Proposals for the long-term funding and major reform of the social care system in England may not be delivered until 2028, sparking backlash from experts.
An independent commission into adult social care, beginning in April and chaired by Baroness Louise Casey, will prepare the ground for a National Care Service, a key Labour manifesto pledge.
The first phase of the review, reporting in mid-2026, will identify the immediate critical issues facing adult social care and set out recommendations for effective reform and improvement in the medium term.
The review will not make long-term recommendations, which focus on creating a fair and affordable social care system, for at least three years. Any changes the government supports will take even longer to implement.
Care England chief executive Professor Martin Green said: “This announcement acknowledges the decade-long crisis in social care, but it risks becoming yet another report that gathers dust while the sector crumbles.
“Care providers are doing their utmost to deliver essential care to society’s most vulnerable, yet the challenges they face only keep increasing.
“While the sector has demonstrated resilience, its repeated calls for help have been ignored, as the Government continues to prioritise reforming the NHS to achieve goals only a fully functioning adult social care system could deliver. This commission will simply confirm what we already know – how many more reports must we endure before action is taken?”
Sarah Woolnough, chief executive at The King’s Fund, has urged the Government to accelerate the timing of the second phase of the commission.
She said: “The current timetable to report by 2028 is far too long to wait for people who need social care, and their families. The most fundamental issue to reforming social care is addressing the very tight means test which effectively limits state support to those with the lowest assets and highest needs.”
Pointing to well-known problems such as workforce pay and conditions, catastrophic costs, patchy care quality, and a “postcode lottery” of access, she said: “The issues and the potential solutions to this are clear and do not require years to consider.”
Caroline Abrahams, charity director at Age UK, said: “It’s imperative that the current administration breaks the mould and puts the commission’s recommendations fully into practice”.
Abrahams added the fact funding for social care will not be addressed until the second phase of the commission is a “major concern, partly because today’s older people do not have time on their side but also because who knows what the state of the world, our politics or our economy will be by then”.
Successive governments have promised to fix social care but all have failed. It is now almost 15 years since Sir Andrew Dilnot recommended a cap on care costs to meet the challenges of an ageing society, but his reforms were never implemented.
What was The Dilnot Report?
In July 2011, The Dilnot Commission published a series of recommendations on how to deliver a fair, affordable and sustainable funding system for social care in England. These were:
A costs cap of £35,000 – Once someone has reached this limit in their personal contributions the state will pick up all ongoing care costs. People living in a care home will have their ongoing living costs capped at £7,000-£10,000 per year. A more generous means-testing threshold – This should be set at £100,000 for people in a care home, which is a large increase from the current threshold of £23,250. This meant that more people will be eligible for state support towards the cost of care. Those who have assets between £14,250 and £100,000 will pay a contribution towards their care, but costs will be met in part by the state. Reducing the postcode lottery – Dilnot also proposed that there should be a national threshold for care eligibility. This means that there will be one level of eligibility across all councils, which will remove the local variability that exists currently.Health Secretary Wes Streeting said the plans announced today “will help to modernise social care, get it working more closely with the NHS, and help deliver our Plan for Change.”
He said: “But our ageing society, with costs of care set to double in the next 20 years, demands longer term action. The independent commission will work to build a national consensus around a new National Care Service able to meet the needs of older and disabled people into the 21st century.”
Opposition parties have been invited to take part in the commission with the aim of building a cross-party and national consensus.
Liberal Democrat Leader Sir Ed Davey said the commission was “long overdue”.
Meanwhile, more investment has been committed to the Disabled Facilities Grant, which allows people to apply for funding to carry out work such as widening doors, improving access, installing ramps or stairlifts, or building an extension.
The £86m boost for this financial year is on top of the £86m announced at the Budget for the next financial year and brings the annual total to £711m. About 7,800 more elderly and disabled people could benefit, ministers estimate.
Under the Government’s proposals, as revealed by The i Paper on Thursday, care workers will be better supported to take on further duties to deliver health interventions, such as blood pressure checks, meaning people can receive more routine checks and care at home.
Wes Streeting said the plans ‘will help to modernise social care [and] get it working more closely with the NHS’ (Photo: Wiktor Szymanowicz/Future Publishing/Getty)Ministers argue upskilling carers will not only help boost morale and the retention of care workers, but will also lead to improved outcomes for patients.
However, The Homecare Association (THA) said although it makes sense for care workers to develop their skills to offer more support for health and social needs, the government’s proposals “continue to ignore the sector’s challenges”.
CEO Dr Jane Townson said its research shows many councils and NHS bodies are already commissioning homecare services unethically at what it called unsustainable rates – some as low as £17 per hour. That cannot cover even basic staff costs, which average £20 per hour at the current minimum wage of £11.44 with statutory employment on-costs, she said.
Dr Townson said: “Ministers talk about fair pay agreements while refusing to fund even statutory increases in employment costs. Its Autumn Budget 2024 is putting many care services at risk.
“How can providers invest in training and digital systems when they’re being paid less than the cost of minimum wage? How can we integrate with NHS neighbourhood teams when most NHS bodies don’t even talk to social care providers? The government cannot fix social care by piling on more responsibilities while stripping away funding.
“We’ve calculated providers need a minimum price of £32.14 per hour for homecare in 2025-26 to ensure sustainability and compliance with regulations. Yet our latest research shows only 1 per cent of contracts with local authorities and NHS bodies meet even current minimum price requirements. Without adequate funding, these new proposals risk accelerating the collapse of care provision.”
Care workers to carry out NHS health checks under plans to fix social care crisis
Read MoreThe disconnect between the NHS and social care has plagued hospitals with up to one in three beds filled at any one time with patients fit enough to be discharged but who have nowhere to go, due to a lack of community care.
Although vacancies fell for a second year running to 131,000 last year, almost one in four people (24.2 per cent) working in care left their jobs in 2023/24, according to the latest State of the Adult Social Care Sector and Workforce in England.
Adam Brimelow, director of communications at NHS Providers, which represents trusts, said: “NHS trust leaders will hope that today’s announcement finally kickstarts the long overdue process of reform and sets out real action to address the many deep-rooted challenges this vital sector faces, including chronic under-funding and major staffing shortages.
“A strong and sustainable social care sector is vital for the NHS so that both services can deliver high quality care for all those who need it. It is welcome then, that in addition to proposals for long-term reform, today’s announcement also sets out a series of measures which seek to ease immediate pressures on vital health and social care services while also supporting patients, disabled people and elderly people to stay well and independent.”
A digital platform for medical information to be shared between the NHS and care staff will also be created, ministers announced.
Amanda Pritchard, chief executive of NHS England, said “a long-term solution for social care is absolutely critical” to build an NHS “that is fit for the future”.
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