Care Now and for the Future an Inquiry Into Adult Social Care

All Party Parliamentary Local Government Group CARE NOW AND FOR THE FUTURE AN INQUIRY INTO ADULT SOCIAL CARE Supported by Report authors: Laurie Thraves, Policy Manager, LGiU Janet Sillett, Briefing Manager, LGiU Jonathan Carr-West, Director, LGiU Andy Sawford, Chief Executive, LGiU Members of the Inquiry Panel Heather Wheeler MP (Con, South Derbyshire), Chair, All Party Parliamentary Group on Local Government Heidi Alexander MP (Lab, Lewisham East) Dave Anderson MP (Lab, Blaydon) Lord Richard Best (Crossbench Peer) Roberta Blackman-Woods MP (Lab, City of Durham) Oliver Colville MP (Con, Plymouth, Sutton and Devonport) George Hollingbery MP (Con, Meon Valley) Barbara Keeley MP (Lab, Worsley and Eccles South) Anne Marie Morris MP (Con, Newton Abbot) Sarah Newton MP (Con, Truro and Falmouth) Eric Ollerenshaw MP (Con, Lancaster and Fleetwood) Lord Graham Tope (Lib Dem) Contents Executive summary 2 1 Introduction 5 2 How did we get here? The policy context 7 3 What do we know about the problem? 11 4 What can we do now? The changing role 16 of local authorities 5 Where do we go now? A system fit for the future 24 6 Funding the system 37 7 Conclusion 44 Appendix 1: oral witness sessions 45 Appendix 2: written evidence 45 Bibliography 46 Forewords For many of my constituents one of their biggest worries is how they are going to be looked after in their old age. They worry about whether they will need care, whether it will meet their requirements and whether they’ll be able to afford it. We should celebrate the fact that more and more of us are living longer, but it does mean that these sorts of worries about care will become more pressing. Government recognises this problem and following the report of the Dilnot Commission last year we now have cross-party talks on funding, a White Paper on social care and a draft bill on the way. As the All Party Parliamentary Group on Local Government, however, we are very conscious that while this is an important national issue, perhaps the most important of our time, it is at local level that it really affects people and it is local government that plays the most important role in the commissioning and management of care services for older people. We wanted to find out, through our Inquiry, what needed to be done and, specifically, what local government could do, to help build a social care system fit for the future. We received evidence from experts and representatives of over 80 organisations, including councils, care providers and carers groups and we are very grateful to all those who helped us in our deliberations, the results of which are set out in this report. We found, as we expected, that the current system faces significant pressures, especially around funding, but we also concluded that the most important reform for a future system was to completely re-orientate it to focus on preventative services and we have made some suggestions as to the practical steps necessary to achieve this. This will save money and deliver better results for older people. The role of local government is also changing fast and we found evidence that councils around the country were already blazing a trail towards a more integrated, more effective system. The challenge now is to spread this good practice. We hope and believe that this report will be useful for national policy makers, but most of all we hope it will provide practical inspiration to local authorities across the country about the things they can do immediately to help ensure we deliver quality care to our elderly people now and in years to come. Heather Wheeler MP Chair, All Party Parliamentary Group on Local Government Care now and for the future There is much to celebrate about the opportunity to live longer. The idea that many people will routinely become centenarians would have seemed fantastical to past generations. Not only can we hope to enjoy a longer life, but also one that is potentially more full. The ideal of course is that we are able to enjoy good health and be active throughout this long and fulfilled life, which one day ends quickly and peacefully. The reality though is that in our later years most of us will have care needs of one form of another, and at the end of our life those needs are likely to become more critical. This should not be something to fear, but rather an accepted and planned for part of the opportunity to grow old. The government, central and local, has a responsibility to do some of the planning. But where in the past the government was relied upon to provide for people’s care needs, in the future we need more of a partnership with individuals, families, communities and the state. This report considers both the action needed from central and local government, particularly the reform of the health and social care system, and how a new partnership can be shaped for the funding and delivery of care. We are delighted to have the opportunity, as advisers to the Inquiry, to work with a wide range of Parliamentarians and many interested organisations in the public, private and voluntary sector, to think about the future of care. For our part, the LGiU is keen to support those who wish to achieve some consensus on the way forward. The MPs and Peers who formed the Inquiry panel, led by Heather Wheeler, were generous with their time and expertise. More than this though, they were generous in spirit, striving to overcome different views of the past history and present condition of the care system, in order to reach a shared perspective on the way forward. The cross-party support for this report makes it a unique contribution to the debate. There are many local government bodies, LGiU included, that have contributed consistently to reviews, consultations and forums debating the future of social care. What is new about this Inquiry is the quality of interactions between Parliamentarians and those who lead local councils and local service provision. We have looked at the general position of local government, but more than this we have focused on different experiences around the country, of innovation and of the challenges ahead. We are grateful, for example, to those authorities who opened up their books and gave us real insight into the funding of care, and the future prospects. All this evidence shines a light on a crucial factor: the future of social care is, and should be, shaped in part by local circumstances and aspirations. Communities, service users, volunteers, carers, businesses, councillors and local public service providers, all have a role and should all have a say. We hope this report inspires many conversations, and even more action. Andy Sawford Chief Executive Local Government Information Unit Care now and for the future Executive summary Local authorities have the primary alignment in the health and social care responsibility to make sure that the care system. The introduction of new Health and needs of older people are met now and in Wellbeing Boards can be a powerful driver the future. In our Inquiry into the social care of these changes and we have made system we have heard evidence from over recommendations on how this can be 80 organisations including local authorities, supported and strengthened. care providers and user groups. Similarly, we believe that the ‘Community As expected this points to an urgent and Budgets’ approach, already being growing social care funding problem. The championed by the government in respect government is very aware of this and a of family intervention, will be key to bringing funding White Paper is due to be published. health and social care together. We have commented on funding reform in the long term, giving particular On the long-term funding changes, the consideration to the proposals made by the evidence we heard was broadly supportive Dilnot Commission. However, we have of the Dilnot Commission’s proposals. chosen as our focus the changes that we Everyone agrees that we need to get more believe can be made now to improve the money into the system and it is clear that care system and meet current funding the taxpayer cannot afford to foot the bill. challenges. The majority of people already fund their own care and this will continue in the We believe that the key to improving care future. What we must do is to help people now and for the future is the systemic plan for their future care needs and ensure re-orientation of the health and social care that, where people are asked to contribute, system towards prevention. This will take that the system is fair and transparent. out costs both for individuals and the public purse, lessen demand for care and provide Clarity around funding will allow both better outcomes for older people. individuals and public agencies to plan for the future and will allow the development of We have heard evidence of innovative and a competitive market in financial and other successful approaches to care that point products that make use of people’s assets the way for local authorities and the NHS. to enable them to provide for their care The best local partnerships are helping to costs. We also urge local authorities to gear manage the demand for and cost of care up to play an increasingly important role in by: enabling citizens to lead independent referring people towards advice and lives through investment in preventative guidance about the options available to and reabling services; helping people to be them.

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