Independent Commission on Adult Social Care

Question

14:53:00

Asked by

To ask His Majesty’s Government what progress has been made by the Independent Commission into Adult Social Care.

The independent commission has begun its work on how to build a social care system fit for the future and will first report in 2026. The noble Baroness, Lady Casey, is a trusted independent figure who will involve political parties and the public to build a national consensus around the future of social care. As the commission is independent, it is for the noble Baroness and her team to provide further updates on their progress in due course.

My Lords, we have had the Sutherland report, the Wanless report and the Dilnot report; your Lordships’ House has produced three Select Committee reports on this subject in the past few years; the Health and Social Care Committee in another place has produced 10 reports in the past eight years; the Public Accounts Committee has produced four reports; not to mention reports from the Care Quality Commission, the Nuffield Trust, the King’s Fund and the National Audit Office. Frankly, asking the noble Baroness, Lady Casey, to produce another report by 2028 is a cop out. The noble Baroness can work at pace. She recently reported on grooming gangs, and the Home Secretary said she had produced “a hugely wide-ranging assessment in just four months”.—[Official Report, Commons, 16/6/25; col. 26.] Should she not be invited to produce a report outlining options by Christmas? That would free the noble Baroness, Lady Casey, to deal with some of the other challenges facing the Government.

My Lords, I think the answer is partly in the question. There have been so many reviews and inquiries, but none of them has come forward and got total ownership from across the House; that is part of the problem. All the work that has been done through those reports will be built on. I would never underestimate the noble Baroness, Lady Casey. It has been my great privilege to work with her for decades. She was responsible for introducing ASBOs for troubled families, as noble Lords may recall. This situation is complex. It needs to be tackled in depth. There are things that can been done quickly, which she will address, but it is critical that we let her do the work and use her skills to reach consensus, which, frankly, has been so plainly missing in all the work that has been attempted in the past.

My Lords, the Minister will know that, as many more people are, thankfully, surviving longer despite having severe disabilities or illnesses, and as we are all ageing, there are more people living in the community than in hospitals who need continuing medical care and social support. The department is not just the Department of Health; it is the Department of Health and Social Care. In the light of what the noble Lord, Lord Young, just set out, can the Minister assure the House that, until the noble Baroness, Lady Casey, reports, health and social care will be given equal weight, and that social care will not be treated as a mere add-on to the health service?

The noble Baroness, Lady Casey, is working towards setting up a national care service that can work alongside the National Health Service. The noble Lord raises critical points. Given that so many people live with frailty and need in the community, it is essential that not only the NHS and social care but the voluntary sector and the wider community are involved. We have seen incredible benefits for our most vulnerable in areas that have managed this successfully. There is an enormous amount to do, as the noble Lord suggests, but we are up for the job.

My Lords, given that many unpaid carers are in effect propping up our social care system, often facing relentless financial hardship and strain to the detriment of their own health, can the Minister explain what specific measures the independent commission is taking to ensure that unpaid carers’ voices are feeding directly into its work and leading to real policy change for unpaid carers, not just warm words?

One of the real differences in the work that the noble Baroness, Lady Casey, is embarking on is that she is committed to working with unpaid carers. The noble Baroness, Lady Tyler, raises a critical point. We know how much this country relies on unpaid carers. I am pleased that we have raised the earnings limit by the highest amount since it was introduced, but the figures are staggering. The significant number of people who are carers has to be taken into account. I am delighted that the noble Baroness, Lady Casey, will work with vested interests, and unpaid carers come very high up that list.

My Lords, between 2011 and 2023, 804 out of the 816 adult care homes that were forcibly closed by the Care Quality Commission in England were run for profit. Corporations running such homes have had profit margins of 35% to 40%, removing billions from front-line services, as is the case with many privatised essential services. Can the Minister say when the Government will end profiteering in the adult care sector?

My noble friend raises an important point. I would stretch that out to talk about the care market’s sustainability. The whole system is in real difficulty, not least because of the funding taken away from local authorities over the past 14 years. Local authorities have had difficulties in sustaining provision. Of course, the whole market needs to be looked at so that we can find the most cost-effective and efficient ways forward which benefit the most people from the most vulnerable cohort in our society.

My Lords, the Minister is absolutely right about the problems for local authorities, which are spending some three-quarters of their budgets on social care, with the result that core services are being cut. She said that there is no consensus on this matter, but the House of Lords Economic Affairs Committee produced a report that was accepted throughout the House and was unanimous in its position, like so many other reports that have been produced. Can the Minister admit that the problem is the Treasury and the cost, and the refusal to understand that money spent on social care will mean less cost to and take the burden off the health service? I am afraid that kicking this into touch for three years with the noble Baroness, Lady Casey, is yet another example of the Treasury playing for time and not being prepared to face up to the realities facing the most vulnerable and elderly people in our country.

The noble Lord raises the point about consensus. I did not mean to offend anyone in this House if the report came to consensus, but the fact is that there was a feeling, particularly in the other place, that the work could not be put on to the statute book. That is where we have the problem. We have to make sure we move forward, but I reassure noble Lords that we are not talking about putting everything on hold for three years. The noble Baroness’s interim report will look at things we can do now. In the next couple of years, we will look at the longer-term issues, particularly, as the noble Lord quite rightly said, around longer-term funding. I have faith that the noble Baroness, Lady Casey, will do a thorough job engaging with all parties and outside interests, and come up with a way forward.

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To make it easy, I will resolve it. My Lords, I take this opportunity to pay tribute to the late noble Lord, Lord Lipsey. He was on the Royal Commission on Long-Term Care of the Elderly in 1998. Many noble Lords may not know this but, before he passed away, we were working on a cross-party proposal to raise awareness of existing later-life insurance products offered by mutuals and private insurance, so that taxpayers fund only those without sufficient assets or those who lived beyond the coverage of the insurance—usually five years. Can the Minister assure us that, whatever the Casey commission proposes, given that we are looking at solutions in the short term, the Government will raise awareness of later-life insurance products currently offered by mutual and for-profit insurers, especially for those who cannot wait for the Casey commission to report?

I thank the noble Lord for making reference to the work of our noble friend Lord Lipsey, who will be greatly missed on all sides. I cannot pre-empt what the noble Baroness, Lady Casey, will say—I have made that point repeatedly; it is absolutely right. The noble Lord raised an interesting point of view. I am sure he will take every opportunity to feed that into the work that is ongoing.

My Lords, one of the most sensible measures introduced by Mr Sunak when he was Chancellor of the Exchequer was a health and social care levy. Sadly, its abolition is the one measure which survived from the Kwasi Kwarteng Budget of 2022. The benefit of a health and social care levy is that it is possible to square it with the Labour Party’s manifesto. I therefore encourage the Minister to suggest that the noble Baroness, Lady Casey, also considers the funding of social care.

I have a feeling that the noble Lord will make sure that the noble Baroness, Lady Casey, is well aware of the issues he raises. I look forward to the outcome of those conversations.