The White Paper and Adult Social Care: Care England’s Initial Response

This week, Care England submitted its response to the Health and Social Care Committee’s inquiry into the Health and Care White Paper. Similarly, we, too, wrote to Matt Hancock regarding its development.

At this point, our submission and letter were primarily comprised of questions rather than answers. For, the White Paper’s future impact on the adult social care sector will be dependent on the detail which informs its practical implementation. In addition, we highlighted that the major deficit of the White Paper is that it fails to consider the financial sustainability of adult social care.

At present, it lacks the requisite detail to make a full assessment of its implications. Take its proposal for a “new duty for the Care Quality Commission (CQC) to assess local authorities’ (LAs) delivery of their adult social care duties.” Care England, due to its experience with poor commissioning practice over the years, very much welcomes anything which places light upon LA commissioners. However, the impact of such a duty will be contingent upon the mechanisms surrounding it. For example, will the CQC be given the regulatory teeth to affect LA commissioning?  Care England is well accustomed to the intransigence of some LAs when it comes to reforming their commissioning practices. Secondly, will the CQC be given the requisite resources to allow it to implement such a system?

Whilst it sets the trajectory, including its focus on integration, this path will ultimately be impacted by the detail. Broad statements from government regarding the need to integrate health and care are ones, which ultimately, we have seen before. We are, as a sector, therefore, rightly sceptical of any proposals which lack detail. Therefore, our submission to the Health and Social Care Committee sought clarity regarding whether adult social care will be directly represented through ICS boards. For example, will this representation only come in the form of LA social care representatives? In our view, LAs cannot represent adult social care independent providers.

The White Paper also focuses on the development of data in the adult social care sector. However, again, there is a lack of clarity in terms of how this may manifest itself. It states its ambition to “improved data collection allowing us to better understand capacity and risk in the social care system.” We believe that any future data collation system needs to be established in collaboration with the sector. To ensure that it places reasonable expectations on the sector and gives care providers tangible benefit, thus, encouraging them to be active partners in refining the data collection system. For, if anything, the Covid-19 pandemic has illustrated the pitfalls associated with centrally imposed data diktats upon the sector and how they serve to impose bureaucracy upon it.

As already stated, we feel that this omission of any detail in relation to the sustainable funding of adult social care in the future is the paper’s major deficit. Sufficient funding is fundamental in creating a system that supports the reforms posited in the White Paper. Rather than merely focusing upon survival, a reality that does not allow providers and commissioners alike to focus on reform and system change. Today’s NAO report is indicative that this omission is not a result of lack of awareness when it states: “The Department acknowledges that most local authorities pay care providers below a sustainable rate but does not use this analysis to challenge local authorities directly.”

Going forward, Care England will continue to scrutinise the development of the White Paper on behalf of the adult social care sector. The Covid-19 pandemic has illustrated, perhaps more than ever before, the need for the adult social care sector’s voice to be heard.  

As ever, we look forward to your feedback and working on behalf of all our members.
Rwilliams@careengland.org.uk