Written evidence submitted by National Star (ASC0018)

The lack of social care reform in the UK has forced the sector into a constant state of crisis, deeply impacting service quality, efficiency, workforce stability, and the well-being of both care recipients and their families.

Impact of Crisis-Mode Operation on Efficiency and Service Quality

Working in continual crisis mode limits efficiency and undermines quality across the health and social care (H&SC) system. Operating reactively rather than proactively means that critical resources are diverted from planning, coproducing and preventive efforts and instead used to address urgent, immediate needs. Commissioners, social workers, clinicians, and providers are all struggling with increased demand and limited capacity, which restricts their ability to plan ahead and collaborate effectively. This lack of capacity makes forward-thinking, collaborative work extremely difficult, and it ultimately prevents the sector from achieving the efficiency and innovation needed for sustainable, high-quality care.

When services lack adequate resources, creative approaches to care and collaborative partnerships are impacted. Collaborative work, which has been shown to improve outcomes by combining expertise from multiple agencies, requires stable funding and sufficient staffing levels to allow time for preparation and meaningful partnership. However, the lack of reform and funding has made planning and prevention nearly impossible, pushing the system into a cycle of crisis management. This reactive model is neither efficient nor effective and often leads to avoidable adverse outcomes for service users, families, and providers alike. Strategic investment in resources such as training, technology, and additional staffing will yield long-term savings by improving efficiency and reducing the need for crisis interventions. However, the government has largely overlooked this approach in the social care sector, leading to a cycle of inefficiency and increased costs in the long run. Without investment in preventive measures, care services lack the flexibility and resilience needed to adapt to the growing complexity of needs within H&SC.

Investing in training, for example, would allow care staff to deliver a higher quality of service, reducing the risk of costly mistakes and improving client satisfaction. Similarly, technology could enable better data tracking, real-time monitoring, and more efficient resource management. Studies in healthcare have shown that even modest investments in technology can streamline processes, increase accountability, and reduce administrative burden, ultimately freeing up staff to focus on direct care. However, without adequate funding, social care services are forced to struggle on with minimal resources, perpetuating a cycle of inefficiency.

The Human Cost of Inaction: Mental and Physical Strain on Service Users, Staff and Families

The lack of reform and resources within the H&SC sector has profound personal consequences. Professionals, already stretched thin by increasing demand, are experiencing significant physical and mental strain as they work to manage their responsibilities. The absence of adequate support systems or joined-up services creates an overwhelming burden, as care workers must bridge gaps that exist due to underfunding and limited staffing.

This strain is also felt by families, who frequently have to step in to provide additional care when professional support is lacking. Family caregivers often experience burnout and are forced to reduce their own work hours or leave their jobs entirely to care for loved ones, affecting their financial stability and mental health. This not only limits their ability to contribute to the economy but also perpetuates a cycle of stress and mental strain that weakens overall family well-being. Without reform, the H&SC sector will continue to place this undue burden on families, further eroding trust in the system. The effects of a crisis-driven, under-resourced H&SC system are most acutely felt by the service users, whose needs often go unmet due to the lack of sufficient support. Many individuals are unable to access care until they reach a crisis point, resulting in delayed interventions that are "too little, too late." This approach forces service users into situations where they may experience preventable declines in health and well-being.

Challenges in Recruitment and Retention: Evidence from Providers

Issues with recruitment and retention are well documented within the H&SC sector, exacerbated by low wages, limited career progression, and the physical and emotional demands of care work. These problems make it difficult for care providers to maintain a stable workforce, leading to high turnover rates that further strain services. Our charity, for example, allocated £2 million from its reserves to invest in workforce retention in an attempt to tackle these issues, but such measures are not sustainable for all providers. Charities, in particular, should not have to rely on public donations to pay their staff, as this places undue strain on already limited resources.

When local authorities provide funding for individuals to manage their own care, they often cannot find enough qualified staff to fill the hours due to sector-wide staffing shortages. Consequently, vulnerable individuals find their support needs going unmet, which further disrupts their lives and places additional stress on family caregivers who must pick up the slack. Low wages and high competition for staff among providers have compounded this issue, and without substantial reform to address pay and working conditions, recruitment and retention challenges will persist, leaving service users and families to bear the brunt.

Erosion of Public Trust in the System

The lack of responsive, high-quality care has resulted in a significant erosion of trust in H&SC. Families are often frustrated by the lack of effective support and the adversarial approach they face when attempting to secure care for loved ones. Without transparency, adequate resources, or reliable support, families are left with little confidence in the system. This breakdown in trust has a ripple effect, leading to strained relationships between service users, families, providers, and commissioners.

When families feel unsupported and have a lack confidence in the system, their mental health is affected, leading to feelings of helplessness, frustration, and distrust toward care providers and local authorities. This adversarial dynamic is harmful to all parties involved, and it ultimately reduces the effectiveness of care, as families are less likely to engage cooperatively with providers when their trust has been eroded.

The Case for Comprehensive Social Care Reform

The UK’s lack of social care reform has left the H&SC sector in a state of continuous crisis, compromising efficiency, quality, and service delivery. The failure to adopt a "spend-to-save" strategy has hindered the sector's ability to operate proactively, forcing a crisis-driven approach that affects all stakeholders, from service users and their families to care providers and commissioners.

This inquiry underscores the urgent need for reform, which should include increased funding, improved workforce support, and investments in training and technology. Without these changes, the H&SC sector will continue to face recruitment and retention challenges, leaving service users without adequate support and further eroding public trust. Comprehensive reform is essential to create a sustainable, resilient social care system that meets the needs of all individuals while also supporting families, workers, and the broader community.

December 2024