Today, 29th January, the Public Accounts Committee published a report analysing the financial sustainability of the NHS. In this article, Kathryn Smith from the Social Care Institute for Excellence, examines its findings.
Kathryn Smith is the Chief Executive of the Social Care Institute for Excellence (SCIE).
The report published by the Public Accounts Committee lays bare that despite the bold plans fixed by the government, including the aspirations of the secretary of state to achieve three major shifts, there is a lack of fresh thinking.
Social care is the best kept secret that can help transform the focus of the NHS away from high-acuity settings and towards community and neighbourhood-based approaches to improving care and support injecting the fresh thinking that is desperately required.
This approach is echoed in Lord Darzi’s ‘Independent Investigation of the National Health Service in England’ which outlines public satisfaction with the NHS is at record lows. There are pressures knocking on the front door, A&E, and the back door, delays in discharge. It’s safe to say change is now a necessity rather than a recommendation.
Igniting change
A sustainable social care sector is fundamental to the success of the NHS. Social care plays a crucial role in supporting people both to prevent the need for emergency care and to recover after a hospital stay. However, the sector remains overstretched, underfunded, and reactive. Adopting a proactive approach would enable community services to focus on early intervention and recovery, reducing the strain on hospitals and improving outcomes for individuals.
For example, our ‘Intermediate care guide’ illustrates how effective community-based models can transform care pathways. Among people receiving intermediate care following a hospital stay:
- 70% returned home safely
- 72% avoided transitioning to higher-dependency care
- 92% maintained or improved independence
Similarly, reablement services demonstrate the impact of supporting people to regain abilities after hospitalisation. SCIE’s ‘Supporting engagement with reablement: a practice guidance resource for reablement services’ highlights the positive outcomes for recovery and continuity of care. By prioritising these approaches, we can embed proactive, joined-up care at the heart of neighbourhood services.
This isn’t just about better care; it’s about addressing systemic challenges. A proactive model of care will require statutory and voluntary services to collaborate more effectively, working together to identify risks earlier, intervene sooner, and integrate care seamlessly.
Investment in community services
Central to achieving the government’s ambitions for the NHS, is a significant investment in community services. Years of underfunding have left the social care sector with workforce shortages, service gaps, and challenges in meeting growing demand. This has affected the entire system: hospital discharges are delayed, recovery is hindered, and preventable crises escalate.
The reasons listed are why Investment in community services is vital. It is particularly urgent for services that support recovery after a hospital stay, where timely and effective care can prevent readmissions and improve long-term outcomes. Without proper resourcing, the aspirations of government will remain unfulfilled.
The economic case is compelling. The social care sector’s work on early intervention through the Time to Act Reform Board ‘Earlier action and support: The case for prevention in adult social care and beyond’ demonstrates that every £1 spent on early intervention generates an average ROI of £3.17. Investing in recovery-focused and preventative services reduces demand on acute care, promotes independence, and improves quality of life.
The human case is just as critical. People recovering from illness or injury should have access to care that helps them regain their strength, independence, and dignity. This is not a luxury; it is fundamental to building a sustainable and compassionate health and care system.
Time for action
The government’s vision for a sustainable NHS is ambitious, but it is achievable if we commit to action. This includes:
- Adopting a proactive care model across statutory and voluntary services, focused on prevention and recovery
- Investing in community services to ensure timely hospital discharges and effective recovery pathways
- Building partnerships to deliver joined-up, person-centred support
When we get this right the impact will be cathartic for individuals, communities and the NHS.
The full report from the Public Accounts Committee can be accessed here.
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