Social care under-funding and the NHS

Senedd Research has published an interesting analysis of the problems that social care under-funding are causing the NHS.[1]  The analysis starts with the Senedd’s Health and Social Care Committee’s finding[2] in June 2022 that a lack of social care capacity is the biggest contributor to delayed hospital discharges and restricted patient flow through hospital.  A finding accepted by the Welsh Government.[3]

Why then is there a such a shortage of social care in Wales?  The Welsh Local Government Association[4] refers to a lack of appropriate pay and conditions as does the Care Forum Wales[5] – pointing out the social care staff can earn the same or higher salaries in the ‘retail, leisure or hospitality sectors … with less responsibility’ while other social care staff choose to move to work for the NHS.[6]  The Senedd Research analysis[7] refers to a statement by the Association of Directors of Social Services (ADSS) Cymru that it had over 1,000 hours of domiciliary care that it had been unable to commission for individuals waiting for support within the community (para 96).  None of this is news to professionals working in the field – nor is the fact that the costs (and harm to individuals and families) of delayed hospital discharge are very significant.[8]

As the Senedd research notes, the Health and Social Care Committee concluded that ‘unless radical steps are taken to reform the way social care is provided, rewarded and paid for, we’re unlikely to see any real change’.

So, we have agreement that in Wales there is a national crisis in social care.[9]  We have agreement that this can only be alleviated by increasing the pay and conditions of care workers and that if social care capacity is increased it will deliver very significant cost benefits for the NHS.

So why does the NHS continue shunting NHS Continuing Healthcare costs to social services; why do social services authorities continue to pay domiciliary care workers at a wholly inadequate rate (and pay direct payments for personal assistants at an even more deplorable rate)?  If the NHS refrained from such cost-shunting and if personal assistants were paid more, then this would go a long way to addressing the ‘biggest contributor to delayed hospital discharges’ and in doing this, the NHS would be better off?

If the Welsh Government is serious about addressing the problems the NHS faces, it would (counter-intuitively maybe) demonstrate the political will to prioritise social care funding over NHS funding. Social care in Wales cannot continue as the Cinderella service and be left to increasingly impoverished council chambers.


[1] Senedd Research Who cares? Why lack of social care is the biggest contributor to delays in hospital discharge 6 October 2022.
[2]  Hospital discharge and its impact on patient flow through hospitals (June 2022) para 91.
[3] Welsh Government’s Written response to the Committee’s findings 2 July 2022.
[4] Welsh Local Government Association WLGA Response to the Health and Social Care Committee’s Inquiry into the Health and Social Care Workforce October 2021 para 9.
[5] Gofal am Gymru Response to the Senedd Health & Social Care Committee Consultation on the Health & Social Care Workforce 8 October 2021 p.1.
[6] A point highlighted by the Health and Social Care Committee Hospital discharge and its impact on patient flow through hospitals (June 2022) at paras 107-108.
[7] Senedd Research Who cares? Why lack of social care is the biggest contributor to delays in hospital discharge 6 October 2022 at para 96.
[8] See for example, S Allen et al ‘The influence of home care supply on delayed discharges from hospital in England’ in BMC Health Services Research volume 21, Article number: 1297 (2021) and Age UK Lack of social care has led to 2.5 million lost bed days in the NHS between the last Election and this one 5 December 2019 – which in 2019 estimated that social care delayed discharges cost the NHS a total £27,000 ‘each and every hour’.
[9] NHS Federation “It’s not just a crisis, it’s a national emergency” (28 September 2022).
Photograph of Cricieth by Richard Jones -@lluniaurich

Posted 23 October 2022