Care questions

Kay Andrews on the government’s ongoing failure to deliver on promises made to the adult social care sector

This Thursday, Peers will debate the state of adult social care in the UK – in the context of two seminal reports, new duties on the Care Quality Commission (CQC), and the government’s own plans following its White Paper, The Future of Social Care.

It could not be a more urgent debate, given the recent Budget failed to put any additional funding into the sector and the possibility that Ministers may cut £500 million from projected funding for the workforce. It also comes at a time when that same workforce is short of 165,000 people; when a decade of austerity means that a million people are now waiting months for assessments and care packages; and when unpaid carers are being asked to do more within an ever more labyrinthine system.

Since the pandemic, things have become measurably worse within adult social care and new duties on the CQC from 1st April to implement a new single assessment system may not have the desired impact.

Two new – and radical – reports, however, reflect a consensus of values as well as recommendations. The Health & Social Services Select Committee report, ‘A Gloriously Ordinary Life‘ is focused on unpaid care-giving, looking at interdependent relationships between carers and those they care for, and the sector’s “entrenched invisibility.” (As Chancellor Jeremy Hunt once put it.)  The Archbishop’s Commission on ‘Reimagining Care’ took a wider remit.

Both start from the fundamental premise that rather than something people have come to dread if forced to depend on it, adult social care has the potential to be so much better. Something to provide the conditions for a ‘fulfilled’ life as well as the foundation of a good society and a resilient health service. Indeed, the Select Committee report argues that adult social care must become a ‘national imperative’ if it is to become the service we all want. That means investing in strategic funding and the workforce to the scale and depth consistently called for over the past few years.

But reducing invisibility involves insight, advocacy, and representation – as well as money. That is why we need a Commissioner for Care and Support, and a change in the design of policy at local and service level. Only then can the ‘experts by experience’ – those who provide and received adult social care – have a far greater involvement over what they are offered. The Integrated Care Services hold the key to this and must be held to account. In turn, the 2014 Care Act must be revisited and properly implemented.

Demand is changing, as more people are ageing without children, Technology can offer more opportunity for innovation and greater capacity, but information on the ground is extremely patchy. Such basic gaps in data need filling, so that change can happen where, when, and how they can work best. Another obvious long overdue priority must be mandatory standards, to guarantee the supply of supported and adapted housing. People can then leave hospital for home and stay safe.

Much of this is in place and can be built on, but other policy promises remain to be honoured. Unpaid carers have been particularly let down, in relation to respite care, Carers’ Leave, more support in the workplace, and increased benefits to reflect the higher costs of caring.

The question that continues to be asked is ‘Who cares about adult social care?’ If no one cares, where is the incentive for reform? Evidence from every quarter is that the changes sought are the right ones and long overdue. So, when is help actually coming? Perhaps the government will tell us later this week?

Baroness Kay Andrews is a Labour Peer, and Chair of the House of Lords’ Adult Social Services Committee

Published 27th March 2023