Deep reform to adult social care cannot be “kicked down the road any longer”, say health leaders, after the publication of a new report by the UK Parliament’s Health and Social Care Committee.
The report, the second from the committee’s investigation into social care, focused on the “cost of inaction” and what is at stake should the “status quo” be kept.
“Without investing in social care nursing staff, recruitment and retention issues will only worsen”
Nicola Ranger
The committee said there was a need to “shift the dial” in the way reform is talked and thought about among decision makers, by “reframing the narrative around the cost of action, to one that interrogates the cost of the status-quo”.
It noted that adult social care was in “desperate need of reform”; it pointed to the £32bn a year social care bill and “unsustainable pressure” currently placed on local authorities with competing financial demands.
In the report, successive UK governments were accused of shying away from much-needed systemic reform of adult social care and it said there had been “too much emphasis” on the upfront cost of change, with too little on the human and financial cost of doing nothing.
Some of these costs, the report said, included the additional pressure that is placed on the NHS when social care breaks down.
The knock-on costs of the NHS not being able to discharge medically fit people from hospital was costing around £1.89bn a year, the report said.
It pointed to figures quoted by Lord Ara Darzi’s 2024 NHS investigation, which suggested around 13% of health service beds were occupied by people waiting for social care or community support.
The committee also noted evidence submitted by the Royal College of Nursing (RCN).
The RCN had said that a lack of investment in the district nursing workforce was a specific driver of higher A&E admissions.
It said that, when an adult social care resident fell ill, too often care staff were more easily able to access A&E than a community nursing service.
The Health and Social Care Committee’s lengthy report also noted other issues it felt needed to be tackled head-on by the government.
It published findings on the financial impact of unpaid carers being unable to work; the impact of low pay in social care on recruitment and retention; and the “life-changing” costs of care.
The UK Government was, in the report, issued a series of recommendations, which included:
Improving funding arrangements for local authorities;
Ensuring future policy changes are properly scrutinised in terms of their impact on the social care sector;
Setting out how social care staff pay rises will be funded;
Publishing annual estimates of how much delayed discharges are costing the NHS, broken down by reason for delay and the costs associated with them;
Reviewing the structure of health and social care investment to ensure preventative care is being given ringfenced funding.
As well as this, the reported acknowledged the recent launch of a review, led by Baroness Casey of Blackstock, into the potential creation of a national care service in England.
The government is wanting the Casey Commission, terms of reference for which were published last week, to “start a national conversation about what adult social care should deliver”.
“We know there is so much more to do and deep reform is needed”
Stephen Kinnock
The Health and Social Care Committee’s report welcomed the launch of the commission’s first phase and said it hoped the review succeeded where “previous reforms failed”.
In its conclusions, the report read: “The government will not succeed in creating an NHS fit for the future unless it effectively reforms the social care system.
“Social care reform is an integral part of NHS reform and cannot be a separate process.”
Stephen Kinnock, minister of state for care, said the government would “respond formally in due course” to the committee’s report.
He added: “Far from inaction, this government has hit the ground running on social care.
“We inherited a social care system in crisis and took immediate action with our plan for change – with a funding boost of up to £3.7bn, an extra 15,000 home adaptations for disabled people, a £2,000 uplift to carer’s allowance, and the first ever fair pay agreement for care workers.
“A lot has been done, but we know there is so much more to do and deep reform is needed.
“That’s why we appointed Baroness Louise Casey to lead the independent commission working to transcend party politics and build consensus on the future of adult social care, with her first report out next year.”
Professor Nicola Ranger, chief executive and general secretary of the RCN, said the report should “act as an urgent wake-up call” for the government.
She said years of “inaction” had led to a deterioration in care, added pressure to the health service and created “unsustainable demands on a depleted nursing workforce”.
“Ministers must now recognise that without investing in social care nursing staff, recruitment and retention issues will only worsen,” said Professor Ranger.
“Not acting now will make any future recommendations undeliverable and leave some of the most vulnerable without the care they need.”
Isabel Lawicka, director of policy and strategy at NHS Providers, added: “The social care can cannot be kicked down the road any longer.
“The MPs’ hard-hitting report lays bare the cost of successive governments dodging difficult decisions on social care reform.
“They highlight the impact of this on people receiving care, those providing it and the impact on wider health and care services. The cost and consequences of inaction are plain to see.”
