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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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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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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Conclusions (4)
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.
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.