Performance and inspection data from ICSs should be made accessible and publicly available to assess the progress of adult social care across the systems, according to a report by the Public Accounts Committee (PAC).
Published today, the reforming adult social care in England report said it was ‘far from clear’ whether ICSs are making a ‘demonstratable difference’ to adult social care delivery.
It made six recommendations for the Department of Health and Social Care (DHSC), including accessibility of ICS data and releasing its plans to identify and address workforce challenges.
It said: ‘We remain concerned about underrepresentation of adult social care in health-dominated systems and are deeply sceptical about the feasibility of integrating health and care when they are funded so differently.
‘Despite the Department’s assurances of “colossal improvement” on data and on how well the system is working, we see no clear strategy for pulling together data from across the sector and making it accessible.’
It added that ‘time will tell’ whether CQC inspections of ICSs will enable greater insight across public services.
Lack of roadmap for vision
The report also called for long-term financial support and a clear workforce strategy for the sector, saying the government was falling short of its promises to fix the social care crisis.
It said: ‘It is worrying that the Department has no roadmap for achieving its 10-year vision for adult social care, or any targets or milestones beyond 2025. Though we agree that some flexibility to adapt as the Department learns has merit, there is currently nothing meaningful in place to demonstrate progress towards targets.’
The committee added that the workforce plan to address the shortfall of staff in the sector was ‘woefully insufficient to the scale of the task’.
Dame Meg Hillier MP, chair of the PAC, said: ‘Years of fragmented funding and the absence of a clear roadmap has brought the adult social care sector to its knees. Waiting lists are rising, the sector is short tens of thousands of essential staff, and local authority finances are being placed under an unsustainable amount of pressure.
‘The decision to dedicate a single chapter in the adult social care reform white paper to the social care workforce does not do justice to the level of work that will be required and feels to us like a bit of a cop-out. While an NHS-style workforce strategy for social care may not be feasible, the DHSC must set out how it will how it provide leadership across the sector to identify and address workforce challenges.
‘Whilst we welcome the increase in funding, we fear this will do little to address the key challenges faced by the sector in the absence of a well-funded multi-year strategy. A 10-year vision is all well and good, but this alone is not enough to bring about the fundamental changes this sector so desperately needs.’
Deputy chief executive at NHS Providers, Saffron Cordery, said: ‘This report shines a much-needed light on the urgent need to reform adult social care, which has been severely under-resourced for years.
‘Successive governments’ failure to tackle deep-rooted challenges across the sector must be redressed. National action is needed to address the growing levels of unmet and under-met need, improve quality of care and fix the 150,000-plus workforce shortages.
‘We need an ambitious vision to ensure the sector is sustainable both now and in the future.’
Recommendations from the report:
Recommendation 1: In its Treasury Minute response, the Department should set out what is doing to:
- bring together its performance and inspection data relating to adult social care (from Integrated Care Systems and other sources); and
- ensure that these data are accessible, publicly available and enable people to i) assess whether patients are getting better outcomes in their areas and ii) allow the public to make comparisons between different areas.
Recommendation 2: The Department should write to the Committee alongside its Treasury Minute response to set out how it is assuring itself that each additional fund aimed at supporting adult social care is achieving value for money, including on benefits in relation to costs, for example:
- how much additional capacity it has bought with the discharge funding through the Better Care Fund.
- how it will ascertain whether funding for market sustainability and improvement has not just ended up increasing provider profit margins.
Recommendation 3: Given it has a 10-year vision for reforming adult social care, in its Treasury Minute response, the Department should set out:
- what it is doing now to prepare for the next spending review and make the case for more stable funding, and
- what it can do to give local authorities greater certainty over funding and allow them to plan for the longer term.
Recommendation 4: In the absence of an NHS style workforce plan, alongside its Treasury Minute response, the Department should write to the Committee setting out how it will lead the sector to identify and address workforce challenges, including:
- achieving a sustained reduction in the number of vacancies in the sector (beyond 2025)
- addressing the challenges and risks associated with international recruitment
- tackling local variations in vacancy rates
- addressing issues around disparity with NHS pay
- assessing which workforce initiatives are most effective for recruiting and retaining staff.
Recommendation 5: The Department should in its Treasury Minute response to this report:
- confirm which of the workforce reform projects depend on this payments system and update us on progress with each; and
- update the Committee on progress with the payments system (including any updates to the RAG rating and implementation date) and when it expects the workforce initiatives that depend on it to start to have an impact.
Recommendation 6: The Department should set out a roadmap for delivering its vision, pulling together all its reform activity (system reform and charging reform), and the risks to delivery with key performance indicators and should publish six-monthly updates on progress to time and budget.
Source: PAC report
