Second Special Report
On 4 August 2022, the Levelling Up, Housing and Communities Committee published its Second Report of Session 2022–23, Long-term funding of adult social care (HC 19). On 20 April 2023 we received the Government’s response to the report with an accompanying letter from the Department of Health and Social Care, both of which are appended below.
Appendix 1: Letter to the Chair from Helen Whately MP, Minister for Social Care, 20, April 2023
Dear Clive,
Thank you for your report on the “Long term funding of adult social care”. I welcome the recommendations made in the committee’s report and thank you and the committee for your time and expertise examining this important topic.
I am delighted to attach the government’s response to your report, in the form of a memorandum. The response sets out the work we are doing to ensure people can access quality care and support.
Please accept my apologies for the delay in responding. We recently published our plan for adult social care system reform, Next Steps to Put People at the Heart of Care on 4 April. This plan sets out how we will build on the progress so far to implement the vision for adult social care set out in the People at the Heart of Care white paper and sets out specific detail on the activity and milestones for how we will spend up to £700 million over the next two years. This includes supporting people to remain independent at home, workforce recognition and career development and other measures. We wanted to provide the committee with a more accurate and detailed response, which we have been able to do following the publication of this document.
As our plan highlights, we have made good progress towards delivering some of the commitments in that white paper. We have invested around £100 million to begin implementing digitisation and technology reforms, local authority oversight, and new robust data collections and surveys.
We have worked closely with colleagues in the Department of Levelling Up, Housing and Communities (DLUHC) to respond to this report. Social care is an important part of local government finance and officials in DLUHC and DHSC work collaboratively on interconnecting policy areas. An example is the Older People’s Housing Taskforce, which will be a new, independently chaired Taskforce jointly hosted by DHSC and DLUHC. The taskforce will work collaboratively with housing, health and social care stakeholders to explore ways to improve housing options for older people – whether that is moving into specialist accommodation or remaining in their own home safely.
We recognise the committee’s concern about current funding for the social care system. I am pleased that we have made a significant amount of additional funding available for adult social care and discharge - up to £7.5 billion over two years. This funding includes the creation of the Market Sustainability and Improvement Fund (MSIF), where £562 million will be available to support the progress made on fee and cost of care exercises, and help local authorities make tangible improvements to care services in 2023–24.
Supporting the social care workforce to develop and progress their careers is at the front and centre of our reforms. Other actions include the new, Care Workforce Pathway to help workers pursue their careers and get the professional recognition they deserve and the funding we are providing for hundreds of thousands of training places. Our measures will be subject to robust monitoring and evaluation to make sure we understand their impacts and to inform subsequent phases of our long-term workforce strategy.
Thank you for your commitment and support for the adult care sector.
Yours sincerely,
Helen Whately
Appendix 2: Government Response
Introduction
The government is grateful to the Levelling Up, Housing and Communities Select Committee for their report on long-term funding of adult social care, published on 4 August 2022. The government has carefully considered the findings and recommendations of the report and this document sets out our response to recommendations. Where appropriate we have grouped recommendations and responded to these collectively.
We extend our sincere apologies to the Committee for the time that has elapsed since its report was published. We paused to allow for a more comprehensive response to the Committee’s recommendations following government policy changes on adult social care. For instance, the Autumn Statement funding settlement on 17 November 2022 set out the funding available for health and social care for the remainder of this Spending Review, and the publication of Next Steps to Put People at the Heart of Care on 4 April 2023 set out the action we are taking over the next two years to reform the adult social care system.
The government remains fully committed to the 10-year vision for adult social care, set out in the People at the Heart of Care white paper, which has person-centred care at its core. This vision was created and shared with people who draw on, work in, or provide care and support, and it revolves around three objectives:
1.People have choice, control, and support to live independent lives.
2.People can access outstanding quality and tailored care and support.
3.People find adult social care fair and accessible.
Our vision will not become a reality without sufficient funding, particularly given the impact of the COVID-19 pandemic on adult social care. That is why we have taken action to ensure adult social care has the funding it needs - at the Autumn Statement in November 2022, having listened to the concerns of local government, we made the difficult decision to delay reforms to the charging system. But none of the £3.6 billion announced for charging reform in 2021 has been diverted away. The savings from this decision are being retained in local authority budgets to help them meet the current pressures in social care. In total, the Autumn Statement made up to £7.5 billion of additional funding available over two years to support adult social care and discharge - with up to £2.8 billion available in 2023–24 and up to £4.7 billion in 2024–25. This is the biggest ever increase in funding for adult social care in England and it will put the system on a stronger financial footing for the long-term, as well as helping to address immediate pressures.
This follows a pattern of sustained government investment that has helped local authorities steadily increase their spending on adult social care, which reached £21.4 billion in 2021–22. This is an average increase of 2.5% per year in real terms between 2014–15 and 2021–22. As the Committee is aware, adult social care is devolved in England and local authorities use money from the nationally distributed Local Government Finance Settlement (LGFS), along with local Council Tax, grants, and business rates to fund social care services. The Department for Levelling Up, Housing & Communities (DLUHC) oversees the overall sustainability of the local government system, which includes funding for adult social care.
Increased funding for local authorities must come with genuine, long-term reform of the adult social care system, which is why we are committing over £2 billion over the next two years to supporting and improving adult social care and discharge in England. Our Next Steps to Put People at the Heart of Care plan sets out our key system reform activities, including how we will invest £700 million of that funding. This includes workforce recognition and career development, supporting people to remain independent at home, joining up services around people, and supporting unpaid carers. We will continue to monitor and evaluate the impact of reforms, to ensure that they are impactful and make a difference to the people who interact with social care. This will include working with people who draw on, work in or provide care to implement reform.
The impact of COVID-19
Conclusion 1 and 2 – extending the Infection Control Fund (ICF)
Response
Throughout the pandemic the government made available over £2.9 billion in specific COVID-19 funding to support the adult social care sector, including £1.81 billion for infection prevention and control (IPC), £523 million for testing and £582.5 million for workforce capacity, recruitment, and retention. From May 2020 until March 2022 the Infection Control and Testing Fund ensured the care sector received financial support to reduce the spread of COVID-19 and protect people drawing on care and support. It was used to pay for a range of additional costs incurred by adult social care providers due to heightened IPC measures, such as paying for staff time taken to undertake tests, testing visitors, offsetting costs arising due to restrictions on staff working across multiple sites and paying for staff time and travel expenses to receive vaccines.
In February 2022, we set out our Living with COVID strategy to relax restrictions where possible, including removing all remaining legal restrictions, while still protecting people most vulnerable to COVID-19. In line with the strategy, most IPC measures in adult social care have now been relaxed. Restrictions on staff movement have ended and the testing burden on staff has been significantly reduced, including no longer having to test visitors. We have also moved away from emergency funding models and have ended the Infection Control and Testing Fund.
We expect all care providers to support good health and safety practice, with staff staying away from the workplace when their presence would be a health risk to those in their care, as they would have done before the pandemic. We are continuing to provide free PPE until March 2024 (or until stock runs out), to continue to support providers to protect against COVID-19. The costs of other remaining IPC measures are now the responsibility of care providers.
Immediate pressures
Conclusion 3 – short term funding
Response
The 2021 Spending Review settlement considered a wide range of pressures facing social care. However, we recognise that since then there has been increased short-term pressure on local authorities’ ability to deliver adult social care, resulting from inflation and other factors. Therefore, at the Autumn Statement 2022 the government listened to the concerns of local authorities and made up to £7.5 billion of additional funding available over two years to support adult social care and discharge - with up to £2.8 billion available in 2023–24 and up to £4.7 billion in 2024–25. Local authorities are expected to use the additional funding to go beyond meeting inflationary, wage and demographic pressures and to deliver tangible improvements in adult social care services, as outlined in the social care resources explanatory note.
This increase in social care funding is part of an overall local government finance settlement (LGFS) which has grown in real terms in the last three spending reviews (2019–2024). Overall, the final LGFS for 2023–24 makes available up to £59.7 billion for local government in England, an increase in Core Spending Power of up to £5.1 billion or 9.4% in cash terms on 2022–23. The funding announced at Spending Review 2021 and the Autumn Statement follows a pattern of sustained government investment that has helped local authorities steadily increase their spending on adult social care, which reached £21.4 billion in 2021–22. This is an average increase of 2.5% per year in real terms between 2014–15 and 2021–22.
The government further recognises the additional pressure that increases in energy bills is having on the sector. The Energy Bill Relief Scheme (EBRS) provided a discount on wholesale gas and electricity prices for all businesses and other non-domestic customers and applied to energy usage from 1 October 2022 to 31 March 2023. Further support will be provided via the Energy Bill Discount Scheme (EBDS), which following a review, has replaced the EBRS from 1 April 2023 until 31 March 2024. Under the new scheme, non-domestic consumers in Great Britain and Northern Ireland, including eligible care homes and other residential care settings, will continue to receive a per-unit discount to their energy bills.
Adult social care funding
Conclusion 4 to 6 – long term funding
Response
The proposed Health and Social Care Levy has been repealed since the publication of the Committee’s report. Instead, the government is making available more funding for adult social care through general taxation and increased Council Tax flexibilities.
As set out in response to Conclusion 3, the Autumn Statement made available up to £7.5 billion of additional funding over two years to support adult social care and discharge - with up to £2.8 billion available in 2023–24 and up to £4.7 billion in 2024–25. This historic funding boost is on top of the funding originally announced at Spending Review 2021 and will put the adult social care system on a stronger financial footing for the long-term, helping local authorities to address waiting lists, low fee rates, and workforce pressures in the sector.
This includes £1 billion of new grant funding in 2023–24 and £1.7 billion in 2024–25 and further flexibility for local authorities on Council Tax. This includes £600 million in 2023–24 and £1 billion in 2024–25 to support discharge from hospital into adult social care, including fast access to domiciliary care and home-based reablement. Reducing delayed discharges frees up hospital capacity and ensures patients can be discharged home or to other appropriate settings, with the right care and support to help their recovery. Addressing this issue requires a coordinated approach across health and social care systems locally. Funding will be split between local authorities and NHS integrated care boards (ICBs) and pooled through the Better Care Fund (BCF) to deliver an integrated plan to reducing delayed discharges and improving collaboration and information sharing across health and social care services.
The government is also taking specific action to improve access to adult social care by expanding capacity in the care sector through increased funding, workforce recruitment assistance and support for volunteers. The new grant funding announced at the Autumn Statement also includes the creation of the Market Sustainability and Improvement Fund (MSIF), where an additional £400 million of ringfenced funding for adult social care will be made available to local authorities in 2023–24, and £683m in 2024–25. This will be combined with £162 million of Fair Cost of Care funding in both years, to total £1.4 billion (£562 million in 2023–24 and £845m in 2024–25). Local authorities will have flexibility to use this funding to drive tangible improvements to adult social care across several areas; to address discharge delays, social care waiting times, low fee rates, workforce pressures, and to promote technological innovation in the sector. We published more detail on the purpose and high-level grant conditions for MSIF in an explanatory note1 alongside the final local government finance settlement (LGFS) on 6 February 2023.
The Delivery Plan for Recovering Urgent and Emergency Services, published in January 2023, set out further detail on how local government, the NHS and the social care sector will work together to improve access to short-term packages of health and social care to support timely hospital discharge. Six new ‘national discharge frontrunners’ have been announced, of which three will focus on intermediate care. NHS England is developing a new planning framework and national standard for rapid discharge into intermediate care, building on the learning from the frontrunner sites.
The Autumn Statement also announced the delay to charging reforms. All savings from this delay, £1.3 billion in 2023–24 and £1.9 billion in 2024–25, are being retained in local authority budgets and paid through the Social Care Grant to help them meet current pressures in social care, which we hope will improve access for care.
Increased funding for local authorities must come with genuine, long-term reform of the adult social care system, which is why we are committing over to £2 billion over the next two years to supporting and improving adult social care and discharge in England. Our Next Steps to Put People at the Heart of Care plan sets out how we plan to spend £700m of funding to support our key system reform activities. This includes workforce recognition and career development, supporting people to remain independent at home, new local authority oversight and data collections, joining up services around people, and supporting unpaid carers.
Conclusion 7 – compensation to private care providers for employer NICs
Response
At the 2021 Spending Review, the government made the decision to fund departments and other public sector employers to cover the increased cost of National Insurance Contributions (NICs), as a result of the Health and Social Care Levy (HSCL).
Whether an organisation received funding for the increased cost of NICs depended on its classification. Employees who were employed by the public sector were included, but not, for example, where services were contracted out. Any other approach would have resulted in differential treatment between private and public sector employers.
The September 2022 announcement repealing the 1.25% increase in NICs from 6 November means that employers are no longer faced with the additional pressure of employer NICs, and their budgets have been adjusted to remove this compensation.
This means we are revising the additional grant funding for councils, announced as part of the 2021 Spending Review by approximately £200 million in each of 2023–24 and 2024–25. There will be no change to budgets in 2022–23, as funding has already been allocated. The 2023–24 Local Government Finance Settlement (LGFS) provides an increase in Core Spending Power for local authorities of around 9%, making available almost £5 billion in additional funding.
Charging reforms
Conclusion 8 and 9 – re-evaluate the impact of charging reforms
Response
As announced in the Autumn Statement 2022, we listened to the concerns of local government and took the difficult decision to delay implementation of the planned reforms to the adult social care charging system (known as ‘charging reform’). Alongside this, the planned extension of Section 18(3) to enable self-funders in residential care to access local authority commissioning has also been delayed.
This delay gives local authorities additional time to prepare for rollout, and none of the £3.6 billion announced for charging reform in 2021 has been diverted away. The savings from this decision are being retained in local authority budgets to help them meet the current pressures in social care. In fact, we are providing even more funding for adult social care on top of the £3.6 billion, with an additional £2.7 billion in new grant funding. This is because we are absolutely committed to ensuring that everyone has access to the right care and support they need, at the right time.
The government published an initial impact assessment in January 2022, which sets out its modelling of the costs and benefits of charging reform. An updated impact assessment will be published in advance of implementation. Additionally, in preparing for implementation in October 2023, the government developed robust monitoring and evaluation plans for the rollout of charging reform to monitor short and long-term impacts on individuals and the care market. These plans will also be reviewed ahead of implementation.
Conclusion 10 – assessor recruitment and training
Response
The government recognises the committee’s concerns around the impact of charging reforms on social care assessors. As set out above, we listened to the concerns of local government and took the difficult decision to delay the planned adult social care charging reforms.
Local authorities made significant progress in preparing for charging reforms – transforming and innovating the way they carry out assessments to meet expected demand. We are grateful to the six charging reform Trailblazers, who provided valuable learning and insights to shape the government’s approach to implementation. We have formally closed the programme of work that was designed to implement charging reform in October 2023. The Local Government Association and Association of Directors of Adult Social Services are currently working on a document to capture key learnings from this programme that we intend to share with other local authorities soon.
We want to use the additional time to continue working with local authorities on these approaches, to improve adult social care services for those who use them now, as well as to ensure the system is more prepared to implement charging reform successfully. To achieve this goal, we 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 training of the adult social care workforce. As part of this, we will also share best practice examples and explore how successful approaches can be scaled up. This activity will enable local authorities to drive efficiencies and improve their responsiveness by decreasing waiting lists, further tailoring care to people who draw on it, and will pave the way for charging reform implementation.
Conclusion 11 – publishing an evaluation of the Trailblazer scheme and charging reform
Response
In light of the new timeline to implement charging reform, we will be reviewing the delivery plan. The six charging reform Trailblazers have already provided valuable learning and insights to shape our approach to implementation. We are currently working in collaboration with Trailblazers and local government partners to conduct a lessons learned exercise, and these insights will be shared with all 152 local authorities in England once completed.
We are 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.
Conclusion 12 – improving transparency
Response
The government welcomes the committee’s interest in proposals to improve fee transparency. We know many local authorities have cultivated strong relationships with providers, working in partnership to deliver good quality care despite the ongoing financial, workforce and broader pressures, in a challenging environment exacerbated by the COVID-19 pandemic and the current economic context.
Evidence has shown that a significant number of local authorities are paying residential and home care providers less than it costs to deliver the care received .2
In December 2022, we launched the Market Sustainability and Fair Cost of Care Fund. This was designed to support local authorities to move towards fees that reflect the actual cost of providing care. The Fund guidance,3 published in March 2022, was designed to ensure there is greater transparency between local authorities and providers in the fee-setting element of local authority commissioning processes and individual contract negotiations.
The guidance provides detail on what is required from local authorities’ cost of care exercises and market sustainability plans. Local authorities were required to identify and publish the median actual operating costs for different service types in their local area by 1 February 2023, to provide greater transparency and ensure there is greater consistency in understanding the local costs and risks to local markets. These reports are now available to view on local authorities’ webpages, and a list of all published URLs is now also available on GOV.UK: Annex G: cost of care reports - GOV.UK (www.gov.uk).
As previously mentioned, we are maintaining current levels of Fair Cost of Care funding for local authorities for the next two years (£162 million per year), given fee uplifts will already have been agreed for year one of the Fund on this basis. However, we have listened to stakeholder concerns that underpayment within the sector is only one issue being faced.
Significantly, the boost to adult social care funding through a ringfenced fund of £400 million in 2023–24, rising to £680 million in 2024–25, will support local authorities to continue to build on the progress councils and providers have made this year on fees and cost of care exercises, while balancing this with wider objectives to support capacity and discharge. Local authorities will have flexibility to use the new funding from the Market Sustainability and Improvement Fund (MSIF) to drive improvements across a range of target areas. These are:
- reducing adult social care waiting times
- increasing adult social care workforce capacity and retention
- increasing fee rates paid to adult social care providers
Finally, as set out in People at the Heart of Care, we have committed to consider changing the Care Quality Commission (CQC) (Registration) Regulations 2009 to require CQC-registered providers to be more transparent about their fees to help people make informed decisions. The Department intends to publish the Post Implementation Review (PIR) of 2009 and 2014 regulations. Further changes to the regulations will be considered in light of the PIR.
Conclusion 13 – focus on outcomes-based commissioning
Response
We agree with the committee’s recommendation for market shaping to include a dedicated focus on outcomes-based commissioning. People at the Heart of Care set out a new ambition for market shaping, emphasising a partnership approach between commissioners of health and social care and people who draw on care and support, in order to deliver what best promotes wellbeing, personalisation, and independence.
To deliver this ambition and ensure that excellent market shaping practice is universal, we are investing funding to strengthen local authority market-shaping, commissioning, and contract management capability. As set out in Next Steps to Put People at the Heart of Care, this programme will include:
- the design and delivery of a new package of support to upskill commissioners with taking strategic, preventative and outcomes-based approaches and making the best use of data
- the development of clear standards for commissioners
- supporting local authorities to access data and market intelligence, as well as providing tools and guidance to improve data analysis
- a central repository to ensure easy access and clearer signposting to guidance and best practice
- establishing strategic oversight for driving improvements in commissioning activity as part of the innovation and improvement unit
The Health and Care Act 2022 also created new duties to enable national government to better understand the issues facing adult social care and target support appropriately. This includes the introduction of a new duty for CQC to independently review and assess the performance of local authorities in delivering their adult social care duties under the Care Act 2014, of which there is a specific duty for local authorities to ensure the promotion of diversity and quality in provision of services. The Secretary of State has also set priorities for local authority assessments so national government can understand better how local authorities are commissioning to support good care outcomes, including for those with complex needs and to support preventative care, and how they are commissioning to support a sustainable local care system.
Local government finance
Conclusion 14 and 15 – sources of funding
Response
The government is committed to addressing the distinct pressures facing social care and that is why we continue to provide significant additional grant funding to councils, alongside the contribution which local authorities deem appropriate. In 2020–21 we introduced a new Social Care Grant then worth £1.4 billion. It was increased to £1.7 billion in 2021–22 and £2.3 billion in 2022–23.
For 2023–24, we recognise the significant inflationary and demand pressures facing social care. In response to this, we are providing around £2 billion in additional grant funding for social care through the Settlement for 2023–24. This includes £1.3 billion made available through the Social Care Grant from delaying adult social care charging reform, £300 million of new discharge funding distributed using the existing Improved Better Care Fund (IBCF) grant shares given that it must be pooled as part of the BCF, and £400 million of ring fenced funding for adult social, which will be combined with the existing £162 million in Fair Cost of Care funding to create the Market Sustainability and Improvement Fund (MSIF).
This increase in grant funding for adult social care, and flexibilities in Council Tax, will support councils to meet pressures. The final Local Government Finance Settlement (LGFS) for 2023–24 makes available up to £59.7 billion for local government in England; this is an increase of £5.1 billion in Core Spending Power. Councils are best placed to make local decisions to meet pressures and ensure social care supports people to be independent and lead enriched lives, and therefore it is for individual local authorities to determine the level of flexibility they use in setting Council Tax. The government expects that councils will keep in mind the pressures on households when setting Council Tax.
We recognise that different places have different abilities to raise local Council Tax income from the ASC precept. In response, we make an adjustment to offset these differences so that areas less able to raise Council Tax income receive a greater share of grant, called equalisation. We have done so since the ASC precept was introduced and will continue to do so in 2023–24.
Conclusion 16 – multi-year funding settlement
Response
We understand the benefits for councils of a Local Government Finance Settlement (LGFS) spanning multiple years. We 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 services.
We released a policy statement in December to provide forward notice of some of the measures which will be included in the Provisional Local Government Finance Settlement 2023–24 and the elements we expect to maintain into 2024–25.
By providing this information ahead of the provisional settlement and setting out expectations for 2024–25 we hoped to support council’s budget setting process by giving councils greater additional, multi-year certainty over their funding levels.
The final LGFS for 2023–24 was published on 6 February. Alongside this, the government published an explanatory note for the social care resources within the Settlement to support local authorities in their budget-setting processes for 2024–25. This note set out additional detail on the Social Care Grant, Discharge Funding through the Better Care Fund, and the Market Sustainability and Improvement Fund.
Conclusion 17 – update the ASC relative needs formula
Response
Local authorities’ differing abilities to generate income from Council Tax is taken into account in the Local Government Finance Settlement (LGFS). We have also equalised against the ASC Precept since its introduction, to level the playing field between local authorities who can raise different amounts from the precept.
We understand the desire for clarity on distribution reform. We confirmed through the 2023–24 LGFS that we will not be proceeding with the Review of Relative Needs and Resources or Business Rates Reset during this Spending Review, and instead have focused on offering stability and clarity, as many in the sector have asked for, following the unprecedented broader challenges since 2020. The Government remains committed to improving the Local Government Finance landscape in the next Parliament.
Conclusion 18 – new burdens assessment
Response
As noted, we have listened to the concerns of local government and taken the difficult decision to delay the planned adult social care charging reforms.
We recognise that our proposed vision for other aspects of social care reform will have an impact on local government. The government will ensure that it complies with the New Burdens Doctrine for all relevant aspects of the adult social care reform programme and will assess and fund any new expectations that fall on the local government sector as a result of the programme, in line with guidance.
The government’s New Burdens Doctrine is clear that anything which issues a new expectation on the sector, irrespective of whether it is legislation, guidance, or a ministerial announcement, should be assessed for new burdens. This includes grant funding that may require additional administration from local authorities. Not all elements of the adult social care reform programme will place burdens on local authorities so a new burdens assessment may not be required for the full package of adult social care reforms.
People at the Heart of Care: the direction of travel for reform
Conclusion 19 – a 10-year plan
Response
The People at the Heart of Care white paper, published in December 2021, set out a 10-year vision for adult social care. The vision has person-centred care at its core and revolves around three principles. First, people should have choice, control and support to live independent lives. Second, people should be able to access outstanding quality and tailored care and support. Third, adult social care should be fair and accessible. This is a shared vision that was shaped by national and local government, care providers, care staff, the NHS, people who draw on care and support, their friends and family, charities and the voluntary sector.
This government remains fully committed to that vision and we have set out plans for the next stage of social care reform and improvement backed by over £2.1 billion over the next two years. On 4 April we published Next Steps to Put People at the Heart of Care, which sets out some of the action we are taking over the next two years to take the next step on our reform journey. Our activity will include improving access to care and support, workforce recognition and development, digital transformation, improving data and accountability, supporting unpaid carers, joining up health and care services, and supporting people to remain independent at home. The plan includes more information on our policies, key milestones for reform and a timetable for the next two years. We will continue to monitor and evaluate the impact of reforms, to ensure that they make a difference to the people who interact with social care.
The Director General of ASC Group, Michelle Dyson, is the Executive Sponsor for the Adult Social Care Reform Portfolio. Each reform programme working within the portfolio has a programme director responsible for delivery objectives.
By 2025 we will have made real change, particularly in how adult social care is planned for and commissioned. This will be backed by increased accountability through better data insights and local authority assessments. The People at the Heart of Care white paper, recognised that our vision is ambitious and will not be realised overnight. The proposals outlined will not solve all of the challenges facing social care, but they are a significant step in moving us towards a new vision for social care that the whole of government is committed to. Spending decisions beyond the next two years will be a decision for government at future spending reviews.
In tandem with our reform activity, we are taking action to ensure that adult social care is adequately funded to meet ongoing pressures as set out above.
Conclusion 20 – distribution of £5.4 billion for social care reform
Response
In December 2021, People at the Heart of Care was published, setting out the government’s 10-year vision for adult social care. These reforms were to be funded by the announced Health and Care Levy, which has since been repealed, but overall funding for health and social care will be maintained at the same level as if the Levy was in place.
Part of the £5.4 billion was to implement charging reform, but as mentioned above we have taken the difficult decision to delay implementation, £1.3 billion in 2023–24 and £1.9 billion 2024–25 in savings from this decision will be distributed via the existing Social Care Grant that supports local authorities to meet the current pressures in social care.
We are also creating a new grant worth £1.4 billion (£562 million in 2023–24 and £845 million in 2024–25) to support market sustainability and improvement. This grant is a combination of new funding confirmed in the Autumn Statement, and £162 million in each year of funding previously earmarked in our reforms for supporting local authorities to move towards paying a fair cost of care.
Our Next Steps to Put People at the Heart of Care plan sets out how we are investing £700 million in reform, and when the public will see the results of our investment. These key system reform commitments include:
- at least £250 million for workforce recognition and career development
- £102 million for supporting people to remain independent at home
- over £100 million for digital transformation in adult social care
- up to £50 million for better insight and join up of care through stronger data and local authority assurance
- at least £35 million for innovation and improvement
- up to an additional £25 million to support unpaid carers
- £15 million to support international recruitment
- at least £3 million to support volunteers and the people who work with them
Of the £1.7 billion the white paper committed to reform, up to £600 million remains to be allocated, which will be invested over the next two years after we have drawn on lessons learned from our investment in improving discharge. This will make sure we are effectively targeting the areas that matter most to people.
Conclusion 21 – working across government
Response
In developing the People at the Heart of Care white paper, we engaged extensively with other government departments, including the Department for Levelling Up, Housing and Communities (DLUHC) and the Department for Work and Pensions (DWP). The whole of government is fully committed to working together to deliver our 10-year vision for people who draw on care and support, unpaid carers, and the adult social care workforce.
Since the white paper publication, DHSC has worked closely with colleagues across government, including DLUHC and DWP, to produce the recently published Next Steps to Put People at the Heart of Care plan. Our work with DLUHC includes preparing for the upcoming establishment of the Office for Local Government (Oflog) which, alongside the new CQC assessments of local authority social care responsibilities, will contribute to local government transparency and accountability. We have also worked with the Department of Business and Trade on the Carer’s Leave Bill, which is currently going through parliament, that will introduce a new leave entitlement as a right from day one, available to all employees who are providing care for a dependant with a long-term care or support need.
Our new Market Sustainability & Improvement Fund (MSIF) is an excellent example of effective joint working between DHSC and DLUHC. DHSC has led on developing the overall design and grant conditions for the Fund, doing so in joint collaboration with DLUHC officials. Once launched, the Fund will be administered, and legal enforcement of those grant conditions be overseen by DLUHC, working in close collaboration with DHSC. This will ensure that the MSIF grant aligns with wider funding streams linked to the local government finance settlement and that we can collectively assess the impact and potential burden on local authorities.
DHSC works closely with DWP to ensure that the ASC charging system aligns with any changes to benefits. We recently announced that the social care allowances (Minimum Income Guarantee and Personal Expenses Allowance) would be uprated for FY 2023–24 in line with CPI inflation (10.1%) and worked extensively with DWP to ensure that this uprating aligned with the rate at which they were uprating benefits.
We also give consideration to how new payments made by DWP should be treated under charging regulations, in terms of whether they should be taken into account when local authorities are calculating what a person should contribute from their income or assets towards their care costs. DWP is currently passing legislation to enact the cost-of-living payments announced in the Autumn Statement, and DHSC has worked closely with the relevant DWP policy officials and lawyers to deliver an appropriate legislative route to disregard the payments for the purposes of charging for social care.
Our 10-year vision is ambitious, and it will not be realised overnight, and we know that the scale of the challenge requires a truly cross-government effort. Beyond the Next Steps to Put People at the Heart of Care plan, we will continue to work alongside our colleagues across government, to explore further areas for joint working and ensure that our reforms deliver on their intended purpose.
Conclusion 22 and 23 – taskforce for housing for working age disabled adults
Response
Achieving the high quality, personalised care and support outlined in People at the Heart of Care, starts in the home where people live. Wherever possible, care and support should be in a person’s own home and personalised in line with their specific needs and the government remains committed to that aim. However, ministers have taken the difficult decision to not progress with the £300 million investment in housing, announced in the white paper, in order to prioritise spending on the reforms we believe are most needed and will have the biggest impact over the next two years.
Since the white paper was published, many local places have made significant progress to join up housing, health and care services. By coming together to develop new partnerships and undertaking work to better understand the needs of their local community, many places have produced robust new plans and long-term strategies. This work will be crucial in helping to shape local markets in those places and improve services for residents. We will continue to work with local government partners to support this valuable work and will look to see it replicated more widely across England.
As the Next Steps to Put People at the Heart of Care plan sets out, the Older People’s Housing Taskforce will be a new, independently chaired taskforce jointly hosted by DHSC and DLUHC. The taskforce will work collaboratively with housing, health and social care stakeholders to explore ways to improve housing options for older people – whether that is moving into specialist accommodation or remaining in their own home safely. Looking across both private and social sector provision, the taskforce will examine barriers to increasing supply, as well as issues faced by older people when it comes to considering their housing options in later life - and identify means to address these issues. The taskforce will have a particular focus on creating the regulatory and market conditions to unlock private investment in new developments. DHSC and DLUHC are currently working together towards a spring 2023 launch, and we expect the taskforce to complete its work in around 12 months. It will deliver recommendations to ministers on options on how we can provide greater choice, quality and security of housing for older people.
To drive work to improve housing options for people with a learning disability and autistic people, the Minister of State for Mental Health and Women’s Health Strategy currently chairs the Building the Right Support Delivery Board. This board brings together representatives from different government departments, including DLUHC, and local systems. Who focus on reducing reliance on mental health inpatient care for people with a learning disability and autistic people by building the right support in the community. The board oversees implementation of the Building the Right Support Action Plan, published in July 2022, which includes commitments from across government and public services, including actions in respect of housing. The government has also committed to consulting on and publishing a new Disability Action Plan during 2023.
Leading improvements to housing requires effective joint working between departments, and these links already exist between DHSC and DLUHC. We will continue to work across government and with external stakeholders, including through the structures described above, to support people of all ages to access the housing options that are right for them.
Conclusion 24 – housing requirements for local authorities
Response
National Planning Policy already makes clear that local authorities must plan for a range of housing needs, including the needs of older and disabled people. In 2018, we revised our National Planning Policy Framework (NPPF) to make clear that local authorities should assess the size, type and tenure of housing needed for different groups in the community and reflect this in their planning policies. In 2019 we published additional Planning Practice Guidance that sets out further detail on how local authorities can best achieve this, including guidance on what range of needs should be addressed and the sorts of evidence that can be taken into account.
In December 2022 we published a consultation on our proposed approach to updating the National Planning Policy Framework, which closed on 2 March. We will publish a government response in due course. As part of this, we proposed strengthening the existing policy by adding a specific expectation that when ensuring that the needs of older people are met, particular regard is given to retirement housing, housing-with-care and care homes. We know these are important typologies of housing that can help support our ageing population.
As more local authorities adopt plans based on the most recent iteration of the NPPF, we anticipate increasing numbers of local authorities will have clear policies for meeting local needs for older and disabled people. We believe that planning policy is the appropriate route for ensuring that these needs are met locally, as it provides authorities with the flexibility to take full account of local circumstances. We do not intend to introduce statutory requirements at this time.
Conclusion 25 – use classes or sub-classes
Response
Different specialist housing types, such as independent living, sheltered housing that provides an element of care, through to care homes, housing for older people, or those with a disability, may fall into either the C2 residential institution or C3 dwelling house use class, or in some cases it may be classed as sui generis (a class of its own).
This provides flexibility to accommodate a wide range of housing and care models for older people and those people with a disability. While there are currently no plans for reform, the new Older People’s Housing Task Force (described above) 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.
Workforce
Conclusion 26 – 10-year strategy for ASC workforce
Response
Our ambition for the social care workforce remains as set out in People at the Heart of Care. We have outlined our plan for delivering the workforce policies set out there in Next Steps to Put People at the Heart of Care.
Alongside the plan set out at a national level, it is local authorities who are ultimately responsible for ensuring there is sufficient capacity to meet care needs in their area. Councils have a key role to play in utilising their oversight of local systems to identify workforce shortages. They can develop local workforce plans that recognise and respond to local challenges, based on their knowledge. Local authorities should work closely with care providers to ensure joined-up workforce planning, including effective system-wide coordination of recruitment and development.
Nationally and in local areas, the adult social care workforce is one of our greatest assets. Yet there are long-standing challenges in recruiting and retaining a workforce of the right size with the right skills. As set out in People at the Heart of Care, our focus is to transform what it is like to have a career in social care, including supporting the workforce to develop the knowledge and skills required to develop and progress, as well as enabling social care employers to recruit and retain staff with the right skills and values. Currently, a significant proportion of the adult social care workforce do not hold a relevant qualification or have access to good quality learning and development opportunities, which contributes to high turnover of staff. Tackling these challenges and improving the perception of social care as a career is our priority. We work in close partnership with adult social care representative bodies and local areas to tackle these challenges together including delivery of the reforms we have set out. Our workforce reforms, which sum to £250 million over the next two years, will provide the workforce with more support to develop and progress within their careers and will improve the quality, safety and personalisation of care.
New national ASC Workforce Competency Framework and additional funding for training
We recently published a call for evidence on the development of a new, national competency framework for the adult social care workforce. This sets out our proposals for how the workforce could be structured. The framework will define and differentiate between roles and the behaviours, knowledge and skills required to undertake them, including recognising specialist skills, and will increase opportunities for progression as people develop expertise. The framework will also articulate the values needed to be part of the adult social care workforce.
Once embedded the framework will improve employers’ ability to recruit and retain individuals who are best suited and committed to a career in adult social care; and enable employers to support their employees’ career progression in their chosen area.
We are committed to co-designing the framework and are working in partnership with Skills for Care who have expertise in skills and development within the adult social care sector. We intend to publish a first version of the framework, focusing on the care worker role, in the autumn.
Alongside the development of the framework, we are providing funding for hundreds of thousands of training places to support development and progression. This funding will give members of the adult social care workforce the opportunity to develop and improve skills to support them to deliver high-quality, personalised care. This training offer will include:
- investment in leadership, dementia, digital and learning disability and autism training
- funding for Continuous Professional Development (CPD) for regulated professionals
- funding for digital skills
- a new Care Certificate Level 2 qualification, which will launch next year. Over time we want this new qualification to become the baseline standard for all new care workers to work towards when they join the profession. The qualification will also address challenges with portability and repeat training in the sector.
Our measures will be subject to robust monitoring and evaluation to ensure the impacts of reform can be measured and understood, and to inform subsequent phases of our long-term workforce strategy.
Conclusion 27 – parity of pay with the NHS
Response
We are incredibly proud of all health and care staff and are grateful for their extraordinary commitment to their work. We welcome the spotlight that the pandemic shone on the heroic efforts of the adult social care workforce, and we hope this can continue to build to ensure that we as a society recognise and value adult social care in a similar way to the NHS.
We are committed to supporting integrated care systems work with local authorities and care providers to improve the integration of health and care services, including enabling and promoting joined-up workforce planning. However, it is important to recognise that the social care sector and its structure is distinct from healthcare. The adult social care sector is primarily a private and independent sector with 17,700 separate employers. Most care workers are employed by private sector providers who set their pay, independent of central government. Private employers are best placed to make decisions on pay and reward, as they understand and respond to local market conditions for workforce supply and demand.
Under the Care Act 2014, local authorities have a duty to manage their local care markets. The Care Act guidance states that they should assure themselves and have evidence that fee levels are appropriate to provide the agreed quality of care, enable providers to effectively support care users, and invest in staff development, innovation, and improvement.
Conclusion 28 – the Shortage Occupation List
Response
In February 2022, we added care workers to the Health and Care Visa and the Shortage Occupation List (SOL), enabling these roles to be recruited from overseas and helping to fill thousands of eligible vacancies. The government has noted the Migration Advisory Committee’s (MAC) recommendation that care workers’ inclusion on the shortage occupation list should not automatically expire after 12 months. In September 2022, we commissioned the MAC to review the SOL and we do not intend to make any changes to the provisions for care workers before receiving the results of this review.
We are pleased that adult social care employers are taking up the opportunity to recruit internationally and benefit from this new recruitment route. We are working with the sector to support employers to navigate international recruitment processes and ensure ethical recruitment and employment practices. Our Next Steps to Put People at the Heart of Care plan confirmed we are investing £15 million to help local areas establish support arrangements for international recruitment in adult social care. This international recruitment fund will promote close collaborative partnerships between local authorities, care alliances and ASC providers, and, where appropriate, with the NHS. The partnerships will create practical forms of support to providers to reduce complexity and cost, help ensure ethical practice and promote positive experiences for international recruits.
The latest data published by the Home Office shows there were 56,900 visa grants for care workers and senior care workers in 2022. We continue to monitor how adult social care employers are using this immigration route, and how we can further support them.
There are minimum salary thresholds to qualify for a Visa under the Skilled Worker route. This is normally £25,600. The Shortage Occupation List provides a reduced minimum salary threshold of £20,480. The thresholds will increase subject to Parliamentary approval on 12 April in line with the latest ONS salary data, to £26,200 and £20,960 respectively. We have no plans to lower the salary threshold.
Our work on international recruitment complements efforts to improve recruitment and retention in the domestic labour market, including through a new domestic recruitment campaign.
Unpaid Carers
Conclusion 29 and 30 – respite care
Response
Our 10-year white paper reform vision puts people at the centre of adult social care and aims to make sure that those who draw on care and support as well as unpaid carers have the choice, control and support they need to live independent lives; can access outstanding quality and tailored care and support; and find adult social care fair and accessible.
We recognise the vital role that unpaid carers play in our communities, and we all owe them a debt of gratitude. The Care Act 2014 requires local authorities to deliver a wide range of sustainable high-quality care and support services, including support for unpaid carers. Local authorities are required to undertake a Carer’s Assessment for any unpaid carer who appears to have a need for support and to meet their eligible needs on request from the carer.
Since 2015, the Better Care Fund (BCF) has enabled local NHS services and local government to jointly invest in a range of preventative services, including supporting unpaid carers. In 2022–23, £291.7 million of BCF funding has been earmarked to provide short breaks and respite services for carers, as well as additional advice and support for carers. The 2023–25 BCF Policy Framework and Planning Requirements will be published in spring 2023, and we will look to improve the clarity and transparency of spend on unpaid carers through BCF reporting requirements and activity data.
As our Next Steps to Put People at the Heart of Care plan confirmed, we will also be investing up to an additional £25 million for unpaid carers, in line with the funding commitment in the white paper. Further detail will be set out in due course. In addition, as outlined in the plan, we are taking steps towards implementing a new survey of unpaid carers which would capture the data and evidence needed to better understand the different circumstances, experiences and needs of unpaid carers in England.
Conclusion 31 – carers assessments
Response
We recognise the importance of providing the right support to unpaid carers. However, the government has no plans to carry out a review into carer’s assessments. As noted above, the Care Act 2014 requires local authorities to deliver a wide range of sustainable high-quality care and support services, including support for unpaid carers. Local authorities are required to undertake a Carers Assessment for any unpaid carer who appears to have a need for support and to meet their eligible needs on request from the carer.
CQC assessment of local authorities’ delivery of their Care Act responsibilities (including, for example, local authority responsibilities related to undertaking an assessment of a carer’s needs for support) will show how effectively local authorities are supporting unpaid carers. Recognising their needs as distinct from those with care needs and ensuring their wellbeing and independence are looked after. As outlined in Next Steps to put People at the Heart of Care, CQC’s duties to assess local authorities will commence from 1 April 2023.
In February 2023, we published Care data matters: a roadmap for better data for adult social care. The draft publication sets out our roadmap to transform the way that social care data is collected, shared and used nationally. The roadmap includes a series of questions to the sector, including unpaid carers, to gather their views on the data they need to commission, deliver and oversee care and support. We have already started to engage on this roadmap and will continue to work with stakeholders, including unpaid carers and people drawing on care and support, to co-develop a greater understanding of the sector’s data needs to ensure that we are collecting, holding and using the right data. We plan to publish a final framework by the end of 2023, taking into account the feedback from our work with partners.
As outlined in Care data matters: a roadmap for better data for adult social care, the department is taking steps towards implementing a new survey of unpaid carers. As part of this, we will undertake a feasibility study to explore how a survey could be representative of all unpaid carers, how it could capture their different circumstances, experiences and needs, and how it would provide an updated and more accurate estimate of the number of unpaid carers in England. The feasibility study will also consider the future role of the existing Survey of Adult Carers in England (SACE).
The new client-level data collection from local authorities will also provide more detailed demographic information on unpaid carers that are known to local authorities, with data beginning collection from April 2023.
Integration
Conclusion 32 and 33 – geographical boundaries, and pooled budgets between NHS bodies and local authorities
Response
Whilst strategic, at-scale planning and commissioning is at integrated care system (ICS) level, the government recognises much of the activity to integrate care should be driven by collaboration between commissioners and providers over smaller geographic areas within integrated care systems (places). Place boundaries should be defined locally between key partners including local government and the NHS. The government will continue to work with place-based partnerships as they develop their collaborative arrangements including governance models. We have seen some good, albeit variable, progress in this area, and we will provide further support and advice to help places develop their approaches where needed.
As far as possible, places should fall within ICS boundaries, but we recognise that in some areas this may be challenging. We have previously committed to reviewing the Cheshire and Merseyside ICS boundaries and the areas of North Yorkshire and Cumbria following the restructuring of local government in these areas. Partners may wish to review place arrangements to ensure that they meet local needs following any decisions related to these ICS boundary reviews.
The government recognises the benefits of pooling resources to support the joint delivery of services. There are many good examples of local areas using mechanisms such as section 75 of the NHS Act 2006 to enable funding to be pooled to support the delivery of shared objectives, including through programmes such as the Better Care Fund. We have committed in the Integration White Paper to undertake a review of the section 75 regulations of the NHS Act 2006 with a view to simplifying them to support further use of pooled budget arrangements. The government has recently engaged with local partners, including from local government and the NHS, to better understand experiences of pooling and aligning budgets. We are also considering how we can best support places further and share good practice in this area.
Conclusion 34 – housing needs within care provision
Response
The government agrees that ensuring there is holistic care that fits around people’s needs includes ensuring that people receive the right care and support, and can maintain healthy independent living, beginning with where they live, and the people they live with. Getting these housing arrangements right for individuals and communities is one example that requires the joining up of not just health and care partners, but a wider set of local government functions and housing providers. We want people to have choice over their housing arrangements, and we also want to ensure places ‘think housing and community’ when they develop local partnerships and plan and deliver health and care services.
We already see an example of this within the devolved Greater Manchester Health and Social Care Partnership where Bury Council brings together the governance of health and social care. This includes pooled budgets, and strategic commissioning across adult social care and health including housing, public health, drug and alcohol services, and children’s social care, allowing for joint workforce planning and commissioning of services to meet needs in a holistic way.
We also recognise that for those who draw on care and support, the right housing arrangements can be critical to supporting independent living outside of residential and institutional settings. We have published guidance on the preparation of integrated care strategies which encourages integrated care partnerships to explore the opportunities by having a joined-up approach to the planning, commissioning and delivery of housing and services related to housing, when setting out how they will meet assessed needs.
Our Integrated Care Strategy guidance published in July 2022 sets out that the development of integrated care strategies should explore the opportunities of having a joined-up approach to the planning, commission and delivery of housing and services related to housing, when setting out how they will meet assessed needs set out in joint strategic needs assessments. Additionally, in November 2022, the government published finalised guidance on how Health and Wellbeing Boards should work with system partners to create a joined up approach across place and system level. This guidance encourages joint strategic needs assessments (JSNAs) to look at wider issues that affect health, such as housing or risk of homelessness, employment, education, crime, community safety, transport or planning.
Conclusion 35 – shared care records
Response
We welcome the committee’s interest in the government’s ambition to have shared care records for all citizens. The Digital Health and Care Plan, published in June 2022, sets out our expectation that by April 2025, health and care professionals will have authorised access to a comprehensive view of a person’s health record, including their medications and key aspects of their health and care history and plans.
In 2021–22 we funded all integrated care systems (ICSs) to acquire a basic shared record system, and these are now being implemented across the country. One of the more advanced implementations, the London Care Record, is accessed more than a million times a month while other programmes in the North East, Yorkshire & the Humber, the North West, Hampshire, Bristol and Dorset and across Thames Valley and Surrey all have mature solutions which are supporting health and care professionals deliver integrated care.
In many cases providers of social care services are already engaged and authorised staff are able to access relevant information about the people they care for from their local Shared Care Record, saving time spent in chasing information from busy GPs and hospitals.
As well as sharing information about the records, as part of the programme we are supporting local systems to develop care planning systems involving local health and social care providers, as well as individuals and their carers. Ready access to such shared care plans is especially important in urgent care situations.
We have recently sponsored work in Suffolk and North East Essex ICS to develop an urgent care plan solution with a high level of patient and carer input. This co-production approach places patients and carers as equal partners in the creation of their urgent care plans, and provides the means for them to enter their personal wishes into the care plan, which can then be accessed by the health and care professionals involved in their care.
We have a set of metrics which we use to measure the progress of integration of the digital care record systems of social care providers into their local ICB shared care record. Recognising the differing speeds at which these local programmes have progressed, we continue work to capture and share knowledge and learning from the early implementors in order to drive uptake and adoption across the rest of the country.
Discharge
Conclusion 36 – discharge to assess funding
Response
The government recognises the positive impact that central funding has had to facilitate the Discharge to Assess approach, particularly in improving patient flow and alleviating pressures during the COVID-19 pandemic.
The government allocated £500 million in 2022–23 to support timely and safe discharge from hospital through investment in social care and reablement services.
In addition, the government provided £200 million of funding to enable integrated care boards to go further in commissioning step-down bed-based capacity and associated clinical and therapeutic support.
Over 2023–24 and 2024–25, the government is providing £1.6 billion which can be spent flexibly by local areas on a range of measures to support timely and effective hospital discharge and free up hospital beds.
Both 2022–23 discharge funding and the further funding committed for 2023–24 and 2024–25 are designed to support more consistent implementation of discharge to assess and ‘home first’ as best practice approaches.