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Rt Hon Paul Burstow was Liberal Democrat Care Minister May 2010 to September 2012. He was appointed to chair the joint Lords and Commons Committee on the draft Care and Support Bill. He now serves as Chair of the Social Care Institute for Excellence and holds a number of non-executive leadership roles including as chair of Hertfordshire and West Essex Integrated Care Board.
Wither wellbeing? The Care Act and social care’s unfinished business
Looking back a decade after the enactment of the Care Act I am in no doubt that the legislation has fallen short of what I and many others had hoped. However, it is right to acknowledge the work of the Law Commission and the Dilnot Commission, as well as the improvements made to the draft Bill through pre-legislative scrutiny.
In 2010 social care law was antiquated, disjointed and mostly based on the 1948 National Assistance Act with a succession of amendments and additions made over the decades scatted across the Statute Book. Failing to keep pace with policy and practice the law was not fit for purpose.
The Law Commission’s comprehensive review aimed to modernise and consolidate social care law to align with contemporary needs, especially in areas such as personalisation, personal budgets, and direct payments.
I took the decision as Minister that the Government would produce and consult on a draft Bill giving effect to the Law Commission’s recommendations. I also decided that the Bill should go further and introduce individual wellbeing as its guiding principle for decision-makers. And with a little encouragement from ADASS colleagues I also drafted an explicit prevention duty into the Bill.
However, despite setting up the Dilnot Commission before the 2010 Summer Recess so it could report in good time, I was unable to get Government agreement to include in the draft Bill anything to implement Andrew’s proposals for a cap on lifetime care costs. This was a bitter disappointment.
Having published the draft Bill in the summer of 2012 I found myself out of office but with an unexpected opportunity to look afresh at the legislation. The draft Bill was to be subject to pre-legislative scrutiny. I was asked to chair the joint Lords and Commons committee that took evidence and made recommendations to improve the Bill.
The Bill finally introduced into Parliament was much improved on the original version and after much debate inside the Coalition Government it was agreed that the Bill would include the measures required to introduce a cap on lifetime care costs. I believe the consultative approach meant that the Bill had benefit of widespread support in the sector and across Parliament.
Yet, a decade later, the aspirations of the Care Act have been overshadowed by the endemic challenges of rising demand and insufficient resources.
While much great care continues to be provided, constrained budgets and rising demand have led to ever more rationing of services. It sometimes seems the only social care KPI that matters is hospital discharge, when the true litmus test should be whether a person’s wellbeing has been promoted or not.
Consequently, there's been a decline in the provision of care packages, a backlog in assessments, and inadequate support for unpaid carers, despite their enhanced recognition under the Act.
Landing the cap on lifetime care costs has proved impossible, a workable solution became the victim of a classic making the best the enemy of the good with no consensus about what ‘the best’ would be.
Attempts to secure a sustainable solution, were thwarted by a lack of consensus within the Coalition government and a perhaps understandable lack of trust across party lines. This has perpetuated the uncertainty surrounding social care finance.
In hindsight I believe that Andrew Dilnot as chair of the Commission should have been empowered to interpret the terms of reference flexibly to increase the prospect of an outcome that could encompass both Government and Opposition, although to be fair it was not for want of effort on Andrew’s part!
Addressing the ongoing challenges in social care requires sincere efforts to transcend partisan divides to foster a cross-party consensus.
I hope that the next Government will in that spirit begin discussions with Opposition Parties about a process aimed at securing that agreement. This need not be about going back to square one. These talks should start by drawing on the wealth of existing reports and international examples of successful reform.
The Dilnot Commission's proposal, while addressing one aspect of funding, highlights the broader issue of ensuring equitable and sustainable financing for social care. By failing to implement these recommendations, policymakers have perpetuated a cycle of short-term fixes and insufficient funding, leaving the sector in a perpetual state of uncertainty forever playing the role of Oliver Twist asking for a few more morsels but lacking long term security.
Looking ahead, I hope for renewed momentum in addressing the fundamental challenges facing social care.
There is a pressing need for substantive action and a genuine commitment to securing a lasting settlement. The upcoming general election presents an opportunity for a fresh mandate and renewed energy in tackling this critical issue.
To conclude, while the Care Act represented a significant step forward in modernising social care legislation, its ultimate impact has been blunted by entrenched challenges and political inertia. To achieve meaningful progress, policymakers must transcend partisan divides, prioritise long-term solutions, and engage in genuine dialogue to forge a consensus on the future of social care.
