Written evidence submitted by the Carer’s trust (HSC0028)
Carers Trust welcome the Committee’s inquiry into the Department of Health and Social Care’s White Paper on Health and Care. Our response will focus on the extent to which we believe the proposals will deliver integrated health and care services and what needs to accompany the proposed reforms to enable them to full their potential. Our response then sets out Carers Trust’s views on the extent to which the White Paper delivers needed social care reforms.
The extent to which the proposals will deliver integrated health and care services throughout England
Carers Trust welcome the White Paper’s proposals to move away from a focus on competition to promoting a model of collaboration, partnership working and integration.
We know that health and care work better when NHS services, local authorities and the Voluntary, Community and Social Enterprise (VCSE) sector work together – including specialist VCSE organisations such as Carers Trust Network Partners.
For the proposals to work to their potential three factors are vital: funding, local cooperation and VCSE involvement at the highest levels.
As we have seen in previous reforms such as the Care Act, funding is central to ensuring local areas can full fill their legal duties. The Care Act had the potential to transform the lives of unpaid carers ensuring that they were identified and had the support they needed. However, we know from Carers Trust’s research, intelligence from Carers Trust’s network of local carer support organisations, as well as ADASS’ annual Budget Surveys that the Care Act has not fulfilled its potential due to cuts in social care spending which local areas have had to make because of central government funding decisions.
The latest ADASS survey revealed that planned savings for 2020/21 were £608m, equating to 3.9% of net adult social care budgets for 2020/21 and, cumulatively savings since 2010 will amount to £8.3bn.
Whilst exacerbated by the Coronavirus crisis, for several years local areas have not been confident that they can meet their legal duties. This year:
These reforms to health and care must go hand-in-hand with wider social care reforms which lead to significant, permanent, and sustainable funding.
Local cooperation and VCSE involvement
As the White Paper itself acknowledges, there will need to be a balance between legislation and a reliance on the working culture of health and care systems. The culture of local health and care systems are paramount in ensuring these reforms achieve their aims, however, this does also need to be balanced with legislation that sets out expectations of local areas.
We know that there are areas that have embraced the changes brought about by the introduction of Integrated Care Systems – such as the West Yorkshire and Harrogate Health and Care Partnership which have shown great leadership in integrating health and care services. This success is, in part, due to the involvement of the local VCSE sector.
There are also areas across the country where these non-statutory reforms have not led to the changes they intended.
To ensure the VCSE are truly involved at all levels of the Integrated Care System (shaping both local strategies, as well as being involved in the delivery of health and care), the current proposals may need to be strengthened. At the moment, it will be up to local areas to decide who sits on statutory ICS Health and Care Partnerships. Whilst Carers Trust understand the need for flexibility for local areas, there may be a need to give local areas a legislative steer to ensure VCSE organisations are involved. This will result in strong Health and Care Partnerships as the VCSE will bring their expertise as well as being a possible connector to the local populations that these boards will serve.
The White Paper does not deliver the necessary social care reforms.
Better integration between health and social care is one steps towards the reforms needed but social care needs more fundamental reform.
Unpaid carers may see benefits of integration between health and care but as set out above, that needs funding and local cooperation. These reforms are welcome but do not go far enough in addressing the need to reform social care.
Adult social care is in crisis and a solution is needed. Local authorities are unable to provide the services that people need and consequently, unpaid carers and people with care needs are going without the care and support they require.
We know that there was a high level of unmet needs across social care before the Coronavirus – a situation in which the crisis was exacerbated. There needs to be an immediate injection of investment to resolve some of the short-term challenges that social care faces – as well as a commitment to resolve the longer-term funding crisis.
Reports from ADASS, The Kings Fund, the Nuffield Trust, the LGA, IPPR, Centre for Policy Studies, amongst others have all highlighted the crisis in social care funding. The reforms set out in the White Paper do not overcome the delivery or funding challenges set out in these reports.
Whilst these reforms should improve the coordination needed for health and care services – and that is welcome, they do not address the fundamental issues of the availability of good quality social care, unpaid carers not being identified and supported, poor practice in commissioning for carer support, the fragility of care providers, or workforce shortages.
The government needs to ensure that the social care system is sufficiently and securely funded. Social care must work for older people, working aged people with support needs and the 5.5 million unpaid carers across England.
The NAO found that unpaid carers provide the majority of care and support to millions of people with care and support needs, who could not manage without them. Bearing in mind demographic changes, unpaid carers’ contribution and centrality to health and social care will only grow in the coming years.
Over 2,000 unpaid carers responded to a Carers Trust survey. Our report based on that survey, ‘A Few Hours To Call My Own’, found:
The Coronavirus crisis has had a massive impact on young carers and young adult carers. Carers Trust’s My Future, My Feelings, My Family report found:
The Coronavirus crisis has shone a light on the urgent need to reform social care and ensure it works for unpaid carers of all ages, and people with care and support needs of all ages.
The proposals within the White Paper are a small step towards the necessary reform, but social care now needs fundamental and far-reaching changes. The time has come for the government to resolve the funding crisis in the shorter term – with a significant injection of investment which plugs the financial shortfall local authorities face; and for the government to work with all stakeholders to develop sustainable funding plans for the long-term reform of social care.
For more information, please contact Carers Trust’s Policy Team – Ramzi Suleiman (Policy and External Affairs Officer) Laura Bennett (Head of Policy and External Affairs)
 ADASS Budget Survey 2020 https://www.adass.org.uk/adass-budget-survey-2020