Recommendations & Conclusions
17 items
4
Conclusion
Second Report - Long-term funding of ad…
Acknowledged
The Rt Hon Boris Johnson MP said as Prime Minister that he would fix the crisis in social care once and for all. We commend the Government for attempting to prevent unpredictable and catastrophic care costs for people and introducing reforms to the sector where previous Governments failed to act. …
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The Rt Hon Boris Johnson MP said as Prime Minister that he would fix the crisis in social care once and for all. We commend the Government for attempting to prevent unpredictable and catastrophic care costs for people and introducing reforms to the sector where previous Governments failed to act. But it should be under no illusions that it has come close to rescuing social care, and needs to be open with the public that there is a long way to go. Ultimately, all our lines of inquiry returned to the same fundamental point: there is a large funding gap in adult social care that needs filling. This is not new information. In October 2020, the Health and Social Care Long-term funding of adult social care 73 Committee estimated a funding gap of £7 billion to cover demographic changes, uplift staff pay in line with the National Minimum Wage, and to protect people who face catastrophic social care costs. We have not yet received an updated estimate of the funding gap to take into account immediate pressures and the Government’s various policy reforms. £7 billion was just a starting point and would not address the growing problem of unmet need nor improve access to care, with the full cost of adequate funding likely to run to tens of billions of pounds.
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Government response AI summary
The government acknowledged the concerns around the impact of charging reforms and stated they have provided funding for charging reforms, but do not address the concerns that they have underestimated the combined cost of introducing a new cap and more generous means test, commencing Section …
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Ministry of Housing, Communities and Local Government
6
Conclusion
Second Report - Long-term funding of ad…
Acknowledged
We do not wish to pit the NHS and adult social care against one another. The two systems are interdependent and each needs to be adequately funded to reduce pressure on the other. Wherever the money comes from—from allocating a higher proportion of levy proceeds to social care, or from …
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We do not wish to pit the NHS and adult social care against one another. The two systems are interdependent and each needs to be adequately funded to reduce pressure on the other. Wherever the money comes from—from allocating a higher proportion of levy proceeds to social care, or from central government grants—the Government urgently needs to allocate more funding to adult social care in the order of several billions each year, at least £7 billion.
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Government response AI summary
The government recognises the committee’s concerns around the impact of charging reforms on social care assessors and will work with IT suppliers and local authorities, supporting local areas to trial and invest in innovative approaches to reforming operating models and to improving the recruitment and …
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Ministry of Housing, Communities and Local Government
7
Conclusion
Second Report - Long-term funding of ad…
Acknowledged
We do not accept the Government’s position that care providers should not be compensated for employer National Insurance Contributions in relation to the Health and Social Care Levy simply because they are, on the whole, private businesses. We heard again and again that there should be parity of esteem between …
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We do not accept the Government’s position that care providers should not be compensated for employer National Insurance Contributions in relation to the Health and Social Care Levy simply because they are, on the whole, private businesses. We heard again and again that there should be parity of esteem between the NHS and social care. Compensating the “health” component of the “Health and Social Care Levy” because it is a public sector employer while not doing so for the “social care” component only serves to reinforce the strongly felt notion that social care is the poor relation of the NHS. It also introduces unfairness between public and private care providers. The additional cost to private providers will make it harder for them to increase wages. This may lead to more care workers leaving the sector, many for jobs in the NHS. Furthermore, it is a perverse logic that care providers should have to undergo further financial strain by paying a tax that is supposed to be helping to relieve their financial strain. Since the Health and Social Care Levy is supposed to benefit both health and social care, private care providers should be compensated for employer National Insurance Contributions to the Health and Social Care Levy. (Paragraph 41) Changing reforms
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Government response AI summary
In light of the new timeline to implement charging reform, the government will be reviewing the delivery plan and considering how to ensure that insights from Trailblazers can be effectively fed back into the development of delivery to refine or adapt our approach to implementation.
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Ministry of Housing, Communities and Local Government
8
Recommendation
Second Report - Long-term funding of ad…
Acknowledged
While the Government has provided funding for its charging reforms, we received many concerns that it has underestimated the combined cost of introducing a new cap and more generous means test, commencing Section 18(3) of the Care Act 2014 in respect of residential care, and the fair cost of care. …
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While the Government has provided funding for its charging reforms, we received many concerns that it has underestimated the combined cost of introducing a new cap and more generous means test, commencing Section 18(3) of the Care Act 2014 in respect of residential care, and the fair cost of care. It has since expressed its intention to stagger the rollout of Section 18(3), which may help to avert the worst-case scenario in terms of local authority capacity pressures and market sustainability. The 74 Long-term funding of adult social care Government should re-evaluate the combined impact of its charging reforms, Section 18(3), and the fair cost of care, to take account of the staggered rollout of Section 18(3). It should regularly monitor take-up of Section 18(3) and update its models accordingly. The Government should provide further funding to local authorities, if necessary, on top of additional funding for underlying pressures.
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Government response AI summary
The government acknowledges the committee's interest in proposals to improve fee transparency and describes existing initiatives like the Market Sustainability and Fair Cost of Care Fund and the Market Sustainability and Improvement Fund, as well as a commitment to consider changing the CQC registration regulations …
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Ministry of Housing, Communities and Local Government
9
Recommendation
Second Report - Long-term funding of ad…
Acknowledged
It is nevertheless disappointing that people currently living in and paying for residential care, whose payments before October 2023 will not count towards the cap, will now not be able to access local authority rates until 18 months later than they were originally told. The Government should put every effort …
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It is nevertheless disappointing that people currently living in and paying for residential care, whose payments before October 2023 will not count towards the cap, will now not be able to access local authority rates until 18 months later than they were originally told. The Government should put every effort into heeding its commitment to rolling out Section 18(3) for those currently living in residential care earlier than April 2025.
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Government response AI summary
The government states they agree with the committee’s recommendation for market shaping to include a dedicated focus on outcomes-based commissioning and investing funding to strengthen local authority market-shaping, commissioning, and contract management capability.
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Ministry of Housing, Communities and Local Government
11
Recommendation
Second Report - Long-term funding of ad…
Acknowledged
The Government should publish real-time and regular evaluation, both of the trailblazer scheme and of the charging reforms when they are rolled out more widely, so that local authorities can apply insights quickly and so that the Government can provide further funding in a timely manner where necessary should its …
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The Government should publish real-time and regular evaluation, both of the trailblazer scheme and of the charging reforms when they are rolled out more widely, so that local authorities can apply insights quickly and so that the Government can provide further funding in a timely manner where necessary should its modelling prove inaccurate to prevent further market instability.
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Government response AI summary
The government states it understands the benefits for councils of a Local Government Finance Settlement (LGFS) spanning multiple years and will aim to provide a multi-year funding settlement wherever possible in recognition of its importance to councils’ budget setting processes and to delivering excellent public …
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Ministry of Housing, Communities and Local Government
12
Recommendation
Second Report - Long-term funding of ad…
Acknowledged
Given the Government’s investment in the fair cost of care, and our calls for further funding and for care providers to be compensated for their employer National Insurance Contributions of the Health and Social Care Levy, it is all the more important that the additional funding reaches the frontline. However …
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Given the Government’s investment in the fair cost of care, and our calls for further funding and for care providers to be compensated for their employer National Insurance Contributions of the Health and Social Care Levy, it is all the more important that the additional funding reaches the frontline. However limited tax avoidance and financial transparency in certain parts of the market are, they must be tackled. The Government should bring forward proposals for both improving the financial transparency of providers and giving consumers transparency in respect of what the price for their care covers.
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Government response AI summary
The government acknowledges the desire for clarity on distribution reform but states that they will not be proceeding with the Review of Relative Needs and Resources or Business Rates Reset during this Spending Review, focusing instead on stability and clarity.
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Ministry of Housing, Communities and Local Government
13
Conclusion
Second Report - Long-term funding of ad…
Acknowledged
While achieving a fair price of care is vital, price should not be the driving factor in commissioning care. Reforms in relation to improvement and market shaping should include a dedicated focus on outcomes-based commissioning, drawing on existing good practice by local authorities. (Paragraph 64) Local government finance
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While achieving a fair price of care is vital, price should not be the driving factor in commissioning care. Reforms in relation to improvement and market shaping should include a dedicated focus on outcomes-based commissioning, drawing on existing good practice by local authorities. (Paragraph 64) Local government finance
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Government response AI summary
The government recognizes the concerns of local government and notes the delay to planned adult social care charging reforms. They will comply with the New Burdens Doctrine for relevant aspects of the adult social care reform programme.
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Ministry of Housing, Communities and Local Government
14
Recommendation
Second Report - Long-term funding of ad…
Acknowledged
As well as the desperate human impact on those needing, receiving, and providing care, the underfunding of adult social care has led to many councils having to cut other public services in order to do their best to meet their care duties. The Government should address three core issues to …
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As well as the desperate human impact on those needing, receiving, and providing care, the underfunding of adult social care has led to many councils having to cut other public services in order to do their best to meet their care duties. The Government should address three core issues to improve the sustainability of Long-term funding of adult social care 75 adult social care funding: the balance of funding sources, long-term planning and forecasting, and geographical distribution.
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Government response AI summary
The government restates its commitment to the 10-year vision for adult social care set out in the People at the Heart of Care white paper and highlights actions being taken over the next two years to take the next step toward person-centred care.
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Ministry of Housing, Communities and Local Government
17
Recommendation
Second Report - Long-term funding of ad…
Acknowledged
The geographical inequity of relying on council tax to provide the majority of funding for adult social care is compounded by an out-of-date adult social care relative needs formula. The Government must update the adult social care relative needs formula by the next financial year. This should be implemented alongside …
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The geographical inequity of relying on council tax to provide the majority of funding for adult social care is compounded by an out-of-date adult social care relative needs formula. The Government must update the adult social care relative needs formula by the next financial year. This should be implemented alongside the Fair Funding Review and council tax equalisation. Geographical fairness should also be taken into account in future allocations of Health and Social Care Levy funding.
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Government response AI summary
The government states that they remain committed to providing care and support in a person’s own home, but have taken the difficult decision to not progress with the £300 million investment in housing, announced in the white paper, in order to prioritize spending on the …
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Ministry of Housing, Communities and Local Government
19
Recommendation
Second Report - Long-term funding of ad…
Acknowledged
Stakeholders have called for adult social care reform for years, and we commend the Government for introducing many welcome initiatives such as around housing and data that could make a significant difference in the long-term. We are also pleased that many stakeholders welcome the Government’s vision for what good care …
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Stakeholders have called for adult social care reform for years, and we commend the Government for introducing many welcome initiatives such as around housing and data that could make a significant difference in the long-term. We are also pleased that many stakeholders welcome the Government’s vision for what good care looks like and how care is experienced by those receiving care and their families. However, the Government currently has nothing more than a vision. We are alarmed that so much of the detail within the People at the Heart of Care White Paper has yet to be worked out, and that there is no roadmap, no timetable, no milestones, and no measures of success. We note that the Health and Social Care Committee has called for a 10-year plan for adult social care in three separate reports since October 2020. The Government should publish a 10-year plan for how its vision in the People at the Heart of Care White Paper will be achieved, taking into account how the different policies interweave and affect one another. The plan should be co- produced with people with lived experience of receiving care and providing care, paid and unpaid. The Government should manage this set of reforms, alongside charging reforms, as a programme, and identify a Senior Responsible Officer. It should publish key milestones, a timetable, and measures of success, and report annually on progress to Parliament.
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Government response AI summary
The government notes that the Older People’s Housing Task Force will provide an opportunity to consider detailed evidence of the operation of the planning system in supporting housing for older people and whether any changes are required, including in respect of use classes, but makes …
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Ministry of Housing, Communities and Local Government
20
Conclusion
Second Report - Long-term funding of ad…
Acknowledged
The lack of information about how the reforms add up to £5.4 billion, why each reform was allocated the amount it was allocated, and how funding will be distributed, does little to instil confidence that the Government has thought through its plans. We have expressed our concerns numerous times about …
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The lack of information about how the reforms add up to £5.4 billion, why each reform was allocated the amount it was allocated, and how funding will be distributed, does little to instil confidence that the Government has thought through its plans. We have expressed our concerns numerous times about the unrealistic demands of requiring councils to compete for relatively small pots of funding, which larger and better funded authorities can win. The Government’s response to our report should include a full breakdown of how the £5.4 billion from the Health and Social Care Levy will be divided between the different reforms with a rationale for each amount, including why some amounts are “at least” and others are “up to”. It should also set out how each pot of funding will be distributed, avoiding using bids as a means of allocating grants as much as possible, and providing justification for any element of competition.
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Government response AI summary
The government emphasizes that local authorities are responsible for ensuring sufficient workforce capacity to meet care needs in their area, and highlights the measures they are taking subject to monitoring and evaluation.
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Ministry of Housing, Communities and Local Government
21
Conclusion
Second Report - Long-term funding of ad…
Acknowledged
Given how fundamentally social care policies made by DHSC affect local authorities’ capacity, budgets, and residents, it is vital that DHSC and DLUHC work together closely on developing and delivering such policies. We were struck by the discrete division of answers to questions by Ministers, who rarely supplemented one another’s …
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Given how fundamentally social care policies made by DHSC affect local authorities’ capacity, budgets, and residents, it is vital that DHSC and DLUHC work together closely on developing and delivering such policies. We were struck by the discrete division of answers to questions by Ministers, who rarely supplemented one another’s answers, and the separate follow-up letters that we received. The Government’s 10- year plan should be developed jointly between DHSC and DLUHC, with relevant input from the Department for Work and Pensions. We expect the Government response to our report to show clear evidence of joint working from the departments, rather than discrete sections according to the departments’ separate remits. (Paragraph 87) Long-term funding of adult social care 77 Housing and Planning
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Government response AI summary
The government acknowledges the importance of health and care staff and integrated care systems working with local authorities, but emphasizes the distinct nature of the social care sector as primarily private.
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Ministry of Housing, Communities and Local Government
23
Recommendation
Second Report - Long-term funding of ad…
Acknowledged
The Government should create a separate taskforce for housing for working age disabled adults alongside the taskforce for housing for older people. Both taskforces should be accountable to both DLUHC and DHSC and should report to the Senior Responsible Officer for the People at the Heart of Care programme. Their …
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The Government should create a separate taskforce for housing for working age disabled adults alongside the taskforce for housing for older people. Both taskforces should be accountable to both DLUHC and DHSC and should report to the Senior Responsible Officer for the People at the Heart of Care programme. Their terms of reference should be developed with input from the Local Government Association and housing stakeholders and should set out the taskforces’ interconnection with housing proposals in People at the Heart of Care.
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Government response AI summary
The government points to their 10-year white paper reform vision and states that they will invest up to an additional £25 million for unpaid carers. They are also taking steps towards implementing a new survey of unpaid carers.
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Ministry of Housing, Communities and Local Government
29
Conclusion
Second Report - Long-term funding of ad…
Acknowledged
Our broken care system is held up by unpaid carers doing vital work out of love and pride. The cost to them can be financial, physical, and emotional. The cost to our economy of carers leaving the workforce is over £3 billion each year—money that could be invested in adult …
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Our broken care system is held up by unpaid carers doing vital work out of love and pride. The cost to them can be financial, physical, and emotional. The cost to our economy of carers leaving the workforce is over £3 billion each year—money that could be invested in adult social care. We recognise that some of the proposals in the White Paper will benefit carers, such as around technology and innovation. However, we think that £25 million over three years is a totally inadequate amount to allocate to initiatives to support carers, whose contribution to the UK economy is estimated by Carers UK at £132 billion a year. £25 million will do little to assure carers that their contribution is valued by the Government.
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Government response AI summary
The government recognizes the vital role of unpaid carers and the importance of supporting them and highlights the Care Act 2014 and Better Care Fund (BCF) as ways they are providing support, and will look to improve the clarity and transparency of spend on unpaid …
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Ministry of Housing, Communities and Local Government
32
Conclusion
Second Report - Long-term funding of ad…
Acknowledged
During this inquiry we heard about a proposal for a national care service, under which health and social care would be delivered by the same organisation. This would be similar to systems in place in Northern Ireland and Wales. This proposal was roundly dismissed by our witnesses. We support the …
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During this inquiry we heard about a proposal for a national care service, under which health and social care would be delivered by the same organisation. This would be similar to systems in place in Northern Ireland and Wales. This proposal was roundly dismissed by our witnesses. We support the Government’s policy of getting health and care to work better together at a local level, which is far more preferable than a massive reorganisation to create a national care service.
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Government response AI summary
The government recognizes the importance of collaboration between commissioners and providers within integrated care systems (ICS) and will provide further support and advice to help places develop their approaches where needed, including reviewing ICS boundaries in certain areas.
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Ministry of Housing, Communities and Local Government
34
Recommendation
Second Report - Long-term funding of ad…
Acknowledged
Integration strategies should seek to integrate not just health and care but health, care and housing. Ensuring there is holistic care that fits around a person’s needs includes preventing care needs from arising by having suitable housing, enabling people to live independently in their own homes, and ensuring that people …
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Integration strategies should seek to integrate not just health and care but health, care and housing. Ensuring there is holistic care that fits around a person’s needs includes preventing care needs from arising by having suitable housing, enabling people to live independently in their own homes, and ensuring that people receive the right care and support in the right setting, recognising that most people who receive care do so in their own home. Getting housing arrangements right for people is an essential part of the equation. We recommend that integrated health strategies have proper regard to a person’s housing needs as part of their care provision.
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Government response AI summary
The government agrees that holistic care should include housing and highlights examples of integrated approaches in areas like Greater Manchester and states their Integrated Care Strategy guidance encourages integrated care partnerships to have a joined-up approach to housing.
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Ministry of Housing, Communities and Local Government