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Published 20 diciembre 2021
What does the government’s long-awaited White Paper on adult social care reform mean for providers in the sector?
The very fact that we now have a White Paper is a big step forward. Billed as a 10 year vision, setting out the government’s long-term aspirations for how people experience care and support, the White Paper also sets out proposals for how the money raised from the new Health and Social Care Levy might be spent to meet the challenges faced by the sector.
For providers of adult social care, however, many questions remain about how the proposals will translate into tangible change for the sector. In this briefing, we look at some of the key takeaways from the White Paper and share some initial thoughts about the impact for providers and what you may want to be thinking about at this stage.
Delivery of care
Central to the reform proposals in the White Paper is the idea of people having choice and control in relation to their care arrangements and, crucially, people remaining as independent as possible for as long as possible.
Although the current legal framework as set out in the Care Act 2014 includes an emphasis on choice and independence, the White Paper acknowledges that the full spirit of the legislation is not always being met. Whilst there are no proposals to change the Care Act itself, the hope is that the reforms to be introduced by the Health and Care Bill 2021 will provide scope for developing more collaborative approaches to care provision which will help deliver the government’s vision of high quality, personalised care across the board.
As part of the shift towards more home-based care, the White Paper earmarks specific funding to support the integration of housing into health and care strategies, to boost the availability of specialist housing and to increase the range of new supported housing options.
The buzzword to drive all this forward is innovation, with the government wanting to build on existing examples of innovative approaches to providing care and support with a view to them being rolled out and adopted at scale. As part of this, the White Paper proposes an Innovative Models of Care Programme (again, with specific funding earmarked), which would provide a vehicle for local areas to trial and embed ambitious new services, focusing on people living in non-residential settings.
Giving people the information they need to make informed choices is also seen as being important to delivering this vision. With this in mind, the government plans to set up a new national website to help people navigate the care system and to understand the options available to them.
The White Paper recognises the care and support workforce as our greatest asset. Reflecting this, the government plans to invest in the skills, training and wellbeing of those working in the sector, with the aim of making them feel recognised and valued for their skills and commitment, with more opportunities for progression than currently. This, it is hoped, should make social care a more attractive and rewarding career option and help address the current high levels of staff turnover in the sector.
There are numerous strands to the workforce strategy proposed in the White Paper, including the introduction of a national knowledge and skills framework which would become a recognised benchmark for all social care roles and would set out clear career pathways within the sector. This would be accompanied by a funded learning and development offer, creating opportunities for the workforce to become experts in their field or progress into new roles. There are also plans to invest in a portable Care Certificate, including exploring options for external validation and accreditation.
Also being proposed is a new digital hub enabling the workforce to access support, information and advice, as well as providing a portable record of their learning and development, skills and achievements via ‘skills passports’.
Another key component of the government’s vision for the future of adult social care is to drive forward the adoption of technology and digitisation across the sector.
Central to this will be unlocking the potential of ‘caretech’ innovation that can support preventative care and independent living - for example, smart devices to help with routine tasks such as medication reminders and sensor technologies to monitor movement and reduce falls risks. To support this, the government plans to publish a social care technology blueprint and advice on ‘what good looks like’ for social care technology to help everyone understand what we should be aiming for, plus a new scheme to test ideas and scale up those where there is proven benefit. As the White Paper says, this undoubtedly presents a significant opportunity for UK-based innovators to develop the next generation of care technologies.
Alongside this, the government wants to see social care records becoming fully digitalised, so that those providing care have at their fingertips all the information they need. There are also plans to establish a social care data framework, to improve the quality and availability of information about the provision of care nationally, regionally and locally.
Funding, investment and regulation
What about the fundamental problem of under-funding across the sector?
The White Paper recognises that high quality, personalised care and support can only be achieved where there is a vibrant, sustainable market of care providers and that, currently, low fee rates and uncertainty over future funding stifles provider investment, all leading to fragility in the market. The government’s vision is for there to be a sustainable, fairer care market, where self-funders do not have to pay more for care than local authorities and local authorities start paying a fairer cost to providers, to be made possible by reforms to the adult social care charging system and funding raised via the Health and Care Levy.
Also to support a thriving adult social care market, the White Paper proposes help for local authorities in meeting their responsibilities for ensuring their local care market remains healthy and diverse, via investment to improve market-shaping, commissioning and contracts management capability in local authorities. Alongside this will be the new duty on the CQC (created under the Health and Care Bill) to review and assess how local authorities are delivering their adult social care duties under the Care Act, although the White Paper says CQC assessment of local authorities will not launch until April 2023 at the earliest. The White Paper is not, however, suggesting changes to the regulation of adult social care providers more generally.
Looking ahead, and based on the adult social care landscape envisaged in the White Paper, it would seem that the providers most likely to attract investment and growth going forward will be those adept at thinking ‘out of the box’ in terms of innovative, flexible care solutions that optimise people’s choice and independence, whilst also embracing technology and collaborating closely with other health and care providers to help meet the needs of their local populations.
The aspirations set out in the White Paper are bold and it is certainly progress to see that reform and development of the adult social care sector is now high on the political agenda. That said, whilst there are many different funding commitments contained within the White Paper, there is relatively little in the way of definite timescales and nothing that would significantly change the legal or regulatory framework within which adult social care providers operate. The proposals are framed as a ten year plan which does of course create questions around continuity in the event that political leadership changes or other significant challenges arise which take up time and financial resources.
The overall themes running through the White Paper focus on developing a more flexible, person centred approach to provision of adult social care which maximises use of technology to allow greater freedom and independence, all of which is positive and likely to be well received by both providers of social care services and those of us who use them, or may need to rely on them in future. However, the challenges facing the sector are complex and significant and it is not yet clear how the aspirations of this White Paper will be made a reality.
Although we should see more detail emerging over the coming months about the implementation of some of these proposals, this is likely to be a ‘slow burn’ and probably not yet the magic wand many feel the adult social care sector currently needs. However, it does offer providers reassurance that the sector remains a priority for the government and highlights the direction of future spending and investment, which in turn gives providers an opportunity to develop their own organisations in a way which will allow them to make the most of the additional funding and innovation being promised.
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