A plan for setting out the implementation of a national care service and wider reforms to the adult social care sector in England is underway, as part of a newly launched government commission.
The government has today published the full terms of reference for Baroness Louise Casey’s independent commission of the adult social care sector – setting out two key phases that will be completed by 2028.
The commission was officially launched this week on 29 April, and it is understood that Baroness Casey has already met with people with lived experienced of the care sector during a meeting.
The commission, which will report directly to the Prime Minister, aims to start ‘a national conversation about what adult social care should deliver for citizens and build consensus with the public on how best to meet the current and future needs of the population’, the government has said.
This work was first announced in January, but at the time nursing and sector leaders warned the plan was too slow for ‘overworked and underpaid’ nursing staff.
Phase 1:
The first phase of the commission will focus on how the government can ‘make the most of existing resources to improve people’s lives over the medium term’.
As part of this it will set out the plan for how to implement a national care service – which was a government manifesto commitment. The government said this plan should be completed in 2026.
Labour’s 2024 manifesto previously described how its national care service would work through the principle of ‘home first’ care which ‘supports people to live independently as long as possible’.
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This first phase of the commission will also examine what changes are needed to improve ‘funding flows’ in social care and to improve quality and productivity in the sector.
‘The commission’s work on medium-term reform will be a data-driven deep-dive into the current system,’ the government said.
‘It will focus specifically on existing funding for local authority adult social care services, together with NHS funding for services at the interface of health and care (for example, intermediate care), and whether they are being best used.’
This phase can also be expected to recommend reforms on how the government can meet its 18-week standard for elective care and to deliver a neighbourhood health service – ‘by reducing unnecessary hospital admissions and addressing delayed discharges’.
Phase 2:
The second phase of the commission will focus on the longer-term recommendations for the transformation of adult social care in England, with a deadline of 2028.
It will build upon the recommendations from the first phase and look at the care model needed to ‘address demographic change’ and discuss alternative models for the future.
Baroness Casey will lead the work independently of the Department of Health and Social Care (DHSC) and will work closely with other government departments, including the Treasury and ministry of housing.
Professor Vic Rayner, chair of the care provider alliance (CPA), said the group welcomes the launch of the commission which ‘cannot come soon enough’.
She added that it was ‘imperative’ that the commission engages with the care workforce, people using care, care providers and commissioners when working on its recommendations.
And she stressed there were ‘huge opportunities’ for the social care sector to support the government’s ambitions for the three shifts from hospital to community, illness to prevention, and analogue to digital.
‘We are keen to bring the many examples of excellent care, good practice and innovation in the sector to Baroness Casey’s attention,’ said Professor Rayner.
Care minister Stephen Kinnock said: ‘Baroness Casey’s independent commission is a once in a generation opportunity to transcend party politics and build consensus on the future of adult social care.
‘As we build an NHS fit for the future through our Plan for Change, we are shifting more care into the community – and we cannot succeed in this mission without transforming social care.
‘This government is grasping the nettle on social care reform, and I am delighted that Baroness Casey – one of our country’s leading public service reformers – is taking forward this work.’
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Previously, Royal College of Nursing (RCN) general secretary and chief executive, Professor Nicola Ranger, warned that quicker change was needed to help ease the growing crisis in adult social care.
‘Vulnerable people needing care cannot wait until 2028 for change and neither can the over-worked, underpaid nursing staff who care for them,’ she said in January.
Casey Commission frames of reference in full:
Phase 1 (medium term)
The purpose of the first phase of the commission is to set out the plan for how to implement a national care service, a government manifesto commitment. This should report in 2026.
The commission should start a national conversation about what adult social care should deliver for citizens and build consensus with the public on how best to meet the current and future needs of the population. It will consider older people’s care and support for working age disabled adults separately, recognising that these services meet different needs.
The commission should produce tangible, pragmatic recommendations that can be implemented in a phased way over a decade. It will aim to make adult social care more productive, preventative and to give people who draw on care, and their families and carers, more power in the system.
The commission should seek to understand the current adult social care landscape and identify a commonly agreed picture of the problems faced, before making recommendations for medium-term improvements, building on work being undertaken by the Department of Health and Social Care (DHSC). The focus will be to support the delivery of the health mission, in the context of ongoing reforms relating to the NHS, local government and the Employment Rights Bill and Fair Pay Agreement for care workers, and deliver tangible improvements for the public with regards to adult social care.
The commission’s work on medium-term reform will be a data-driven deep-dive into the current system. It will focus specifically on existing funding for local authority adult social care services, together with NHS funding for services at the interface of health and care (for example, intermediate care), and whether they are being best used. It will seek to identify what changes can be made to funding flows and accountability mechanisms to improve quality and productivity. It will recommend reforms that help government to hit the 18-week standard for elective care and deliver a neighbourhood health service – by reducing unnecessary hospital admissions and addressing delayed discharges. The commission’s recommendations must remain affordable, operating within the fiscal constraints of Spending Review settlements for the remainder of this Parliament.
Phase 2 (long term)
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The second phase should then make longer-term recommendations for the transformation of adult social care, reporting back by 2028. This should build on the commission’s medium-term recommendations to look at the model of care needed to address demographic change, how services must be organised to deliver this and discuss alternative models that could be considered in future to deliver a fair and affordable adult care system.
Baroness Casey will lead work fully independently with DHSC as the lead sponsor department and be based in the Cabinet Office.
The commission must also work closely with relevant other government departments, including HM Treasury, the Ministry of Housing, Communities and Local Government and the Department for Work and Pensions to discuss findings. All relevant government departments will co-operate fully, be transparent and provide all data and analysis needed to support the commission.
