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
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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
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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
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Oral Evidence
Anita Charlesworth · Health Foundation Ms Emily Holzhausen CBE · Carers UK Oonagh Smyth · Skills for Care
8 Jan 2025
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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
12 results
Clear
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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Government Response AI assessment · 27 of 15 classified
Accepted 4
Acknowledged 5
Deferred 12
Rejected 6
Total 15 recs + 12 conclusions