Social care Insights
From Simon Bottery

Simon Bottery outlines the four key documents driving Government policy on adult social care and, with Netflix-style ratings, sorts the ‘Visionary’ from the ‘Scary’.

Were it not for the trauma of a global pandemic and, now, a European land war, the last 12 months might have been remembered for the sheer volume of white papers and policy documents affecting adult social care. There have been four main ones and, combined, they will bring in major changes to the sector. But how to keep track of them all?

One way is to borrow a trick from Netflix, which has taken to providing you with a handful of adjectives to describe its shows. Bridgerton, for example, is ‘Witty’, ‘Emotional’ and ‘Romantic’. Star Trek is ‘Suspenseful’ and ‘Exciting’. Texas Chainsaw Massacre? ‘Ominous’ and ‘Scary’. You get the picture. So, what adjectives should we apply, Netflix-style, to the four?

The first of them, ‘Integration and Innovation: Working together to improve health and social care’, was published in February 2021 and set out plans for joining up health and care systems through the formal establishment of Integrated Care Systems. There were also a couple of social care specific measures, added because of the Government’s experience in the first stages of COVID-19: a power for the CQC to oversee care commissioning by local authorities and plans to greatly improve data collection in adult social care. In Netflix terms, I’d describe it as ‘Important’ (because it’s laying out the landscape for the NHS and social care in the future); ‘Centralising’ (because it’s bringing back a degree of central oversight of local authority functions); maybe even ‘Visionary’ for that stuff about data.

The second, ‘Build Back Better’, set out plans for the Government’s funding reforms. These make the means test more generous and introduce an £86k cap on a person’s lifetime care costs. This all sounded fairly promising at the time but the Government has since rowed back on the cap, changing the small print so that people with limited assets will gain very little from it. In Netflix terms, then, our adjectives would be ‘Promising’ and ‘Disappointing’, in that order.

‘People at the Heart of Care’ was the full adult social care white paper after the ‘Build Back Better’ trailer. It gave us more details on the cap and floor reforms and, in a subsequent impact assessment, details about ambitious plans to introduce a ‘fair cost for care’, whereby self-funders would pay the same amount for their care as local authority-funded clients. This latter measure has gotten a lot of worried attention from providers and local authorities, with more detail on how it will work coming soon. However, there were few other major measures to address problems like unmet need or the social care workforce. So, you might say ‘Eye-catching’ and even ‘Scary’ for that fair cost measure and ‘Underwhelming’ for much
of the rest.

Finally, the ‘Integration’ white paper, which emerged in February 2022. This one mainly clarified and built on the previous one. It said sensible things about integration, talked about shared health and care outcomes at ‘place’ level (typically a local authority area) and outlined some progressive social care ambitions – such as digitising records. The Local Government Association welcomed it. In Netflix terms, we’d go with ‘Sensible’ and ‘Evolutionary’.

Together, these four set the policy framework for health and social care for the foreseeable future. You won’t see a movie about them on Netflix any time soon but they are worth getting to grips with if you want to understand what will shape the social care sector in the coming months.

Simon Bottery is a Senior Fellow in Social Care at The King’s Fund. Email: Twitter: @blimeysimon


About Simon Bottery

Before joining The King’s Fund in 2017, Simon spent almost 10 years as Director of Policy at the older people’s charity Independent Age. He has wide experience in policy, communications and journalism, including as Director of Communications at Citizens Advice, in the commercial sector for Guinness and in BBC local radio.

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