Adult Social Care Reform: The Cost of Inaction

Health and Social Care Committee Open Inquiry
Opened: 31 Oct 2024 Parliament page
Successive governments have presented reform ideas for adult social care, yet few of these have been implemented. This inquiry seeks to understand what this inaction is costing. We will investigate the cost of inaction to individuals, the NHS, local authorities and also to the wider economy and HM Treasury, focussing … Read more
15 Recommendations
12 Conclusions
1 Report
4 Oral sessions
4 Events
Activity timeline 10 events
9 Jul
2025
Report published
5 May
2025
Report published
19 Mar
2025
Oral evidence
19 Mar
2025
Formal meeting (oral evidence session) · The Thatcher Room, Portcullis House
5 Mar
2025
Oral evidence
5 Mar
2025
Formal meeting (oral evidence session) · The Thatcher Room, Portcullis House
5 Feb
2025
Oral evidence
5 Feb
2025
Formal meeting (oral evidence session) · The Thatcher Room, Portcullis House
8 Jan
2025
Oral evidence
8 Jan
2025
Formal meeting (oral evidence session) · The Grimond Room, Portcullis House
Oral evidence sessions 4 sessions
19 Mar 2025
View on parliament.uk
Oral Evidence
Caroline Abrahams · Age UK Dr Maria Petrillo · Centre for Care, University of Sheffield Holly Jayne Simpson Keyaan Tom Gentry · Age UK
5 Mar 2025
View on parliament.uk
Oral Evidence
Anu Singh · NHS Black Country Integrated Care Board Councillor David Fothergill · Local Government Association Dr Birju Bartoli · Northumbria Healthcare NHS Foundation Trust Hugh Evans · Bristol City Council Isabel Lawicka · NHS Providers Melanie Williams · Association of Directors of Adult Social Services
5 Feb 2025
View on parliament.uk
Oral Evidence
Anita Charlesworth · Health Foundation Ms Emily Holzhausen CBE · Carers UK Oonagh Smyth · Skills for Care
8 Jan 2025
View on parliament.uk
Oral Evidence
Kathryn Smith · Social Care Institute for Excellence (SCIE) Simon Bottery · King's Fund Sir Andrew Dilnot CBE · Commission on Funding of Care and Support
Title HC No. Published Items Response
2nd Report - Adult Social Care Reform: the cost of inaction HC 368 5 May 2025 27 Responded
Recommendations & Conclusions
27 results
1 Conclusion Accepted
2nd Report - Adult Social Care Ref…
Adult social care system fails to meet needs and lacks robust data for effective reform.
The current adult social care system does not sufficiently meet the needs of the population despite the efforts of millions of paid and unpaid carers. Financial pressures mean that those needing care sometimes only receive basic support, far from enough … Read more
Government Response
The government recognised the challenges and data limitations in adult social care, stating it would be challenging to publish an annual assessment of unmet need. It highlighted ongoing efforts by the CQC to assess all local authorities and DHSC's funding of a support programme to address identified issues.
Department of Health and Social Care
View details
2 Recommendation Deferred
2nd Report - Adult Social Care Ref…
Publish annual assessment of unmet care needs for adults, including methodology and supporting data.
The Government should publish an annual assessment of the level of unmet care needs for both older adults and working age disabled adults, publishing its methodology and supporting data to ensure transparency and allow for scrutiny. (Recommendation, Paragraph 21) Read more
Government Response
The government did not commit to publishing an annual assessment of unmet care needs. Instead, it described existing measures like the Adult Social Care Outcomes Framework (ASCOF) for measuring outcomes, and ongoing efforts to improve data quality and support local authority commissioning.
Department of Health and Social Care
View details
3 Recommendation Rejected
2nd Report - Adult Social Care Ref…
Develop robust methodology for measuring care's impact on people's lives, health, and the economy.
The Government must also develop a robust methodology for measuring the impact of care on people’s lives, the wider health system, and the economy. As well as supporting the case for reform, such methodology would help councils to deliver outcome-based … Read more
Government Response
The government rejected the recommendation to develop a robust methodology for measuring the impact of care. It stated that existing procedures for impact assessments for policy or fiscal decisions relating to the workforce are sufficient and a new form of cross-government impact assessment is not accepted.
Department of Health and Social Care
View details
4 Conclusion Deferred
2nd Report - Adult Social Care Ref…
Previous social care reform attempts have failed, eroding the upper threshold and increasing costs.
There have been multiple failed attempts to advance a version of Dilnot’s reforms, during which time more and more people are faced with unknowable social care costs, and inflation has eroded the value of the upper threshold, meaning fewer people … Read more
Government Response
The government's response did not address the recommendation regarding social care costs or the Casey Commission. Instead, it discussed DWP's use of PAYE data and SIC codes for Universal Credit customers, and its lack of SOC codes.
Department of Health and Social Care
View details
5 Recommendation Deferred
2nd Report - Adult Social Care Ref…
Consider measures to address the erosion of the social care upper threshold.
Given how often this was raised as an issue, 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. (Recommendation, Paragraph 29) 53 Unpaid … Read more
Government Response
The government's response did not address the recommendation to consider the erosion of the social care upper threshold. Instead, it committed to consulting on the design of the Fair Pay Agreement process this year, with secondary legislation and the establishment of a negotiating body to follow in 2026.
Department of Health and Social Care
View details
6 Conclusion Acknowledged
2nd Report - Adult Social Care Ref…
Unpaid carers face significant personal and financial costs due to social care reform failures.
Unpaid carers are bearing the highest cost from successive governments’ failures to reform adult social care. They provide care worth £184 billion, “equivalent to a second NHS”, but this is often unrecognised and comes at great personal, emotional and financial … Read more
Government Response
The government agrees that publishing cost estimates of delayed discharges would improve transparency and will explore how best to publish this data, acknowledging methodological challenges.
Department of Health and Social Care
View details
7 Recommendation Deferred
2nd Report - Adult Social Care Ref…
Require the Casey Commission to establish a workstream to reduce pressures on unpaid carers.
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 … Read more
Government Response
The government agrees with the recommendation but deflects by detailing £9 billion in Better Care Fund funding for 2025-2026, which focuses on prevention and community care, rather than committing to a specific Casey Commission workstream for carers.
Department of Health and Social Care
View details
8 Conclusion Rejected
2nd Report - Adult Social Care Ref…
Local authorities face unsustainable adult social care costs, impacting other essential public services.
Local authorities are buckling under the strain of the costs of providing adult social care. The current system is unsustainable. Failure to reform adult social care, especially the funding structure, comes at a significant cost to local authorities. The increasingly … Read more
Government Response
The government agrees adult social care supports economic growth and highlights current efforts like the Employment Rights Bill and investment in digital tools, but it explicitly rejects developing a dedicated adult social care 'growth strategy'.
Department of Health and Social Care
View details
9 Recommendation Deferred
2nd Report - Adult Social Care Ref…
Prioritise agreement on adult social care funding structure, including a ring-fence for prevention.
We recommend that 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 … Read more
Government Response
The government agrees reform is essential and supports the independent Casey Commission, but states Baroness Casey has autonomy to determine priorities and shape the commission's work, deflecting the recommendation to prioritize funding structure and ring-fence preventative work.
Department of Health and Social Care
View details
10 Conclusion Deferred
2nd Report - Adult Social Care Ref…
Unstable adult social care market results from inadequate funding and rising provider costs.
The funding structure for adult social care, rising costs and the inability to make long-term investment, is creating an unstable and unsustainable care market. Providers are making losses, creating inequities by charging more to self-funders or even planning to close … Read more
Government Response
The government notes it annually reviews capital limits and social care allowances, but largely defers to the independent Casey Commission, which has a broad remit to examine the long-term transformation of adult social care and make recommendations on the charging system.
Department of Health and Social Care
View details
11 Recommendation Deferred
2nd Report - Adult Social Care Ref…
Require cross-government impact assessments for all workforce policy changes impacting the social care sector.
We recommend that 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 … Read more
Government Response
The government focuses on actions to support carers, committing to increasing the Carer's Allowance weekly earnings limit from April 2025 and reviewing Carer's Leave and the benefits of introducing paid Carer's Leave, rather than addressing the recommendation for cross-government impact assessments for social care workforce policy changes.
Department of Health and Social Care
View details
12 Recommendation Deferred
2nd Report - Adult Social Care Ref…
Instruct the Casey Commission to prioritise identifying interventions for a sustainable care market.
We recommend that the Casey Commission prioritises identifying interventions to create a more sustainable care market. (Recommendation, Paragraph 75)
Government Response
The government states that Baroness Casey has full autonomy to determine the commission’s priorities, thereby deflecting the recommendation for her to prioritize sustainable care market interventions, although it also mentions its commitment to local government reforms and the importance of prevention under existing legislation.
Department of Health and Social Care
View details
13 Conclusion Deferred
2nd Report - Adult Social Care Ref…
Low pay for social care workers does not recognise skills and pushes some into poverty.
Low pay does not adequately recognise the level of skill adult social care workers need to do very difficult physical and emotional work. It is both morally unacceptable, and economically shortsighted, that the current pay regime is pushing some into … Read more
Government Response
The government defers to Baroness Casey's full autonomy to determine the independent commission’s priorities, acknowledging her task to make adult social care more productive and preventative, rather than committing to specific actions regarding low pay for care workers.
Department of Health and Social Care
View details
14 Conclusion Deferred
2nd Report - Adult Social Care Ref…
Funding for adult social care fair pay and career pathway plans remains unclear.
We further welcome plans to establish the Adult Social Care Fair Pay Agreement and improve career pathways. However, the Government needs to set out how these measures will be funded, as providers and local government cannot afford to fund them. … Read more
Government Response
The government states that the independent Casey Commission has the autonomy to decide how best to examine models of care and funding flows needed for a sustainable system, thereby deflecting the request to set out funding details for the Adult Social Care Fair Pay Agreement and career pathways.
Department of Health and Social Care
View details
15 Recommendation Deferred
2nd Report - Adult Social Care Ref…
Instruct DWP to collect occupational data to assess Exchequer costs of low care worker pay.
We recommend that the Department for Work and Pensions explores collecting occupational data for benefit claimants, to better understand the cost to the Exchequer of low pay for care workers and to support the case for better pay. (Recommendation, Paragraph … Read more
Government Response
The government defers to the independent Casey Commission's autonomy to recommend steps for supporting the adult social care sector, implying it will not directly act on the recommendation for DWP to collect occupational data on benefit claimants for care workers.
Department of Health and Social Care
View details
16 Recommendation Accepted
2nd Report - Adult Social Care Ref…
Require full quantitative analysis for Adult Social Care Fair Pay Agreement impact assessments, including economic costs
We recommend that the impact assessment for any secondary legislation to establish an Adult Social Care Fair Pay Agreement be accompanied by a full quantitative analysis, including the impact on sector productivity, financial costs faced by providers and expected return … Read more
Government Response
The government commits to beginning the Fair Pay Agreement consultation this year, with secondary legislation and the negotiating body established in 2026, aiming for the first agreement within this Parliament. It also confirms an impact assessment including monetised estimates will be produced once the agreement is ratified.
Department of Health and Social Care
View details
17 Conclusion Acknowledged
2nd Report - Adult Social Care Ref…
Inadequate adult social care system imposing significant costs on the NHS, particularly from delayed discharges
Social care is a vital public service in and of itself and should not be valued only for how it supports the NHS. However, the current state of adult social care is imposing significant costs on the NHS. The best … Read more
Government Response
The government agrees that publishing cost estimates for delayed discharges would in principle improve transparency but notes methodological challenges. It commits to exploring how best to publish such data, without a firm commitment to immediately produce the comprehensive data requested by the committee.
Department of Health and Social Care
View details
18 Recommendation Deferred
2nd Report - Adult Social Care Ref…
Publish annual official estimates of delayed discharge costs to the NHS, broken down by reason
We recommend that the Department provides 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 … Read more
Government Response
The government agrees that publishing cost estimates would improve transparency but notes methodological challenges. It commits to exploring how best to publish cost data rather than directly providing an official, annually updated estimate broken down by delay reason, effectively deferring the specific action.
Department of Health and Social Care
View details
19 Recommendation Rejected
2nd Report - Adult Social Care Ref…
Mandate Casey Commission research into NHS costs and savings linked to adult social care failures
We recommend that the Casey Commission undertakes research to better understand the costs that the NHS is bearing as a result of failures in adult social care, and where the NHS is saving money due to good social care. This … Read more
Government Response
The government states that the independent Casey Commission has the autonomy to decide its research, implying the government will not direct it to undertake the specific cost analysis recommended or commit to continuing such analysis itself.
Department of Health and Social Care
View details
20 Conclusion Acknowledged
2nd Report - Adult Social Care Ref…
Adult social care system undermining Integrated Care System development due to funding disputes
The current state of the adult social care system is undermining the relationship building that is fundamental to the development of Integrated Care Systems (ICSs). Too much relies on local leadership, where often it feels that progress is made despite … Read more
Government Response
The government states it agrees with the conclusion and highlights its commitment of £9 billion to the Better Care Fund for 2025-26, refocusing it on prevention and community care. However, it does not explicitly commit to addressing how the current social care system undermines ICS relationships or fosters funding disputes.
Department of Health and Social Care
View details
21 Conclusion Accepted
2nd Report - Adult Social Care Ref…
Welcome new Better Care Fund objectives supporting preventative services over hospital discharge focus
We welcome the new objectives for the Better Care Fund to support preventative services, rather than simply focusing on solving challenges with hospital discharge. (Conclusion, Paragraph 111)
Government Response
The government agrees with the conclusion, stating it has committed £9 billion to the Better Care Fund (BCF) for 2025-26 and refocused its policy framework towards prevention and community-based care, setting new performance metrics. It is also considering longer-term reforms for 2026 and beyond.
Department of Health and Social Care
View details
22 Recommendation Accepted
2nd Report - Adult Social Care Ref…
Review NHS investment in the Better Care Fund to meet its preventative service focus
We recommend that the Government and the NHS review the structure and level of NHS investment in the Better Care Fund to ensure it is fully capable of meeting its renewed focused on upstream and preventative work. (Recommendation, Paragraph 112) 56
Government Response
The government agrees with the recommendation and has committed £9 billion to the Better Care Fund (BCF) for 2025-26, refocusing its policy framework on upstream and preventative work with new performance metrics. It also stated it is considering longer-term reform options for the BCF for 2026 and beyond.
Department of Health and Social Care
View details
23 Conclusion Acknowledged
2nd Report - Adult Social Care Ref…
Social care reform integral to creating a fit-for-future NHS, cannot be separate process
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. (Conclusion, Paragraph 117)
Government Response
The government acknowledges the conclusion by stating the independent commission has autonomy and its first phase will focus on supporting the health mission within ongoing reforms. However, it does not explicitly commit to ensuring social care reform is fully integrated with NHS reform and not a separate process.
Department of Health and Social Care
View details
24 Recommendation Rejected
2nd Report - Adult Social Care Ref…
Require Baroness Casey to outline adult social care's role in the 10-Year NHS Health Plan
In her first report, Baroness Casey should 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. Achieving these should … Read more
Government Response
The government states the independent commission has autonomy to make recommendations and that its terms of reference already align with supporting the government's health mission, but does not commit to ensuring Baroness Casey sets out the immediate steps or assessments as specifically recommended.
Department of Health and Social Care
View details
25 Conclusion Acknowledged
2nd Report - Adult Social Care Ref…
Government must view social care as an enabler and driver of economic growth
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 - both for the invaluable service it provides to so many … Read more
Government Response
The government strongly agrees that adult social care is an important enabler for economic growth and contributes significantly to the economy. However, it reiterates that a dedicated 'growth strategy' for the sector is not considered necessary or proportionate, consistent with its response to a related recommendation.
Department of Health and Social Care
View details
26 Recommendation Rejected
2nd Report - Adult Social Care Ref…
Develop a growth strategy for adult social care informed by productivity study, highlighting regional growth.
We recommend that the Government produce a growth strategy for the adult social care sector, including a focus on its potential to drive regional growth. This should be informed by a detailed study of how to improve productivity in the … Read more
Government Response
The government rejects the recommendation for a dedicated adult social care 'growth strategy', arguing it is not proportionate or necessary given the sector's core purpose of individual wellbeing. While acknowledging social care's economic role, it notes the Casey Commission's independence for studying productivity, without committing to the specific recommended study.
Department of Health and Social Care
View details
27 Recommendation Rejected
2nd Report - Adult Social Care Ref…
Commission research to quantify the full costs of inaction on adult social care reform.
We recommend that the Government commissions research with the aim of fully quantifying the cost of doing nothing on adult social care reform. That research should seek to quantify costs to individuals, including unpaid carers and care workers, to local … Read more
Government Response
The government rejects commissioning a dedicated study to quantify the cost of inaction on adult social care reform. It states it already commissions a wide range of research and data through the NIHR to inform its approach to reform.
Department of Health and Social Care
View details
Government Response AI assessment · 27 of 15 classified
Accepted 4
Acknowledged 5
Deferred 12
Rejected 6
Total 15 recs + 12 conclusions