The Government’s White Paper proposals for the reform of Health and Social Care Contents

4Proposals for Social care

55.The executive summary of the White Paper states that “the Department recognises the significant pressures faced by the social care sector and remains committed to reform,” and that the Government is “committed to bringing forward proposals this year [2021]”.89 However, we note that the Queen’s Speech did not include detailed plans for social care reform and we will be extremely disappointed if these plans are not brought forward by the end of the calendar year. Although there is no detail on the long-term reform of social care, the White Paper does contain a number of specific and targeted social care changes including:

56.A significant number of submissions to our inquiry pointed out that the White Paper did not address the urgent need for a long-term plan for social care. Below is a selection of extracts that focus on the absence of that plan:

57.The absence of a long-term settlement for social care was also a concern for our witnesses from academia and stakeholder organisations. The King’s Fund highlighted to us that the White Paper’s proposals were predominantly reforms to the NHS and that the White Paper did not “commit to the long promised and overdue plans to reform the adult social care system”.99 As a result, it argued that the White Paper did not provide a “clear overall vision” for the three arms of the health and care system, namely the NHS, public health and social care”.100

58.Witnesses also noted that the absence of a funding settlement had the potential to unbalance the work of ICSs. For example, the Health Foundation noted “without additional funding or a comprehensive plan for reform, the fundamental issues in social care remain”; and that further delays meant that the Government was “choosing to prolong one of the biggest public policy failures of our generation”. Similarly, The Nuffield Trust also asserted that the White Paper “does nothing to meet the Government’s explicit promises of meaningful reform”.101 NHS Providers also emphasised the importance of properly funding and reforming the social care system, while the NHS Confederation argued that detail on what that reform would look like was required “as a matter of urgency”.102

59.Commenting on the absence of a long-term plan for social care, Sarah Pickup from the Local Government Association stressed that the long-term plan for health, and the aspirations for health, “can only be delivered if social care and other public services like housing and public health services are developed and funded appropriately in line.”103

60.Sir Simon Stevens said that the NHS supported the need for proper reform of a “well-funded adult social care system” and that it had been making that case for that for “some time”.104 However, he argued that “pragmatically” he wanted to “get on with making the changes that are set out in the White Paper” which he believed provided a “better docking mechanism for a reformed adult social care system”.105 That said, Sir Simon noted the importance of adequate funding for social care and that it was “vitally important that social care can be there as equally resourced partners in that journey as well”.106

61.When we questioned the Secretary of State on the absence of a long-term plan for social care, he said that the White Paper reforms would deliver “better integration with the health service” that would help. However, he acknowledged that there were broader questions around the long-term funding for social care that had yet to be answered.107 He went on to explain that reform and funding would be addressed in a separate White Paper and would be legislated separately from the current proposals.108

62.We also questioned the Secretary of State on the absence of any reference to unpaid carers.109 In a written response, the Secretary of State acknowledged the “essential role” that unpaid carers played in ensuring the health and wellbeing of others and that they were “a highly significant contributor to the wider care system”.110 He said the Committee had raised “a number of important questions” about the role and representation of carers in his Department reforms and as a result he had instructed his officials to “examine these in detail, to consult further with Carers UK and other carers organisations and to see what more we can do”.111

63.Recently, the Chair of our Committee has pressed the Government to commit to a fully funded settlement for social care—in line with the recommendations of our Report, Social care: funding and workforce.112 At the Liaison Committee meeting on 24 March 2021, he pressed the Prime Minister on reform and funding for social care. In response the Prime Minister confirmed that the Government would be bringing forward a 10-year plan “later this year”.113 However, in response to an Oral Question on the same subject from the Chair on Tuesday 13 April, the Secretary of State for Health and Social Care did not provide any further details:

We are working hard, including with stakeholders, and the Minister for Care has held a number of roundtables on the subject. We want this to be an open and broad programme, to ensure that we get the right answers to these long-standing questions.114

64.We were concerned that the White Paper did not set out a long-term plan for social care. The absence of a fully funded plan for social care has the potential to destabilise Integrated Care Systems and undermine their success. However, we note that the Prime Minister has committed the Government to producing a 10-year plan later this year; and we would be extremely disappointed if detailed plans for this were not published before the end of the calendar year. It is vital that this plan is fully costed and funded at the levels set out in our Report, Social care: funding and workforce. Without secure, long-term funding, the problems that have bedevilled the care sector over the last two decades will not be solved.

65.The social care sector needs reassurance that both the structural and financial problems it faces will be tackled by the Government in a timely way. For that reason, we recommend that a duty is included in the Bill for the Secretary of State to publish a 10-year plan with detailed costings within six months of the Bill receiving Royal Assent.

66.Unpaid carers are partners in care and it is deeply concerning that the White Paper does not mention unpaid family carers at all. We welcome the commitment by the Secretary of State to consider what support and representation can be given to unpaid carers, and recommend that the NHS should have a responsibility to have regard to carers and to promote their health and wellbeing. This should be included in the Bill. We further recommend that provisions to protect carers’ rights on discharge also be included in the Bill.

CQC rating of local authority provision

67.One of the specific proposals on social care is the introduction of a new Assurance Framework for social care including a duty on the CQC to assess local authorities’ delivery of adult social care. This proposal received a mixed response from our witnesses. The Nuffield Trust broadly welcomed this proposal but thought that it “misses an opportunity to bolster the CQC’s role in regulating the provider market”.115 Nigel Edwards from the Nuffield Trust was also concerned about the state of the provider sector which he described as “fragmented, and often quite financially precarious”.116 He noted that the CQC already had an oversight role in relation to social care and that was an infrastructure that could be built on. However, he argued that “the White Paper proposals, as they are currently put, would not solve that particular problem”.117 Furthermore, Nigel Edwards believed that without fundamental change in the nature of the funding and the social care system the proposal would result in local authorities “effectively being set up to fail”.118

68.The Local Government Association made clear to us that the proposals in the White Paper, “have not been subject to public consultation or engagement” and called on the Government to commit to:

An inclusive consultation and engagement on any proposals that have not previously been in the public domain. These changes will impact some of the core functions of local government, so it is crucial the sector is fully engaged.119

It also described as “disappointing” that the Government’s immediate priority for social care was to strengthen national oversight of care and support, rather than bring forward its long-awaited wider funding reforms.120 In evidence to us, Sarah Pickup reiterated the LGA’s position, stating that the proposals were for “more assurance of a system that is not funded to deliver its responsibilities as set out in the Care Act.”121 She agreed that assurance and transparency in the adult social care system was important but stressed to us that it was already “locally accountable to democratically elected councillors” and that part of the assurance must not be ignored.122

69.Richard Murray, Chief Executive of the King’s Fund, agreed. He did not believe that intervention was answer to either the “question of social care” or “question of integration”.123 Although he saw merit in either the CQC or local authorities regulating the provider market, he argued that the proposals were an example of “trying to use regulatory levers for something that is not a regulatory issue”.124 In particular, he argued that when the Secretary of State intervened in Trusts it was not as a result of “bad management” but as a result of “being asked to do things they could not do”.125

70.Hugh Alderwick, Head of Policy at the Health Foundation, also asserted that the proposals represented a topdown performance management for a system that was being set up to fail.126 Although he agreed that there was a role for “stronger national support for learning improvement in the sector”, intervention and stronger national oversight would not solve the systemic problems around funding and pay in the system and he believed that the focus of intervention should be on “Government to release the funding to support the system effectively”.127

71.Sir Simon also noted the proposal for the CQC to rate local authority provision but stressed that it was a matter for the Government and fell outside of the recommendations made by the NHS.

72.The involvement of the CQC in Ofsted-style rating of social care provision by local authority area would create parity in accountability with the new ICSs and shine a much-needed light on local variation in the provision of social care. However, for this to be successful the social care system needs to have in place a fully funded 10-year plan to sit alongside the NHS’s own 10-year plan.

73.We recommend that, following consultation with local government on its implementation, the Bill gives the CQC powers to give Ofsted-style ratings for local authority social care.

74.We further recommend that the CQC ratings includes consideration of food standards in social care settings to better align social care and the NHS in relation to the proposals in the White Paper on food and nutrition standards in the NHS.

75.We recommend that the new Bill gives the CQC powers to give Ofsted-style ratings for local authority social care provision but that these are not enacted until the 10 year social care plan is published later this year and there has been full consultation with local government.

89 White Paper, Executive summary

90 White Paper, para 5.96

91 White Paper, para 5.100

92 White Paper, para 5.108

93 White Paper, para 5.113

94 Professor Judith Smith, Professor Jon Glasby and Professor Robin Miller at the University of Birmingham (HSC0868)

95 Allied Health Professions Federation (AHPF) (HSC0774)

96 Carer’s Trust (HSC0028)

97 Local Government Association (HSC0011)

98 The Chartered Society of Physiotherapy (HSC0927)

99 King’s Fund (HSC001)

100 King’s Fund (HSC001)

101 Nuffield Trust (HSC0002)

102 NHS Confederation (HSC0005)

110 Letter from the Secretary of State, dated 7 April 2021

111 Letter from the Secretary of State, dated 7 April 2021

112 Third Report from the Health and Social Care Committee, HC206 of Session 2019–21

113 Oral evidence: Evidence from the Prime Minister, HC 1285, Q37

114 HC Deb, Tuesday 13 April 2021, col 133

115 Local Government Association (HSC0011)

119 Local Government Association (HSC0011)

120 Local Government Association (HSC0011)




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