Recommendations & Conclusions
27 items
1
Conclusion
2nd Report - Adult Social Care Reform: …
Accepted
The current adult social care system does not sufficiently meet the needs of the population despite the efforts of millions of paid and unpaid carers. Financial pressures mean that those needing care sometimes only receive basic support, far from enough to enable them to live fulfilling lives. Despite this, costs …
Government response. The government recognised the challenges and data limitations in adult social care, stating it would be challenging to publish an annual assessment of unmet need. It highlighted ongoing efforts by the CQC to assess all local authorities and DHSC's funding …
Department of Health and Social Care
2
Recommendation
2nd Report - Adult Social Care Reform: …
Deferred
The Government should publish an annual assessment of the level of unmet care needs for both older adults and working age disabled adults, publishing its methodology and supporting data to ensure transparency and allow for scrutiny. (Recommendation, Paragraph 21)
Government response. The government did not commit to publishing an annual assessment of unmet care needs. Instead, it described existing measures like the Adult Social Care Outcomes Framework (ASCOF) for measuring outcomes, and ongoing efforts to improve data quality and support local …
Department of Health and Social Care
3
Recommendation
2nd Report - Adult Social Care Reform: …
Rejected
The Government must also develop a robust methodology for measuring the impact of care on people’s lives, the wider health system, and the economy. As well as supporting the case for reform, such methodology would help councils to deliver outcome-based commissioning, which is more likely to provide people with meaningful …
Government response. The government rejected the recommendation to develop a robust methodology for measuring the impact of care. It stated that existing procedures for impact assessments for policy or fiscal decisions relating to the workforce are sufficient and a new form of …
Department of Health and Social Care
4
Conclusion
2nd Report - Adult Social Care Reform: …
Deferred
There have been multiple failed attempts to advance a version of Dilnot’s reforms, during which time more and more people are faced with unknowable social care costs, and inflation has eroded the value of the upper threshold, meaning fewer people benefit from it. We note the establishment of the Casey …
Government response. The government's response did not address the recommendation regarding social care costs or the Casey Commission. Instead, it discussed DWP's use of PAYE data and SIC codes for Universal Credit customers, and its lack of SOC codes.
Department of Health and Social Care
5
Recommendation
2nd Report - Adult Social Care Reform: …
Deferred
Given how often this was raised as an issue, we recommend that the Casey Commission considers measures to address the erosion of the upper threshold. In the meantime, we recommend the Government does the same. (Recommendation, Paragraph 29) 53 Unpaid carers: the hidden cost of inaction
Government response. The government's response did not address the recommendation to consider the erosion of the social care upper threshold. Instead, it committed to consulting on the design of the Fair Pay Agreement process this year, with secondary legislation and the establishment …
Department of Health and Social Care
6
Conclusion
2nd Report - Adult Social Care Reform: …
Acknowledged
Unpaid carers are bearing the highest cost from successive governments’ failures to reform adult social care. They provide care worth £184 billion, “equivalent to a second NHS”, but this is often unrecognised and comes at great personal, emotional and financial cost as well as a cost to their own health. …
Government response. The government agrees that publishing cost estimates of delayed discharges would improve transparency and will explore how best to publish this data, acknowledging methodological challenges.
Department of Health and Social Care
7
Recommendation
2nd Report - Adult Social Care Reform: …
Deferred
We recommend that the Casey Commission includes a specific workstream dedicated to reducing the pressures on carers, especially young carers. This workstream should consider how to support unpaid carers better, to ensure they get the respite they need and to look after their own health and wellbeing. It should also …
Government response. The government agrees with the recommendation but deflects by detailing £9 billion in Better Care Fund funding for 2025-2026, which focuses on prevention and community care, rather than committing to a specific Casey Commission workstream for carers.
Department of Health and Social Care
8
Conclusion
2nd Report - Adult Social Care Reform: …
Rejected
Local authorities are buckling under the strain of the costs of providing adult social care. The current system is unsustainable. Failure to reform adult social care, especially the funding structure, comes at a significant cost to local authorities. The increasingly high proportion of spending on adult social care is crowding …
Government response. The government agrees adult social care supports economic growth and highlights current efforts like the Employment Rights Bill and investment in digital tools, but it explicitly rejects developing a dedicated adult social care 'growth strategy'.
Department of Health and Social Care
9
Recommendation
2nd Report - Adult Social Care Reform: …
Deferred
We recommend that securing agreement on the funding structure must be the top priority for the Casey Commission and for any future Government reforms. Without this agreement, reform can only ever be piecemeal and short-term in outlook and, ultimately, will fail. We also recommend that any future funding structure includes …
Government response. The government agrees reform is essential and supports the independent Casey Commission, but states Baroness Casey has autonomy to determine priorities and shape the commission's work, deflecting the recommendation to prioritize funding structure and ring-fence preventative work.
Department of Health and Social Care
10
Conclusion
2nd Report - Adult Social Care Reform: …
Deferred
The funding structure for adult social care, rising costs and the inability to make long-term investment, is creating an unstable and unsustainable care market. Providers are making losses, creating inequities by charging more to self-funders or even planning to close entirely. The Government has not properly considered either the immediate …
Government response. The government notes it annually reviews capital limits and social care allowances, but largely defers to the independent Casey Commission, which has a broad remit to examine the long-term transformation of adult social care and make recommendations on the charging …
Department of Health and Social Care
11
Recommendation
2nd Report - Adult Social Care Reform: …
Deferred
We recommend that any future policy changes or fiscal decisions relating to the workforce should be accompanied by a cross-government impact assessment that sets out the immediate and ongoing consequences for the social care sector. As part of this, the Government should set out what mitigating actions they would take …
Government response. The government focuses on actions to support carers, committing to increasing the Carer's Allowance weekly earnings limit from April 2025 and reviewing Carer's Leave and the benefits of introducing paid Carer's Leave, rather than addressing the recommendation for cross-government impact …
Department of Health and Social Care
12
Recommendation
2nd Report - Adult Social Care Reform: …
Deferred
We recommend that the Casey Commission prioritises identifying interventions to create a more sustainable care market. (Recommendation, Paragraph 75)
Government response. The government states that Baroness Casey has full autonomy to determine the commission’s priorities, thereby deflecting the recommendation for her to prioritize sustainable care market interventions, although it also mentions its commitment to local government reforms and the importance of …
Department of Health and Social Care
13
Conclusion
2nd Report - Adult Social Care Reform: …
Deferred
Low pay does not adequately recognise the level of skill adult social care workers need to do very difficult physical and emotional work. It is both morally unacceptable, and economically shortsighted, that the current pay regime is pushing some into poverty. Higher wages would achieve better quality care and reduce …
Government response. The government defers to Baroness Casey's full autonomy to determine the independent commission’s priorities, acknowledging her task to make adult social care more productive and preventative, rather than committing to specific actions regarding low pay for care workers.
Department of Health and Social Care
14
Conclusion
2nd Report - Adult Social Care Reform: …
Deferred
We further welcome plans to establish the Adult Social Care Fair Pay Agreement and improve career pathways. However, the Government needs to set out how these measures will be funded, as providers and local government cannot afford to fund them. (Conclusion, Paragraph 86)
Government response. The government states that the independent Casey Commission has the autonomy to decide how best to examine models of care and funding flows needed for a sustainable system, thereby deflecting the request to set out funding details for the Adult …
Department of Health and Social Care
15
Recommendation
2nd Report - Adult Social Care Reform: …
Deferred
We recommend that the Department for Work and Pensions explores collecting occupational data for benefit claimants, to better understand the cost to the Exchequer of low pay for care workers and to support the case for better pay. (Recommendation, Paragraph 87)
Government response. The government defers to the independent Casey Commission's autonomy to recommend steps for supporting the adult social care sector, implying it will not directly act on the recommendation for DWP to collect occupational data on benefit claimants for care workers.
Department of Health and Social Care
16
Recommendation
2nd Report - Adult Social Care Reform: …
Accepted
We recommend that the impact assessment for any secondary legislation to establish an Adult Social Care Fair Pay Agreement be accompanied by a full quantitative analysis, including the impact on sector productivity, financial costs faced by providers and expected return to the Exchequer (through tax receipts or reduced welfare claims) …
Government response. The government commits to beginning the Fair Pay Agreement consultation this year, with secondary legislation and the negotiating body established in 2026, aiming for the first agreement within this Parliament. It also confirms an impact assessment including monetised estimates will …
Department of Health and Social Care
17
Conclusion
2nd Report - Adult Social Care Reform: …
Acknowledged
Social care is a vital public service in and of itself and should not be valued only for how it supports the NHS. However, the current state of adult social care is imposing significant costs on the NHS. The best estimate we found was that delayed discharges alone are costing …
Government response. The government agrees that publishing cost estimates for delayed discharges would in principle improve transparency but notes methodological challenges. It commits to exploring how best to publish such data, without a firm commitment to immediately produce the comprehensive data requested …
Department of Health and Social Care
18
Recommendation
2nd Report - Adult Social Care Reform: …
Deferred
We recommend that the Department provides an official estimate of how much delayed discharges are costing the NHS, broken down by the reason for the delay and including costs associated with the beds themselves, staff time and wider activity that cannot happen as a result of a delayed discharge. This …
Government response. The government agrees that publishing cost estimates would improve transparency but notes methodological challenges. It commits to exploring how best to publish cost data rather than directly providing an official, annually updated estimate broken down by delay reason, effectively deferring …
Department of Health and Social Care
19
Recommendation
2nd Report - Adult Social Care Reform: …
Rejected
We recommend that the Casey Commission undertakes research to better understand the costs that the NHS is bearing as a result of failures in adult social care, and where the NHS is saving money due to good social care. This should be used in future departmental budget setting processes and …
Government response. The government states that the independent Casey Commission has the autonomy to decide its research, implying the government will not direct it to undertake the specific cost analysis recommended or commit to continuing such analysis itself.
Department of Health and Social Care
20
Conclusion
2nd Report - Adult Social Care Reform: …
Acknowledged
The current state of the adult social care system is undermining the relationship building that is fundamental to the development of Integrated Care Systems (ICSs). Too much relies on local leadership, where often it feels that progress is made despite funding mechanisms rather than because of them. By maintaining a …
Government response. The government states it agrees with the conclusion and highlights its commitment of £9 billion to the Better Care Fund for 2025-26, refocusing it on prevention and community care. However, it does not explicitly commit to addressing how the current …
Department of Health and Social Care
21
Conclusion
2nd Report - Adult Social Care Reform: …
Accepted
We welcome the new objectives for the Better Care Fund to support preventative services, rather than simply focusing on solving challenges with hospital discharge. (Conclusion, Paragraph 111)
Government response. The government agrees with the conclusion, stating it has committed £9 billion to the Better Care Fund (BCF) for 2025-26 and refocused its policy framework towards prevention and community-based care, setting new performance metrics. It is also considering longer-term reforms …
Department of Health and Social Care
22
Recommendation
2nd Report - Adult Social Care Reform: …
Accepted
We recommend that the Government and the NHS review the structure and level of NHS investment in the Better Care Fund to ensure it is fully capable of meeting its renewed focused on upstream and preventative work. (Recommendation, Paragraph 112) 56
Government response. The government agrees with the recommendation and has committed £9 billion to the Better Care Fund (BCF) for 2025-26, refocusing its policy framework on upstream and preventative work with new performance metrics. It also stated it is considering longer-term reform …
Department of Health and Social Care
23
Conclusion
2nd Report - Adult Social Care Reform: …
Acknowledged
The Government will not succeed in creating an NHS fit for the future unless it effectively reforms the social care system. Social care reform is an integral part of NHS reform and cannot be a separate process. (Conclusion, Paragraph 117)
Government response. The government acknowledges the conclusion by stating the independent commission has autonomy and its first phase will focus on supporting the health mission within ongoing reforms. However, it does not explicitly commit to ensuring social care reform is fully integrated …
Department of Health and Social Care
24
Recommendation
2nd Report - Adult Social Care Reform: …
Rejected
In her first report, Baroness Casey should set out the immediate steps that the Government needs to take to ensure the adult social care sector can play its vital part in the three shifts for NHS reform. Achieving these should be the measure against which the success of the 10-Year …
Government response. The government states the independent commission has autonomy to make recommendations and that its terms of reference already align with supporting the government's health mission, but does not commit to ensuring Baroness Casey sets out the immediate steps or assessments …
Department of Health and Social Care
25
Conclusion
2nd Report - Adult Social Care Reform: …
Acknowledged
The Government needs to fundamentally change how it views the social care sector, seeing it as an enabler and talking about it in those terms in the public debate - both for the invaluable service it provides to so many people and also as a driver of economic growth. We …
Government response. The government strongly agrees that adult social care is an important enabler for economic growth and contributes significantly to the economy. However, it reiterates that a dedicated 'growth strategy' for the sector is not considered necessary or proportionate, consistent with …
Department of Health and Social Care
26
Recommendation
2nd Report - Adult Social Care Reform: …
Rejected
We recommend that the Government produce a growth strategy for the adult social care sector, including a focus on its potential to drive regional growth. This should be informed by a detailed study of how to improve productivity in the adult social care sector, which we recommend the Casey Commission …
Government response. The government rejects the recommendation for a dedicated adult social care 'growth strategy', arguing it is not proportionate or necessary given the sector's core purpose of individual wellbeing. While acknowledging social care's economic role, it notes the Casey Commission's independence …
Department of Health and Social Care
27
Recommendation
2nd Report - Adult Social Care Reform: …
Rejected
We recommend that the Government commissions research with the aim of fully quantifying the cost of doing nothing on adult social care reform. That research should seek to quantify costs to individuals, including unpaid carers and care workers, to local authorities, to care providers, to the NHS and to the …
Government response. The government rejects commissioning a dedicated study to quantify the cost of inaction on adult social care reform. It states it already commissions a wide range of research and data through the NIHR to inform its approach to reform.
Department of Health and Social Care