Adult social care reform: The cost of inaction

In all the excitement of the NHS 10-year plan being published on 3 July, you might have missed the Government’s response to the Health and Social Care Committee’s (HSCC) report on adult social care reform and the cost of inaction which was published on 4 July!

The HSCC report itself was published on 5 May containing five chapters:

1. Costs to those receiving care
2. Unpaid carers: the hidden cost of inaction
3. Costs to the care system
4. The NHS and wider system costs of inaction
5. Costs to the economy

This was a hard-hitting report with some 15 recommendations (see pages 53-58 for a summary). The HSCC took evidence from a wide range of those involved in the sector, including Care England, Nuffield Trust, The Health Foundation, Leonard Cheshire, Methodist Homes, The Priory, HC-One, Voyage Care, NHS Norfolk and Waveney Integrated Care Board and the Care Provider Alliance, to name but a few.

They also dipped into Lord Darzi’s independent investigation of the NHS in England, noting that he found 13% of NHS beds were occupied by people waiting for social care support or care in more appropriate settings. He clearly stated that it was “impossible to understand what was happening in the NHS without understanding what has happened to social care”.

During the inquiry, the HSCC was repeatedly told that adult social care would be vital to delivering the “three shifts”.

The inquiry concluded that whilst it had not proven possible to estimate the full cost that we as a country are paying for inaction, it was likely to more than justify the cost of reform.

So, what did the Government say?

They set out their three objectives for adult social care:

• To join up services at a neighbourhood level so people receive holistic, wraparound support across their community
• To provide people with greater choice and control that promotes “home first” and helps them to stay independent
• To radically improve care quality through a valued, professionalised workforce

They state that adult social care is part of their vision for a neighbourhood health service, with the NHS working in partnership with local authorities, social care providers and the voluntary sector.

Nearly half the recommendations relate to Baroness Casey’s Commission. The Government comment on how she has full autonomy to determine the Commission’s priorities within its remit, as set out in the terms of reference.

Responses to the other recommendations (both positive and negative) include:

• It would be challenging to publish an annual assessment of the level of unmet care needs
• Not accepting the need for a cross governmental impact assessment that sets out immediate and ongoing consequences of future policy changes or fiscal decisions on the social care sector
• They will explore how best to publish cost data on how much delayed discharges are costing the NHS (subject to caveats)
• The Government and NHS to review the structure and level of NHS investment in the Better Care Fund

We will have to await Baroness Casey’s first report expected next year.