies, head of the NAO, said: “Adult social care reform has been an intractable political challenge for decades. Government has set out its ambition to meet this challenge and now needs to demonstrate how it is delivering on these plans.

“If government 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, government will need to ensure it understands the impact of its ambitions on local authorities and other stakeholders and establish a costed plan which ensures delivery of its long-term goals.”

Sir Julian Hartley, chief executive of NHS Providers, said: “The report highlights the persistent lack of attention being paid to adult social care when there is a huge number of people still waiting to be assessed for care.

“Adult social care needs to be an urgent priority for the government with meaningful reform and long-term, sustainable funding to address huge unmet need, quality of care, innovation and severe workforce shortages.

“The NHS works hand in glove with the overstretched social care sector. We want to see those working in social care properly rewarded for their valuable work which supports people to live independently at home and in the community.

“It is disappointing to see that government funding earmarked for adult social care reform has been underspent.”

Vic Rayner, National Care Forum chief executive, said: “The National Audit Office has hit the nail on the head and highlighted that the government’s reform agenda is not the dynamic ‘fix’ the electorate was promised. The report confirms what many already knew – the majority of the reforms have been reprioritised with 58% of the £1.7 billion system reform money being reallocated and the entirety of the £3.6 billion charging reforms being delayed until after a general election. Even after these reprioritisations, there has been desperately limited progress in other areas.”

A Department of Health and Social Care spokesperson said: “We remain committed to reform, and are investing up to £700 million over this year and next to make major improvements to the adult social care system. This includes £42.6 million to support innovation in care and increasing the Disabled Facilities Grant by £50 million.

“Additionally, we have made up to £8.1 billion available to help local authorities tackle waiting lists, low fee rates, and workforce pressures, £570 million of which will help local authorities improve adult social care provision, in particular by boosting the workforce.”