A new report on the state of the NHS, commissioned by the Secretary of State for Health and Social Care and led by Rt Hon Professor Lord Darzi, OM, KBE, has identified several challenges facing the NHS, along with key areas for reform and modernisation. In addition, the report has shed light on the inadequate funding of social care and the lack of value that has historically been placed on the sector.
On this topic, Lord Darzi wrote in his report, ‘Social care has not been valued or resourced sufficiently, which has both a profound human cost and economic consequences. In my examination of the social care system, the connection between inadequate social care funding and the strain on the NHS is glaringly clear.’
The lack of available social care support is contributing to the patient backlog in the NHS – it can be argued that, with greater integration between social care and health care, this could be avoided. According to Lord Darzi’s report, a ‘desperate shortage of capital prevents hospitals being productive’, which means patients are not flowing through hospitals as they should be.
With social care being means-tested, rather than funded by taxpayers like the NHS, the gap between those in need of social care and those receiving publicly funded care (those with the greatest need and those who are least able to pay) continues to grow. This in turn places a burden on the NHS, as more people are staying in hospital for longer than they need to be, rather than being discharged to more appropriate facilities.
In fact, 13% of NHS beds house people who are waiting for social care support or more appropriate care in other settings. This has an effect on how productive the workers in the NHS are able to be; the report found that surgical activity for each surgeon has reduced by 12% and each clinician working in emergency medicine has seen their activity fall by 18%. While governments for the last eight years have promised to move care away from hospitals and place it back in the community, in actuality the opposite has happened.
With a social care system unable to prop up the needs of an older, sicker population and different economic models between the NHS and social care, Lord Darzi stated, ‘Too many people end up in hospital, because too little is spent in the community.’
The interim findings of the review of the Care Quality Commission (CQC) by Dr Penny Dash found ‘significant failings in the internal workings of CQC which have led to a substantial loss of credibility within the health and social care sectors, a deterioration in the ability of CQC to identify poor performance and support a drive to improve quality – and a direct impact on the capacity and capability of both the social care and the healthcare sectors to deliver much needed improvements in care’. Lord Darzi agreed with Dr Dash on the failings of the CQC and stated that accountability is important but, with 3,000 people employed by the Department of Health and Social Care in 2024 (an increase of 50% in just 10 years), he highlighted that there are ‘too many people holding people to account, rather than doing the job’. This, he stated, can be counterproductive.
With hospitals being the focus of single-year budgets, rather than primary care, community services or mental health provision, Lord Darzi highlighted ministers ‘throwing more money at hospitals where the pressure is most apparent as waiting areas fill up and ambulances queue outside’. In contrast, ‘publicly funded social care is provided for fewer and fewer people while the demand for it has risen, largely as the result of an ageing population’.
I have spent years navigating health and social care, so I know the frustration, confusion and heartbreak of these systems not working together. The reality is simple: you cannot separate people’s health and care needs. We do not fit into neat little boxes. We are whole individuals with interconnected needs, and when those systems are not joined up, it is people like me who pay the price. I have lived through delays, miscommunication and times where I have felt completely invisible – just another number in a system unable to support me as a whole person. The recent report shining a spotlight on the lack of value and resources given to social care hit home hard. It makes it clear that if we are serious about improving lives, health and social care must be fully integrated. While the report highlights the challenges we face, it also presents an incredible opportunity. The way forward is through co-production and co-design, where people like me – those with lived experience – are invited to help shape the services that we use. Too often, decisions about care are made from the top down. The vision of a properly integrated health and social care system is not a pipe dream – it is something we can achieve if prioritised. The report points to the need for investment in community-based care, with services designed around people’s lives, not just their illnesses. Imagine a system where your care does not stop at the hospital door, where health and social care professionals work together seamlessly to support you at home and in the community. But to get there, we need bold action. We need policymakers to take the report’s findings seriously and commit to meaningful health and social care integration. We need investment – not just in hospital infrastructure but in community services that prevent people from needing to go to the hospital in the first place. We can no longer afford to treat health and social care as separate entities. We must demand a system that sees people as whole, that values their needs and that helps them live healthy, independent and fulfilling lives. Let’s seize this opportunity and make sure that the changes we need are not just talked about but delivered. X: @TLAP1 Email: [email protected] Isaac Samuels, Co-Production Advisor, Think Local Act Personal (TLAP)
Although the care sector was outside the scope of this report, to quote Lord Darzi himself, ‘It is impossible to understand what is happening in the NHS, without understanding what is happening to social care.’ This view is something that we strongly support; these two parallel sectors are fundamentally linked, and only when we finally have a fix for social care, will the cure for the NHS’s challenges be found. The deterioration of social care, which should be a sector that creates stability and opportunity in our communities, creates a chain of negative impacts that affect people who draw on support, care workers, family carers, public services and our economy. For many years, the sector has been calling for a more joined-up approach to support a solution for these challenges. In particular, the NHS and social care systems must provide properly integrated care and support when the two systems are dependent upon each other for ensuring better care of people with learning disabilities. This includes better delivery of integrated health and care services in the community, in turn reducing avoidable admissions into hospital and delayed discharges from hospital into community settings. Now, with Lord Darzi’s analysis as guidance, we look forward to seeing strong action from Government to improve the health, care and support of people with learning disabilities, to enable them to live their best lives possible. Beyond that, Government must address the long overdue reform of social care as a whole. As a champion of improved pay for frontline support workers, Community Integrated Care strongly supports the Government’s commitment towards a fair pay agreement for care workers, the development of a National Care Service and the plan for cross-party talks on future funding of the care system. As a first step, Government should take immediate action to increase the pay of frontline support workers to improve the lives of those receiving and providing care, to increase the productivity of social care and healthcare services and to contribute to economic growth – as called for in our ‘Who Cares Wins’ Unfair To Care 2024 report. Linkedin: Search ‘Jim Kane’ Email: [email protected] Jim Kane, Chief Executive Officer, Community Integrated Care