Casey Commission reforms doomed to fail, unless Government measures true cost of inaction on social care, say MPs

Reporting on the problems of England's social care sector, MPs say that too much emphasis is put on the cost of change and not enough consideration is given to the human and financial cost of inaction.  

Parliament's cross-party Health and Social Care Committee today (Monday 5 May) warn that the Government needs to measure the true cost of inaction on social care, to be able to present a robust financial case for reforms of the system, saying that “without this we fear that the reforms that come out of the Casey Commission will be doomed to failure, leaving everyone continuing to suffer under the current unsustainable system.” 

The Committee's report cites the lack of official data held by the Government relating to social care and says it believes that the Government does not know what the potential monetary benefits of a reformed system might be and cannot assess which social care reform interventions would result in the highest returns.  

MPs fear that reforms will continue to be frustrated by concerns about the expense, unless there is a robust understanding at the centre of government of the cost of doing nothing. They warn that ignoring the cost of the status quo would leave us all continuing to pay “a high price for a failing system”.  

MPs want the Government to commission research to fully quantify the cost of continued inaction and call on it to publish data including an annual assessment of the level of unmet care needs for adults, as well as an annually published official estimate detailing how much delayed discharges are costing the NHS.   

Broken social care system 

The Committee's report sets out how the existing adult social care (ASC) system is not meeting the needs of the population and “the Government and taxpayers are currently paying £32 billion a year for a broken system”. 

MPs highlight that this is despite the enormous contribution by unpaid carers, who provide care worth £184 billion a year, "equivalent to a second NHS", and who are bearing the highest cost from failures to reform adult social care.  

The broken system is also straining local authorities' budgets with an increasingly high proportion of spending on adult social care, which MPs state is crowding out spending on other services, such as fixing potholes, keeping libraries open and providing youth services.  

The report expresses the Committee's concern that there is a growing disconnect between where council tax revenue is being spent and what services residents expect to see delivered from their council tax – undermining trust in local democracy.  

MPs also point to the impact of the status quo on the NHS and say that social care reform is an integral part of NHS reforms and cannot be a separate process. The Committee urges Baroness Casey, in her first report, to set out the immediate steps that the Government needs to take to ensure the adult social care sector can play its vital part in the three shifts for NHS reform.   

Potential for growth 

The Committee's report highlights the social care sector's potential to drive economic growth, contribute to regional rebalancing, and increase employment, but says that the economy is currently missing out on this potential.   

The report finds that every £1 invested in the sector would generate a £1.75 return to the wider economy and that an extra £1 billion spent on social care would create 50,000 jobs across the country.  

Stressing the need for reforms, MPs call on the Government to produce a growth strategy for the adult social sector care sector, and say “the Government needs to fundamentally change how it views the social care sector, seeing it as an enabler and talking about it in those terms in the public debate.”  

The Chair of the Health and Social Care Committee, Layla Moran MP, said:  

“Successive governments have shied away from implementing meaningful reforms to the social care system. But this is an active choice that is no longer tenable. We are living with a broken social care system. It is not providing adequate care to the people who need it, it is creating ever increasing costs for local authorities and the NHS, and it is putting unsustainable pressure on unpaid carers, many of whom have to leave work to care for loved ones. Meanwhile, many paid carers are living in poverty and needing state support in the form of Universal Credit.  

“Inaction, and the current state of affairs, are harming those who need care, the people delivering care, the NHS, local government, the Treasury, and the economy. But there is another side to the coin. The social care sector is rarely, if ever, discussed as a driver of economic activity, but it has enormous potential to contribute to the Government's wider agenda on economic growth and employment.   

“In our inquiry, we heard that an investment of £6.1 billion would provide full economic benefits of £10.7 billion - a return on investment of 175%.  

“Alongside the strong economic potential of the sector, it is clear that the Government has to reform social care, if it is serious about making the NHS fit for the future. While social care is a vital public service in and of itself and should not be valued only for how it supports the NHS, the two systems are inextricably intertwined, and one cannot be reformed without the other.  

“In order to achieve this, the Government needs solid data. Our inquiry has found that there is currently a severe lack of granular, numerical data on many aspects of the social care system. The Department of Health and Social Care needs to commission research on the costs that the NHS and the wider economy are bearing as a result of failures in adult social care. Unless the Government measures the true cost of inaction and can make a convincing case to the Treasury, the recommended reforms that come out of the Casey Commission will be doomed to fail. 

“We want this report to change the narrative on social care, and to act as a catalyst for building a strong and long-lasting case for reform. It might seem that reforms will be costly and difficult, but continuing with inaction will cost us all more.”  

ENDS 

The full list of the Committee's findings and recommendations can be found on page 53 of the attached embargoed report, but they include: 

Costs to those receiving care 

• Government should publish an annual assessment of the level of unmet care needs for both older adults and working age disabled adults. 
• Government must develop a robust methodology for measuring the impact of care on people's lives, the wider health system, and the economy. This would help councils to deliver outcome-based commissioning, which is more likely to provide people with meaningful care than the current task based approach.
• The threshold at which people become liable for their own social care costs has not increased since 2010. Inflation has eroded the value of the threshold, meaning fewer people benefit from it. We recommend that the Casey Commission considers measures to address the erosion of the upper threshold. In the meantime, we recommend the Government does the same. 

Unpaid carers: the hidden cost of inaction 

• Unpaid carers are bearing the highest cost from successive governments' failures to reform adult social care. We recommend that the Casey Commission includes a specific workstream dedicated to reducing the pressures on carers, especially young carers. This workstream should consider how to support unpaid carers better, to ensure they get the respite they need and to look after their own health and wellbeing. 

Costs to the care system including local authorities 

• Securing agreement on the funding structure must be the top priority for the Casey Commission and for any future Government reforms. Without this agreement, reform can only ever be piecemeal and short-term in outlook and, ultimately, will fail.
• The Government has not properly considered either the immediate or long-term impact of Budget measures, such as Employer National Insurance Contributions and the National Living Wage, on care providers' staffing costs. Any future policy changes or fiscal decisions relating to the workforce should be accompanied by a cross-government impact assessment that sets out the immediate and ongoing consequences for the social care sector. As part of this, the Government should set out what mitigating actions they would take to minimise any adverse effects on the social care sector, and how that compares to actions being taken to support the NHS.
• The Casey Commission should prioritise identifying interventions to create a more sustainable care market.
• We welcome plans to establish the Adult Social Care Fair Pay Agreement and to improve career pathways. As well as better recognising the skills and the work of carers, higher wages would achieve better quality care and reduce recruitment and training costs.
• Government needs to set out how these measures will be funded, as providers and local government cannot afford to fund them.  
• The Department should, in its response to this report, set out its timetable for establishing the Adult Social Care Fair Pay Agreement, including the date by which it will be finalised.

The NHS and wider system costs of inaction

• DHSC needs to assemble sound research and data on the impact the status quo is having on the NHS, in order to make the best case to HM Treasury for investment in reform of ASC.
• DHSC should provide an official estimate of how much delayed discharges are costing the NHS, broken down by the reason for the delay and including costs associated with the beds themselves, staff time and wider activity that cannot happen as a result of a delayed discharge. This should be published and updated annually. 
• Government and the NHS should review the structure and level of NHS investment in the Better Care Fund. 
• In her first report, Baroness Casey should set out immediate steps that the Government should take so that the ASC sector plays its part in the three shifts for NHS reform and supports the delivery of the 10-Year Health Plan. 
• The first phase of the Casey Commission should also set out what, if any, changes might be needed to the 10-Year Health Plan or the NHS to support the ASC sector. 

Costs to the economy  

• Government should view the social care sector as an enabler and discuss it as such in the public debate - both for the invaluable service it provides to so many people and as a driver of economic growth. 

• Government should produce a growth strategy for the ASC sector, including a focus on its potential to drive regional growth. This should include plans to improve productivity in ASC, which we recommend the Casey Commission draws up as part of its first phase.
• The Committee recommends that the Government commissions research with the aim of fully quantifying the cost of doing nothing on adult social care reform.