Source · Select Committees · Health and Social Care Committee
2nd Report - Adult Social Care Reform: the cost of inaction
Health and Social Care Committee
HC 368
Published 5 May 2025
Recommendations
2
Deferred
Publish annual assessment of unmet care needs for adults, including methodology and supporting data.
Recommendation
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)
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Government Response Summary
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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3
Rejected
Develop robust methodology for measuring care's impact on people's lives, health, and the economy.
Recommendation
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 …
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Government Response Summary
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
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5
Deferred
Consider measures to address the erosion of the social care upper threshold.
Recommendation
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 …
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Government Response Summary
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
Deferred
Require the Casey Commission to establish a workstream to reduce pressures on unpaid carers.
Recommendation
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 …
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Government Response Summary
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
Deferred
Prioritise agreement on adult social care funding structure, including a ring-fence for prevention.
Recommendation
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 …
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Government Response Summary
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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11
Deferred
Require cross-government impact assessments for all workforce policy changes impacting the social care sector.
Recommendation
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 …
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Government Response Summary
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
Deferred
Instruct the Casey Commission to prioritise identifying interventions for a sustainable care market.
Recommendation
We recommend that the Casey Commission prioritises identifying interventions to create a more sustainable care market. (Recommendation, Paragraph 75)
Government Response Summary
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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15
Deferred
Instruct DWP to collect occupational data to assess Exchequer costs of low care worker pay.
Recommendation
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 …
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Government Response Summary
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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16
Accepted
Require full quantitative analysis for Adult Social Care Fair Pay Agreement impact assessments, including economic costs
Recommendation
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 …
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Government Response Summary
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
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18
Deferred
Publish annual official estimates of delayed discharge costs to the NHS, broken down by reason
Recommendation
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 …
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Government Response Summary
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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19
Rejected
Mandate Casey Commission research into NHS costs and savings linked to adult social care failures
Recommendation
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 …
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Government Response Summary
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
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22
Accepted
Review NHS investment in the Better Care Fund to meet its preventative service focus
Recommendation
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 Summary
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
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24
Rejected
Require Baroness Casey to outline adult social care's role in the 10-Year NHS Health Plan
Recommendation
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 …
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Government Response Summary
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
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26
Rejected
Develop a growth strategy for adult social care informed by productivity study, highlighting regional growth.
Recommendation
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 …
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Government Response Summary
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
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27
Rejected
Commission research to quantify the full costs of inaction on adult social care reform.
Recommendation
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 …
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Government Response Summary
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
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Conclusions (12)
1
Conclusion
Accepted
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 to enable them to live fulfilling lives. Despite this, costs …
Government Response Summary
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.
4
Conclusion
Deferred
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 benefit from it. We note the establishment of the Casey …
Government Response Summary
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.
6
Conclusion
Acknowledged
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 cost as well as a cost to their own health. …
Government Response Summary
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.
8
Conclusion
Rejected
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 high proportion of spending on adult social care is crowding …
Government Response Summary
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'.
10
Conclusion
Deferred
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 entirely. The Government has not properly considered either the immediate …
Government Response Summary
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.
13
Conclusion
Deferred
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 poverty. Higher wages would achieve better quality care and reduce …
Government Response Summary
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.
14
Conclusion
Deferred
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. (Conclusion, Paragraph 86)
Government Response Summary
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.
17
Conclusion
Acknowledged
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 estimate we found was that delayed discharges alone are costing …
Government Response Summary
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.
20
Conclusion
Acknowledged
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 funding mechanisms rather than because of them. By maintaining a …
Government Response Summary
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.
21
Conclusion
Accepted
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 Summary
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.
23
Conclusion
Acknowledged
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 Summary
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.
25
Conclusion
Acknowledged
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 people and also as a driver of economic growth. We …
Government Response Summary
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.