On 16 October 2023, the House of Lords is due to debate the following motion:

Baroness Andrews (Labour) to move that this House takes note of the report from the Adult Social Care Committee ‘A “gloriously ordinary life’’: Spotlight on adult social care’ (HL Paper 99).

1. Background

Since 2011, successive governments have made announcements on reforming adult social care. This section provides an overview of some of these proposals.

1.1 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.

1.2 ‘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 “Dilnot-style” adult social care charging reforms, such as the cap on personal care costs, and moving towards paying a ‘fair rate of care’, by allowing self-funders to ask their local authority to arrange their care for them so that they can find better value care, 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:

In December 2021, Boris Johnson’s government published the adult social care white paper ‘People at the heart of care’ which, it argued, set out “an ambitious 10-year vision for how we will transform support and care in England”. Proposals in the paper included funding to integrate housing into local health and care strategies; funding to drive greater adoption of technology and achieve widespread digitisation across social care; funding to ensure the social care workforce have the right training and qualifications; a new practical support service to make minor repairs and changes in people’s homes to help people remain independent and safe in their home; and a new national website to explain the upcoming changes and at least £5mn to pilot new ways to help people understand and access the care and support available.

2. House of Lords Adult Social Care Committee report

2.1 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, during the premiership of Boris Johnson, 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 greater 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; and putting co-production at the heart of care. The committee defined co-production as “when people who use services and carers work with professionals in equal partnerships towards shared goals”, meaning where the choice of who cares and what is provided rests with the person whose life is at the centre of the decision, and the people they wish to include. The committee received written evidence and oral evidence from a number of individuals and organisations.

Prior to the committee report’s publication, in November 2022 the committee’s chair, Baroness Andrews, wrote to Rishi Sunak’s 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?

She criticised plans to increase funding through council tax and to delay the cap on care costs and extension of the means test as “regressive”. Baroness Andrews called for more details for unpaid carers and argued the government lacked a coherent strategy across adult social care.

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 [House of Commons] 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.

Chancellor 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).

2.2 Report findings

The committee published its report ‘A “gloriously ordinary life”: Spotlight on adult social care’ on 8 December 2022. 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 with 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 policymakers 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 December 2021 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 noted that the scale of the funding gap facing social care was difficult to estimate, as there was no national budget for adult social care in England; most adult social care in England is financed through local government revenue. It pointed to decreases in government funding for local authorities, noting “given that spending on adult social care constitutes a significant proportion of local authority spending, this has important implications for the delivery of services”.

The report was critical of announcements made in the November 2022 autumn statement which further delayed the introduction of social care funding reforms, such as the cap on personal care costs, to October 2025. While welcoming the £4.7bn funding for adult social care services in 2024/25 it argued that this should not be “at the expense of further delay in the first steps towards long-term reform of the system”. Highlighting the repeal of the Health and Social Care Levy Act it argued “the lack of certainty that has surrounded future funding […] is a significant impediment to meaningful change”. It called on the government to increase the financial settlement for adult social care over three years. In relation to future funding, it argued the government should:

[…] commit to sustain realistic, long-term and protected funding for the sector to enable robust planning. Funding requirements over and above what has already been committed should be assessed on the best estimates from independent experts and agencies.

In addition, the report included recommendations on the collection of data, 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.

2.3 Government response

In July 2023, the government published a response to the report. It followed the publication of the white paper ‘Next steps to put people at the heart of social care’ by the government on 4 April 2023 which the government said built upon the 10-year plan outlined in December 2021.

In its response the government pointed to commitments made in the white paper on a range of different areas including reform of the adult social care workforce, housing for people who require care and tackling delayed discharge and unnecessary admissions to hospitals. It stated it was committed to “delivering an ambitious vision for reform”. It argued that the April 2023 white paper:

[…] builds on progress over the last year and sets out the plan for how we are implementing the most impactful white paper commitments, along with some new commitments. It includes key milestones for reform and sets out the key changes we can expect to see for people who draw on care and support, unpaid carers, and people who work in social care.

The government stated that “strengthening the adult social care workforce in a sustainable way is essential to improve the lives of people who draw on care and support and their carers”. It pointed to work to develop a new care workforce pathway for adult social care, which it said would identify the skills and knowledge needed to work in adult social care and improve career pathways and career progression in the sector. The government committed to publishing the first phase of the framework in autumn 2023. The response also emphasised £15mn of funding for local areas to assist with international recruitment.

In addition, the response drew attention to announcements in the autumn statement 2022 regarding funding of the adult social care sector, noting it had made available up to £7.5bn in additional funding over the next two years to support adult social care and discharge.

It claimed that the funding would help local authorities address inflation, waiting lists, low fee rates and workforce pressures in the sector. The sum included £2bn to support and improve discharge from hospital and access to social care.

The government welcomed the committee’s focus on allowing individuals to “live in a place they call home”. It drew attention to the establishment of the ‘Older people’s housing taskforce’, arguing it would help “unlock investment in retirement housing”. Commenting on the committee’s recommendations regarding data collection, the government pointed to commitments in the April 2023 white paper aimed at improving data collection and utilisation.

The government rejected the committee’s recommendation to establish a commissioner for care and support to act as a champion for older and disabled people and unpaid carers arguing that “statutory roles are not the most efficient way to promote and protect the rights of these groups”. It also confirmed that it had “no plans to carry out an independent review of the Care Act 2014”.

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