Darzi review: Social care in ‘dire’ state with profound human and economic cost

A major review of the health service has described the state of social care as “dire”.

The report by independent peer Lord Darzi is focused on the NHS but noted the impact an under-resourced social care sector has on the health service.

A growing gap between people’s needs and those getting publicly funded social care in England is placing “an increasingly large burden on families and on the NHS”, the surgeon said.

He wrote: “Social care has not been valued or resourced sufficiently, which has both a profound human cost and economic consequences.”

While stating that social care was outside the scope of his investigation, Lord Darzi said it is “impossible” to understand the situation in the NHS without understanding how things are in social care.

The sector, which cares for older people and children and working age adults with disabilities, has a “colossal gap” between resources and need, he said.

He wrote: “Whereas the NHS is funded by taxpayers and free at the point of need, social care is means-tested and only provided to those with the greatest need and least ability to pay.

“With each passing year, the gap grows between those in need and those receiving publicly funded care.

“This places an increasingly large burden on families and on the NHS. The impact on the NHS has been more people staying in hospital for longer than their medical needs require them to be there.

“This means older people have been stuck in acute hospital wards rather than in facilities better suited to their needs (so-called delayed discharges).

“It is apparent that the different economic models between the NHS and social care is driving the most expensive outcome — people spending time in hospital when there is no medical reason for them to be there — that is also a poorer experience for elderly people and their families.”

More than half a million extra roles in social care will be needed in the next 15 years to keep up with demand, a major new workforce strategy for the sector estimated earlier this year.

Skills For Care, the strategic workforce development and planning body for adult social care in England, also said figures showed there were 131,000 vacancies on any given day, with a rate of 8.3% for the social care sector, around three times the average for other sectors.

The Independent Care Group, representing adult social care providers in York and North Yorkshire, said it was “pleased that Lord Darzi’s report acknowledges the crisis in adult social care” but disappointed the review’s scope did not include detailed review of the sector.

Chairman Mike Padgham said: “We are dismayed that adult social care was not included in the remit of the report in the first place.

“That is a serious omission and makes something of a nonsense of the whole process.

“You can’t fix the NHS unless you fix social care.”

Nuffield Trust chief executive Thea Stein said it is right that the report “repeatedly references the inter-related, compounding pressures of the desperate state of social care and cuts to public health provision”.

She added: “But by design it does not dig into those issues. In future, we hope to see serious work by the Government to address those broader societal issues that determine population health and impact healthcare access.”

Melanie Williams, president of the Association of Directors of Adult Social Services (Adass), said: “We support Lord Darzi’s recommendation to shift focus and funding from hospitals towards community and mental health services.

“But social care must be at the heart of any plans to create a ‘neighbourhood NHS’, otherwise we’re at risk of failing to deliver this once-in-a-generation opportunity to transform health and social care.”

Caroline Abrahams, charity director at Age UK, said: “Social care and the NHS are really two sides of the same coin, especially for our older population.

“It is unusual for an older person who has health needs, for example long-term conditions like heart disease, cancer or diabetes, not to have social care needs too.

“For this reason, it is essential that the 10-year NHS Plan, for which the Darzi report establishes the baseline, sets out how we can ensure social care plays a full part in the joined-up care at home or a care home that many older people need.”