Table of contents

On 30 March 2023, the House of Lords is scheduled to debate the following motion:

Baroness Andrews (Labour) to move that this House takes note of the future of adult social care given (1) the recent reports from the House of Lords Adult Social Care Committee (HL Paper 99) and the Archbishops’ Commission on Reimagining Care, (2) the Care Quality Commission’s local authority assessment duties which commence from 1 April, and (3) His Majesty’s  Government’s stated intention to publish a social care plan in spring 2023.

1. Future government plans for adult social care reform

In February 2023, Baroness Wheeler, Labour’s shadow spokesperson for health and social care in the House of Lords, asked the government what steps it would take to bring together different initiatives, white papers and funding streams “into a clearer plan for social care reform”. Lord Markham, a parliamentary under secretary of state at the Department of Health and Social Care, responded that the government would publish a plan for adult social care reform in spring 2023. He explained:

This will set out how we will build on the progress so far to implement the vision for adult social care set out in the ‘People at the heart of care’ white paper, published in December 2020.

The plan will include key milestones for reform, including for workforce, data and technology. The final local government finance settlement, published on 7 February, sets out the resources available to local authorities in 2023/24, including for adult social care services.

2. Earlier plans for reform

Since 2011, successive governments have made announcements on reforming adult social care. This section provides an overview of some of these proposals. It also contains information on the Care Quality Commission’s new local authority assessment duties.

2.1 Developments from 2011 to 2020

In July 2011, the independent Commission on Funding of Care and Support, chaired by Sir Andrew Dilnot, published its report, ‘Fairer care funding’. This set out proposals for reform of adult social care, including on the support individuals should be given to help pay for care and what they should contribute themselves.

The coalition government accepted the proposals in principle but set out changes to some of the recommendations. It initially set an implementation date of April 2016 and legislated for its plans in the Care Act 2014. However, implementation of the relevant provisions was delayed until 2020 and then effectively indefinitely postponed.

In 2017, the government under Theresa May said that it would publish proposals for adult social care funding in a green paper. However, the paper was delayed and was not published prior to Mrs May leaving office in July 2019. Further information on developments in this period is available in the House of Commons Library briefing ‘Adult social care: The government’s ongoing policy review and anticipated green paper (England)’ (30 September 2019).

Following this, the 2019 Conservative Party general election manifesto stated that a Conservative government would seek a cross-party consensus on how to reform paying for adult social care. In January 2020, then Prime Minister Boris Johnson said that his government would bring forward a plan “this year”, with changes introduced before the end of the parliament in late 2024. However, the government later said these plans would be delayed due to the Covid-19 pandemic.

2.2 ‘Build back better: Our plan for health and social care’

In September 2021, the government led by Boris Johnson published ‘Build back better: Our plan for health and social care’. In this plan, the government said that it would reform adult social care and create a new integrated system between health and social care focused on improving outcomes for people. It said that to begin this “transformation” in adult social care, the government would:

  • introduce a cap on personal care costs
  • provide financial assistance to those without substantial assets
  • deliver wider support for the social care system, particularly social care staff
  • improve the integration of health and social care systems

As part of this, the government said it would invest £5.4bn in adult social care between 2022/23 and 2024/25 to deliver the funding and system reform commitments that it had set out. Of this:

  • £3.6bn would be used to reform how people pay for social care (of which £1.4bn would be to help local authorities move towards paying “a fair cost of care” to providers)
  • £1.7bn would be used to support wider system reform

The government explained that it would raise taxes to fund these proposals. It set out plans to introduce a UK-wide 1.25% health and social care levy based on national insurance contributions that would be ringfenced. It said that this levy would effectively be introduced from April 2022, with a temporary increase in national insurance contributions, and fully come into force as a separate levy from April 2023. The adult social care charging reforms would be introduced later, in October 2023. The Health and Social Care Levy Act 2021, which provided for the levy, received royal assent in October 2021. The levy came into force as planned in April 2022.

Following changes in prime minister, the plans for the health and social care levy and charging reforms were later reversed and delayed respectively:

2.3 Health and Care Act 2022: Care Quality Commission local authority assessment duties

The Health and Care Act 2022 placed a duty on the Care Quality Commission (CQC) to assess local authorities’ delivery of their adult social care functions under part 1 of the Care Act 2014. It also provided for the secretary of state to intervene where a local authority is failing. This duty will apply from 1 April 2023.

Under the 2014 act, local authorities must make sure that people who live in their area:

  • receive services that prevent their care needs from becoming more serious, or delay the impact of their needs
  • can get the information and advice they need to make good decisions about care and support
  • have a range of provision of high quality, appropriate services to choose from

The CQC has published information on its approach to these new duties, as well as interim guidance. The guidance explained that the CQC will use a new single assessment framework to assess all types of services in all health and care sectors and at all levels, including local authority level. The quality statements in this framework are based on people’s experiences and the standards of care they expect; a subset of these statements will be used to assess local authorities.

The guidance also explained that the CQC will be carrying out initial assessments for all local authorities to achieve a baseline understanding of quality before starting its longer-term approach for ongoing assessment. After this baseline period, the CQC has said that it will award ratings for all local authorities. The CQC has also set out an implementation timeline from April 2023 to early 2024 onwards, saying that this approach will make its assessment “as effective as possible”.

Some organisations have raised concerns about the April 2023 start date for these changes, citing pressures on services. For example, the Association of Directors of Adult Social Services (ADASS) has called for a delay to enable councils to focus “on winter and reduce expenditure on inspection preparation and processes” and on improving care and support. However, ADASS has welcomed the CQC’s staged approach to implementation set out in its timeline.

In addition, there have been concerns raised about the type of ratings that could be awarded under the new system. Joint chief executive of ADASS Sheila Norris has argued for a narrative report over a single-word assessment (such as ‘outstanding’, ‘good’, ‘requires improvement’ or ‘inadequate’):

Though the government wants individual ratings for each council, it’s important that any single word rating is presented very clearly alongside narrative and potentially sub-ratings across the seven theme areas that the CQC will be assessing, like care provision, access and personalisation.

A single-word rating alone wouldn’t show the public how good different parts of the service are, and experience from Ofsted’s inspections of children’s social care shows the detrimental impact a negative single judgement can have on retaining vital staff.

David Fothergill, community wellbeing board chair for the Local Government Association, also raised concerns. He argued that the LGA did not think that single-word ratings could “adequately reflect how a council is performing across the wide spectrum of services that comprise adult social care or adequately reflect the local context”.

3. House of Lords Adult Social Care Committee report

3.1 The inquiry

The House of Lords appointed an Adult Social Care Committee to consider the planning for, and delivery of, adult social care services in England. In April 2022, the committee launched a call for evidence which invited contributions on:

[…] what needs to change to create a fair, resilient and sustainable care system that better enables everyone to ‘live an ordinary life’, and in so doing, to have great choice and control over their lives.

The committee said that it would focus on three key issues:

  • the invisibility of adult social care, and its consequences
  • better support for carers
  • putting co-production at the heart of care

The committee received written evidence and oral evidence from a number of individuals and organisations.

3.2 Response to autumn statement

Prior to the committee report’s publication, in November 2022 the committee’s chair, Baroness Andrews, wrote to the government following the autumn statement. She argued that the autumn statement had raised many questions, including on both the breakdown of the announced funding that had been made available and on the government’s strategy and vision for adult social care. Baroness Andrews then set out seven questions to the government, which she said required a response. These included:

  • What is the exact breakdown of the additional £4.7bn that has been made available for adult social care in 2024/25?
  • What provisions, if any, have been made to provide targeted support for unpaid carers?
  • What provisions, if any, have been made to protect the £1.7bn investment in social care pledged by the government in the ‘People at the heart of care’ white paper?

In a press release accompanying the letter, Baroness Andrews said:

Whilst we welcome the additional £4.7bn that has been unlocked for social care in the next three years, this falls short of what was recommended to our committee by Mr Hunt himself only a few months ago, when he pointed to the estimate produced by the Health and Social Care Committee, which he chaired at the time, and indicated the need to provide an additional £7bn in funding for adult social care in 2023/24.

Moreover, freezing one area of adult social care policy, much needed and long promised, to pay for other aspects of the service which are underfunded and understaffed, is not the coherent, realistic long term national plan for adult social care which is so urgently needed.

Jeremy Hunt responded on 9 January 2023, setting out responses to each of the seven questions posed by the committee in Baroness Andrews’ letter. He also said that the “historic funding boost” for adult social care was announced “in the context of difficult decisions taken at the autumn statement to ensure broader economic stability”. Mr Hunt said that it would “put the sector on a stronger financial footing and improve quality of and access to care for many of the most vulnerable in our society”.

Further information on the funding of adult social care is available in the House of Commons Library briefing ‘Adult social care funding (England)’ (17 January 2023). Information on the autumn statement more generally can be found in the House of Lords Library briefing ‘Autumn statement 2022: Key announcements and analysis’ (25 November 2022).

3.3 The committee’s report

On 8 December 2022, the Adult Social Care Committee published its report ‘A “gloriously ordinary life”: Spotlight on adult social care’. It contained an estimate that 10 million people are affected by the adult social care system in England at any one time, “almost one in five people”. However, the committee argued that adult social care “continues to be out of sight and off the public agenda until we need it”. It contrasted this to the NHS and argued that “our understanding of adult social care, as a society, is partial and often flawed”, with social care seen as for those who cannot support themselves and as “a burden on resources that is synonymous with decline and crisis”.

The committee argued that these assumptions have often framed past and present policy. As a consequence, “adult social care has been denied the opportunity to be what it should be: a service that enables people to live fruitful, active and valuable lives”. The committee said that change could be achieved by social and economic investment as a society.

Considering the current state of the sector, the committee said that it had focused on the voices of those who have lived experience of the system. It said that many disabled adults and older people “continue to be denied choice and control over their lives” due to a number of issues, but “largely because of the lack of resources”. The committee noted that most adult social care is provided by local authorities, which have seen a real-terms reduction in their spending power. It estimated that this had led to a 12% decrease in spending per person on adult social care services between 2010/11 and 2018/19. It argued that the quality and consistency of services had suffered because of this and that the Covid-19 pandemic had “aggravated” the challenges.

The committee also focused on unpaid carers, arguing that many people “step up to provide care and support when the system is failing”. It estimated that there were between 2.4 and 6.5 million unpaid carers in the UK, “with the actual figure likely to be much higher”. It estimated the value of this care as up to £132bn per year. However, the committee said that as both wider society and policy makers assume that social care happens “first and foremost in the family circle”, the work of unpaid carers is “largely invisible, unrecognised and unsupported”.

Noting the government’s recent white paper on adult social care, the committee said that it applauded its ambition. However, the committee added that the plan “falls sadly short of providing a concrete and fully resourced programme of change, which is necessary to realise these ambitions”. It also argued that the government’s recent funding announcements made in relation to adult social care had “further lessened expectations that the white paper will be realised in practice”.

To address these issues, the committee set out core changes to enable the adult social care system to become “progressive, visible, fairer and kinder”. It argued that its recommendations were also about building a more resilient, cost-effective, sustainable and modern service, with greater efficiency at its core. These core changes included:

  • making adult social care a national imperative, to be reflected in an “appropriate and long-term funding settlement”
  • giving people who draw on care the same choice and control over their lives as other people
  • providing a system that is not based on the assumption that families will automatically provide care and support for each other as no other choice is open to them

The committee set out a number of recommendations in relation to this vision. These included recommendations on the collection of data, increasing the financial settlement for the system, remedying low pay in the sector, creating a national long-term plan for adult social care, and establishing a commissioner for care and support to act as a champion for older and disabled people and unpaid carers. It also recommended an independent public review of the Care Act 2014.

At the time of writing, the government had not yet published its response to the committee’s report. However, the chairman of the LGA’s community wellbeing board, David Fothergill, strongly welcomed the report and gave it the LGA’s backing:

This excellent report could be a blueprint for the way forward for adult social care and we fully support the central message that social care should be seen as a “national imperative”. The positive framing of social care and the core focus on people who draw on care and support is particularly welcoming.

It rightly highlights the invisibility of the social care workforce and the incredible work they do to allow those who draw on care to live an equal life. It also brings to light the importance of greater choice and control for disabled adults and older people, and ensuring those who draw on care are centred throughout all decision making processes.

We support the recommendations of the report, particularly that the government must deliver realistic, predictable and long-term funding for the sector to allow it to thrive alongside a properly resourced plan for supporting the workforce.

4. Archbishops’ Commission on Reimagining Care

4.1 The commission’s report

The Church of England has several commissions which “consider aspects of life in England today and the role that the Church of England has to play”. In April 2021, the archbishops of Canterbury and York tasked a commission with “developing a radical and inspiring vision, drawing on Christian theology and tradition, that reimagines care and support”. The commission was led by Dr Anna Dixon, previously the chief executive of the Centre for Ageing Better, and was co-chaired by the bishop of Carlisle, James Newcome, who is the lead bishop on health and social care in the House of Lords.

On 24 January 2023, the commission published its report, ‘Care and support reimagined: A national care covenant for England’. It said by exploring the pressures on people drawing on care and support, those working in the social care sector, and people who cared for a family member, it was clear that “tinkering around the edges is no longer an option”. The commission therefore argued that to reimagine care and support “we must uphold values that recognise the dignity, value and gift of every human being”. To achieve this, the commission set out three ideas to realise a new vision for care and support:

  • rethinking attitudes to care and support
  • rebalancing roles and responsibilities
  • redesigning the social care system

The commission also called for a national care covenant, to be developed through national dialogue, that would set out the roles and responsibilities of government, communities, families and individuals. Key elements of the proposed covenant included investment in communities, a stronger role for the state, a new deal for unpaid carers and “a commitment to our responsibilities as actively engaged citizens”. In addition, the commission contended that the starting point for reimagining care and support should be tackling negative attitudes to ageing and disability.

It also made “radical recommendations for redesigning the care system, with a long-term aspiration of making care and support a universal entitlement”. It said this would include:

  • a simplified assessment that leads to a guaranteed budget
  • people being trusted to manage their own care and decide what help they need
  • independent advocacy to help people access their rights and entitlements

Noting that there had been “a lack of progress” in implementing the proposals of previous high-profile reports, the commission said that a broad coalition was needed to act. This would include politicians, faith communities, charities and user-led organisations.

4.2 Reaction to the commission’s report

Responding to the report, the director of policy and public affairs at the charity Carers UK, Emily Holzhausen, welcomed the opportunity for unpaid carers to share their experiences with the commission. Ms Holzhausen also welcomed the proposed new deal for unpaid carers, arguing that it recognised the challenges faced and how a change in approach could support unpaid carers. She urged the government to implement the elements of the new deal “so that unpaid carers have the fulfilling life that they need and deserve”.

Carers Trust CEO Kirsty McHugh also welcomed the report. Ms McHugh labelled the call for a national care covenant “a welcome contribution to the debate”. She was also supportive of a new deal for unpaid carers, arguing that many were being “plunged into poverty” and urgent reform was needed.

David Fothergill of the LGA said the report was “another important and helpful contribution to the conversation around adult social care”. He said:

The archbishops’ commission rightly highlights the importance of shifting the narrative on ageing and disability, as well as building better attitudes towards social care and the people who draw on it. It also brings to light the importance of people being trusted to manage their own care and decide what help they need. We support the recommendations of the report, particularly the need for investment in communities.

5. Read more

Cover image by Freepik.