“The NHS undoubtedly saved my life, butsocial carehelps me live it.” That is what a participant at a roundtable event on social care told me recently.
Last October, the health and social care select committee I chair resolved to investigate the cost of successive governments’ inaction on reforming adult social care. Of course, the human cost to individuals in terms of unfulfilled lives is a weighty moral argument – reason enough in itself to reform the sector, as the government has promised to do, starting with anindependent commissionled byLouise Casey.
But we set out to calculate something different. There are economic costs resulting from the desperate situation in social care: unmet care needs hinder individuals from being able to work, study, acquire skills and participate in the economy, with all the resulting costs to the Treasury through the loss of potential tax receipts and the costs to theNHSif physical or mental health issues result. So rather than producing yet another hand-wringing report on the state of the sector, or suggesting reforms and wading into an estimation of their costs, we decided instead to flip the lens and ask a simple question: what is the current economic cost of not doing any reform at all?
Unfortunately our report,published today, does not conclude with an accurate figure – the bill to the country for not fixing the social care system. That’s because, despite our best efforts, we were frustrated in our aim by a serious lack of official data.
Let’s unpack why this is important. We probably all know someone affected by the broken social care system, but when the Treasury says: “No, we can’t – that’s too expensive”, there is a cost to that too – to individuals, their carers, the sector, the NHS and the wider economy.
And it’s the Treasury that most needs convincing. We spoke to Sir Andrew Dilnot, who knows more than most on this subject. After all, he also led a government-backed social care commission. That was 14 years ago. The recommended reforms then received royal assent – twice. But they were never enacted. Reflecting on the reasons for this, Dilnot told us that one of the critical tasks for the Casey commission will be getting through the Treasury “nexus”.
For the Treasury to grasp the economics of this, it needs to know the pounds and pence of what the failing system is costing – very often in other areas of government.
We were made aware of the impact of inaction on the people who need care, and heard how financial pressures are forcing local authorities to “care ration”, resulting in some people receiving only the most basic level of care, far from enough to enable them to live fulfilling lives. How much does it cost to find hospital beds for people who could have avoided engaging with the NHS at all if they’d received timely and effective social care at home? How many millions are missing from the exchequer because carers have quit their jobs to look after loved ones at home When we looked for answers, we found large gaps in the data.
The biggest cost of inaction is clearly with unpaid carers. More than 4 million unpaid carers provide care for their loved ones, sometimes to the detriment of their own health and wellbeing, their employment and education opportunities. This costs the Treasury through loss of tax receipts as people have to give up work and withdraw from participating in the economy. There are increased demands on the NHS, as carers’ health may suffer, and on the necessary benefit payments to support low-income households. Young carers, missing more than a month’s worth of school every year, are distinctly affected. But the picture there is partial: there is only emerging data on the total lifetime costs to a young carer and the resulting knock-on costs to the Treasury.
Conversely, high-quality care can give people fulfilling lives and can also have economically beneficial outcomes. There are many examples of projects successfully delivering effective and life-enhancing adult social care, and we were lucky to be able to visit some of them. On a visit toCare in the Garden, a not-for-profit organisation supporting people with additional needs on the Isle of Wight, I was moved by the written testimony of a young man: “I am not a burden on society. I have so much to give,” he said. But once again, the government itself does not have figures on the beneficial outcomes of high-quality care, and this is a problem, because without such figures, how can it assess which interventions would result in the highest returns? How can it make a convincing case to the Treasury for these interventions?
The lack of adequate data was a problem we found across all the areas we looked at. There is no official data on the number of hours of care needs going unmet. There is no official estimate of how much delayed discharges are costing the NHS, let alone the eventual costs of people’s care if they deteriorate while waiting for discharge.
We heard about high levels of poverty among workers in the care sector and are keen to quantify that. Between 2017 and 2020, 19.6% of the residential care workforce drew onuniversal credit and legacy benefits, according to findings by the Health Foundation, twice the rate for workers in other sectors. But when we asked the Department for Work and pensions for the current figure, they could not give us an answer. In too many areas, there just isn’t the information.
The good news is that there is wide acceptance of the need for reforms. Now what’s needed is strong and sustained public and political support to guarantee their longevity and the buy-in from the Treasury. For this, the government needs better, more comprehensive and joined-up data. Without this, the committee fears that the Casey commission will bedoomed to fail, leaving everyone continuing to suffer under the current unsustainable system.
Because while we may not be able to quantify it in financial terms, we do know that the cost of inaction is high indeed.
Layla Moran is chair of the health and social care select committee and MP for Oxford West and Abingdon