Adult Social Care Reform: the cost of inaction. Second Report of Session 2024–25 (Health and Social Care Committee, 5 May 2025)

Summary

Adult social care is in desperate need of reform. Done well, social care has the power to positively transform people’s lives. Yet too many people aren’t getting the care they need, care workers are undervalued and far too much pressure is placed on unpaid carers. The cost of this vital public service continues to increase, with £32 billion spent on adult social care in 2023/24, and an unsustainable pressure is falling on local authorities. Without reform we will all keep paying a high price for a failing system.

This Health and Social Care Committee report does not aim to document fully the current state of this failing system though the evidence does expose aspects of this, nor does it suggest how to fix it. Instead, it aims to shift the dial when it comes to reform by reframing the narrative around the cost of action to one that interrogates the cost of the status-quo or ‘inaction’.

Content

Some of the unaccounted-for costs of inaction include:

• 2 million people aged 65+ and 1.5 million people of working-age are not getting the care they need, leading to lives led at the bare minimum rather than to their fullest.
• Individuals face unknowable, and potentially life-changing, charges for care, including 1 in 7 older people with care costs over £100,000.
• The care individuals do receive can be inadequate, or neither the right care nor in the right place, leaving people unable to work or take part in other meaningful activities and risking the worsening of existing conditions.
• 1.5 million unpaid carers are providing over 50 hours of care per week to loved ones, and many of these withdraw partially or wholly from employment as a result, and who themselves suffer adverse outcomes as a consequence of putting the needs of their loved ones before their own.
• Due to the current funding model, local authorities’ budgets are buckling under the pressure of adult social care, with more councils seeking emergency funding and increasing proportions of budgets being spent on adult social care to the detriment of other services, leading to the perception of a democratic deficit in local government with people paying more and more for fewer and fewer services.
• The care provider market is in distress, struggling to cover existing costs via fees and facing underfunded increases in the National Living Wage and National Insurance.
• Care workers continue to be underpaid, driving high turnover and vacancy rates, and are twice as likely to be claiming benefits;
• The NHS struggles to divert admissions from the community and to discharge medically fit patients, causing knock-on costs of at least £1.89 billion, putting at risk the mission to build an NHS fit for the future.
• The economy is missing out on the sector’s potential to drive growth and regional rebalancing, as well as on tax receipts from unpaid carers and people in receipt of care, who are unable to work as much as they would like.