An annual review of adult social care services in the UK has warned that thousands of vulnerable adults are at risk of eviction due to mounting and far-reaching cost pressures.

The Sector Pulse Check 2024, produced by Care England and the learning disability charity Hft, is the culmination of a survey of more than 200 independent and charitable providers of adult social care. It says that social providers are operating in “survival mode… sprinting to stay afloat”, arguing that spiralling cost and workforce pressures have put “the entire sector…in a state of acute precarity”.

Financial pressures mounting

The report finds that the financial pressures on social care providers are far-reaching and having a tangible effect on the sector’s ability to provide quality services. In their responses to the survey, 90.9 per cent of providers said that workforce related costs were among the top financial pressures, with 38.8 per cent citing the cost of utilities, and 29.1 per cent unpaid or delayed bills by local authorities. Of these workforce related costs, increases to the national living wage were identified by 95.8 of providers as one of the biggest challenges. Critically, 85 per cent of providers did not experience increases in fees paid by local authorities to cover the national living wage rise

To cope with financial pressures, three in ten providers closed parts of their organisation or handed back care contracts to local authorities in 2024, often evicting some residents in the process. One third of all providers have curbed inward investment in the last year to offset rising costs, rising to two fifths of providers of care for older people, a move likely to impact care capacity and quality over the long-term.

Although the share of providers in deficit fell for the third consecutive year (down to 29 per cent from 40 per cent the year before), 60 per cent of those in deficit reported an increase in the size of deficit from the year before. It is estimated that seven in ten providers currently operating with a decreasing surplus will be in deficit within three years. This is expected to increase if the government does not add exemptions for social care from the rise in Employer National Insurance Contributions (NICS) announced in the 2024 Autumn Budget. Social care providers have been pushing the government for exemption, but the government has yet to announce any policy to mitigate the increased costs for the sector.

“Severe” workforce shortages

The report identifies workforce concerns as an ongoing and “severe problem” for the social care sector, pointing to its 8.3 per cent vacancy rate. The whole UK economy’s vacancy rate is 2.6 per cent, indicating the unique difficulties facing social care. 33 per cent of providers reported a fall in job applications in 2024, compared to 2023. This is partly attributed in the report to changes to legal migration rules introduced in March 2024, which include a ban on foreign care workers bringing dependants on their visa, along with an increase to the minimum baseline salary to be sponsored as a Skilled Worker (rising from £26,200 to £38,700).

While 40 per cent of providers (particularly smaller organisations) reported relying on international recruitment to fill posts, providers reported a decline in international applications following the new immigration restrictions, and expect to see yet further impact with time. Hft and Care England argue that the government should lift the ban on dependents for international social care staff to help protect the sector’s supply of workers.

Due to staff shortages, 29 per cent of providers reported refusing new admissions, while 40 per cent have increased their use of agency workers to fill gaps. Agency workers are typically more expensive and considered “less prepared to deliver quality care compared with their full-time equivalents”.

The sector’s future

The Sector Pulse Check report concludes that “there can be no expansion in the capacity of the social care sector without both more funding and more workers”. Lord Darzi’s recent revelation that the equivalent of 13 per cent of NHS beds are occupied by people waiting for social care support or care emphasises that the NHS cannot thrive without a functioning social care sector. The sector’s high turnover rate of nearly 26 per cent demonstrate social care’s challenge in attracting and retaining skilled workers.

While the government has recently announced the launch of an independent commission to reform adult social care, led by crossbench peer Baroness Louise Casey, some in the sector have voiced concerns over the commission’s three-year scope. Martin Green, Chief Executive of Care England, commented that “waiting until 2025 is not an option,” and voiced concerns that this will be “yet another report that gathers dust while the sector crumbles”. Regarding immediate action, the report highlights Skills for Care’s Workforce Strategy for 2024, which offers a series of policy recommendations to “attract, retain, train and transform the social care workforce”.

The report makes two major policy recommendations:

• Commit to a credible, multi-year funding settlement for the adult social care sector when the Spending Review concludes in Summer 2025. Funding increases must cover future increases in the national living wage, and any changes to Employers National Insurance, and inflation, to avoid real-term pay cuts and the large-scale market exit of care providers.
• Create a fully funded roadmap toward parity between care workers and workers in the NHS. Pay and conditions are central to this, yet the significance of status and respect must not be ignored. This should include adopting the recommendations of the Skills for Care Workforce Strategy to address the high vacancy and turnover rate in the sector.

Alongside these, it calls on the government to either exempt care providers from the increase in Employer NICS contributions, or to fully fund the rise itself. It also urges the government to ensure that the NHS and local authorities are sufficiently funded to reimburse care providers through the Local Government and NHS funding settlement.

The full Sector Pulse Check 2024 report can be accessed here.