Baroness Casey made her first speech on social care since chairing the Independent Commission on Adult Social Care, at today’s Nuffield Trust Summit. She set out the work of her team so far in gathering evidence, looking at past reviews and visiting services, communities and people accessing social care support.
Our response can be found here.
The speech covered a great deal - from the need for GPs and the NHS to play their part, a nod to challenges around funding, and a focus on the impact of an ageing population. However it did not cover everything, and more detail will follow in the phase one report due later this year.
Points we have raised around commissioning and funding, transitions, housing and the needs of working age disabled people were not covered in any detail, but there was clear recognition that nothing short of whole system change will succeed.
Along with the phase one report, there will also be a public conversation on social care - to inform the public about social care, dispel myths and also co-design solutions and gain a mandate for change.
We continue to engage with the Commission and support members to host visits, to ensure people's lived experience is shared directly with the commisison team.
Summary of Baroness Casey Speech
There was reference made to Beveridge’s plan in 1948 and the five giants of post-war Britain: education, full employment, housing, the NHS ‘for disease’ and social insurance. Social Care was not mentioned or needed. People were not living as long and where support was required, families or the NHS could cover this.
Clearly with progress (and there was acknowledgement of significant progress around life expectancy and rights) that is no longer the case and social care has become the ‘sixth giant’.
‘We haven’t had our Beveridge moment’.
There’s clearly lots of work still to be done by the team including more visits, data and research into international comparators and evidence of hidden costs. There’s also a big argument to be won with the Treasury.
While there have been 22 major reviews of social care since 1997, they have failed to fix the system, often looking at issues rather than the whole. Although really, ‘the system’ does not exist. There’s been lots of add-ons and plasters but the vision for social care is lacking. Important steps forward have been taken - community care reforms were powerful, greater personalisation, carers rights and the Care Act. BUT it is a symptom of ‘poor and irresponsible governments’ to give new rights without taking responsibility to fund and enable them to be fulfilled.
The Care Act is welcome, but the commission have heard too many examples of councils and others not being able to meet responsibilities as money and systems are not there. Councils have been hallowed out and forced to gatekeep and do the bare minimum.
Social care has never had a ‘creation moment’ looking at what it’s for, what people can expect and who / how people should pay for it. The system was inherited from a different age and people are living with it.
‘We need a social care reckoning.’
Baroness Casey spoke about when done well, social care is not about services and systems, it is often not glamorous - it's about independence and compassion, people keeping quiet dignity. But this ‘quietness masks problem’. No-one owns the problem or opportunity, but everyone owns it – regulation is split, funding sits in one department, policy in another. Separation between the NHS and ‘social care’ compounds the problem and ICBs have failed to integrate workforces for the benefit of people but rather work for the system and the public are having to navigate.
‘When responsibility is shared it can end up being no-one's responsibility and no-one’s accountable.’
Other areas Baroness Casey specifically referred to included:
- Adult Safeguarding is lacking with no national board, but localised solutions meaning learning is not shared and lessons are not learned.
- Fragility of the workforce and reliance on underpaying care workers, high use of zero-hour contracts, not paying for transport time or guaranteeing hours. Workforce reform is welcome and doesn’t need to wait for the commission to start.
- Fragility of providers and commissioning - small providers barely keeping the show on the road, finding work arounds to make money work or staff facing the brunt. Money from councils barely enough for staff and definitely not adequately covering overheads. There’s also councils feeling held to ransom by private equity backed providers seeking to extract maximum profit. Boom and Bust cannot continue.
- Separation and 'deep and fundamental divide between health and social care' needs addressing. GP’s have a critical role. ‘The NHS has become the National Hospital Service’ – not everything is about beds. The power dynamic needs rebalancing with the NHS often holding all the power on decisions. CHC huge issue and continues to be a priority for the commission.
- Ageing, dementia and frailty must be prioritised through modern service frameworks, a new tzar for dementia, funding for research and improved treatment for older people – Baroness Casey shared her feeling that older people are being ignored because they are not economically active.
- The experience of people with MND was also mentioned and the experience they have waiting for home adaptations and support which doesn’t move quickly enough given the evidence we have on life expectancy following diagnosis.
The commission has already recommended three actions to the Health and Social Care Secretary, with a phase 1 report to follow and s public conversation.
Three asks:
- Set up a new national safeguarding board, on a statutory footing as it is for children.
- Immediate scaling up of finding on dementia trials, a Dementia Tzar and faster progress on modern service framework on frailty and dementia.
- A fast-track passport for people with MND to get the support needed quicker.
Finally, there will be a public conversation on social care:
- The public are not exerting pressure for things to be done better. They assume health and social care will operate as one ‘until you have the misfortune to need it’.
- We need an honest conversation with the public directly to know what they want the national care service to look like.
- Baroness Casey was clear there needs to be a mandate from people who pay for health and social care through tax and NI.
- The conversation will consider who can draw from system, where do lines lay, what role should people and families play and how it will be funded.
Responses
VODG's response to Baroness Casey's speech can be found here.
The Health and Social Care Secretary, Wes Streeting, has formally responsed to Baroness Casey's speech here and confirmed action on the three requests already made around safeguarding, MND and dementia.
The ADASS response is here.
More to follow.