People are needing more complex care and support due to illness and disability, but local councils are struggling financially to meet people’s higher-level needs, says the latest annual survey from the Association of Directors of Adult Social Services (ADASS).

For example, the survey reveals a 7.5% increase in the number of people requiring multiple visits from two or more care workers, called ‘double-handed care’, since last year, now totalling 49,000 people.

As more care workers are needed to provide care and support to people with complex needs, costs to councils are increasing.

This is illustrated in the average annual number of home care hours councils are providing per person, which has risen from 697 hours in 2022 to 750 hours in 2024. This has contributed to a rise in spending on home care by councils by just over a quarter during this period.

Directors report that this rise in complex care is partly the result of an ongoing push to discharge people from hospital more rapidly. 

The average size of care packages for people being discharged from hospital has increased in 76% of council areas over the past 12 months. This means that many older people and adults with a disability need more support from social care as they are more unwell following their hospital stay.

In addition, directors are concerned that increasing numbers of people whose care and support was covered by the NHS (Continuing Healthcare) or jointly funded are now having to seek support from their local council or pay for it themselves.

“After NHS treatment, many people will still need considerable social care support because they are being discharged more rapidly to reduce pressure on NHS hospital beds”

There has also been an increase in the number of people receiving publicly funded long-term care among working-age and older adults.

Directors ranked higher costs due to increased complexity of need as the greatest concern in relation to financial pressures on their budgets.

As councils provide more hours of complex care and support, those people needing low-level, early support at home – which has gained cross-party support – are at risk of missing out or their needs escalating, ADASS said.

This means that people are more likely to need to access emergency care and hospital treatment, which is bad for everyone and piles further pressure on the NHS.

NHS and social care interdependence

This picture illustrates the interdependence between health and social care – 99% of directors agreed that increased NHS pressures in 2023/24 will result in additional pressures for adult social care.

For example, those waiting for NHS treatment often face deteriorating and loss of independence, which requires more social care support. After NHS treatment, many people will still need considerable social care support because they are being discharged more rapidly to reduce pressure on NHS hospital beds.

In addition, eight in 10 directors say frontline adult social care staff are increasingly undertaking tasks that were previously delivered by NHS staff on an unfunded basis, an increase from 70% reported in our 2023 Autumn Survey. As the complexity of care tasks grow to support people’s increasing needs, this is not being reflected in social care budgets.

Financial picture

Directors report that the increase in complex and long-term care, in addition to National Living Wage increases and inflationary pressures, mean almost three quarters (72%) of councils in England overspent on their adult social care budgets in 2023/24, totalling £586 million nationally.

They also plan to deliver £903 million in savings to their budgets and a further £905 million of savings next year. Yet the real cost of this shift is too many people missing out on low-level, early support, which enables them to stay living independently at home for longer.

President of ADASS, Melanie Williams, said: “This report shows an unsustainable and worrying picture for the four out of five of us needing adult social care in the future and sends a clear message that we can’t keep doing more of the same. Instead of focussing on investment in hospitals and freeing up beds, the new government must shift to investing in more social care, supporting unpaid carers, and providing healthcare in our local community to prevent people reaching crisis point and ending up in hospital in the first place.

“Frontline adult social care staff are increasingly undertaking tasks that were previously delivered by NHS staff on an unfunded basis”

“Without investment in early care and support at home or the community, spending more on the NHS is like pouring water down a sink with no plug in. This approach is also better for us all in terms of mental health, sense of independence and overall wellbeing. 

“The next government must have the courage to commit to a long-term, fully funded solution for social care and shift from short-term crisis management, especially during winter, to more care at home in the long term. Care at home is better for all involved, but also makes more financial sense.”

The report also found that:

• Statutory duties: 90% of directors indicated that they are either partially confident or have no confidence that their budgets will be sufficient to fully meet their statutory duties in 2024/25, up from 86% in 2023/24. Of these, 16% have no confidence; 
• Waiting times: there were 418,029 people waiting for an assessment, care or direct payments to begin or a review of their care plan as of 31 March 2024, this is a reduction of 11.1% from 470,576 people at the end of August 2023;
• Complex care: 92% of directors indicated that on average the cost of each care package exceeded their assumptions when their adult social budget was set which had some or a significant contribution to their overspend;
• Long-term care increasing: 89% of directors indicated that the number of people requiring council-funded long-term care exceeded the numbers assumed in their adult social care budget either had a significant or some contribution to their overspent.