Social Care’s Slow Collapse Will Drag Local Government and the NHS Down With It—and Affect Us All
A response to the Nuffield Trust report by Steve Veevers, CEO of Hft.
The title might seem alarmist, but for the 836,000 people relying on publicly funded social care, it reflects an unsettling truth. Years of insufficient government action has pushed the sector to the brink. And the people most affected? Those who need care and support.
Most people working in social care do so because they care—it’s a calling, not just a job. As someone who started as a support worker and now leads Hft, I’ve spent my career striving to improve lives, both for the individuals we support and the dedicated workers who make it possible. That’s why I feel compelled to respond to the Nuffield Trust’s report on the proposed changes to National Insurance and their devastating implications for social care.
A Sector Under Strain
The Nuffield Trust highlights the immense pressures on social care. Rising employer National Insurance contributions alone will add £940 million to already stretched budgets. Coupled with increases to the National Living Wage, the funding gap balloons to £2.8 billion. Yet, of the £22.6 billion allocated for NHS and social care, just £600 million was earmarked for social care—a paltry amount, barely enough to cover these added costs.
This chronic underfunding leaves local authorities with impossible decisions, forcing cuts or emergency measures to fill gaps. For a sector already in crisis, this feels like further proof that its essential role remains undervalued and misunderstood.
The Lifeline to the NHS
Social care and the NHS are deeply intertwined. Social care supports recovery, prevents avoidable health crises, and helps people remain independent. Without it, the NHS will be overwhelmed.
The Darzi report underscores this fragile balance. If care providers collapse, hospital discharges will stall, and avoidable admissions will rise. Beds will be occupied by patients who could recover at home with proper support. Without robust social care, the NHS’s £22 billion budget becomes an exercise in futility—patching holes in a sinking ship.
Beyond Health: The Local Government Fallout
The collapse of social care won’t stop at healthcare. Local government is already teetering. Earlier this year, I heard a senior local government official warn that, even before this budget, half of councils were at risk of insolvency within five years, with one in ten potentially going bankrupt within a year.
Social care is the largest pressure on council budgets. When providers fail, councils scramble to find costlier, harder-to-source placements, accelerating financial strain. A cascade of bankruptcies will follow, leaving communities to suffer. Essential services like parks, libraries, housing, and waste management will be gutted.
A Crisis That Touches Us All
One in two people will need social care at some point—whether for themselves, a parent, a partner, or a child. Its collapse will mean longer hospital stays, fewer care options, and families scrambling to fill gaps.
For the economy, the stakes are enormous. One in twenty UK workers is employed in social care. A collapse would devastate livelihoods and the broader economy, rippling through every community and family.
Social care is not just an expense—it’s preventive healthcare. It keeps people out of hospitals, supports timely discharges, and enables independence. Underfunding it is both short-sighted and counterproductive, akin to fixing a leaking roof while ignoring collapsing foundations.
No Good Options
Hft’s annual Sector Pulse Check reveals the grim choices providers face: cutting services, freezing pay, making redundancies, or handing back contracts to local authorities. These aren’t hypothetical scenarios—they’re already happening.
The workforce crisis exacerbates the problem. With sky-high vacancy rates, low pay, and poor conditions, social care is becoming less attractive. Addressing these issues requires investment, yet current pressures push solutions even further out of reach.
This isn’t the boy who cried wolf; it’s the canary gasping its final warning.
A Call to Action
The government must act. Closing the £2.2 billion funding gap this year—and addressing the broader £6-8 billion underfunding—is critical. This isn’t about keeping the lights on; it’s about ensuring the sustainability of a system that underpins our health, economy, and communities.
But this isn’t just about money. Values-led care providers like Hft are ready to help chart a better future. This will require tough decisions, but also an opportunity to reshape the sector. Prevention-focused care, personal budgets, and community-based solutions show promise, but they need leadership and investment to succeed.
The choice is stark: invest now or face the collapse of a system that supports millions, undermines local government, and leaves families and communities to pick up the pieces.
Social care is more than a budget line; it’s about dignity, independence, and a society that values its most vulnerable. If we fail to act, the consequences will touch every one of us.
