Rt Hon Sir Norman Lamb

As Care Minister from 2012 to 2015, I had the responsibility of overseeing the passage through Parliament of one of the most significant reforms for many decades, which would become the Care Act 2014.

Hopes for the future

It is now ten years since the Act achieved Royal Assent, and when I think back to that time, I reflect on my high hopes for the legislation. 

I hoped it would promote a cultural change alongside a shift to a more modern approach to how we effectively empower and support people who are in need of care.

An approach reflected in the principles which underpin the legislation, of choice and control, prevention, personalisation, and the promotion of wellbeing. As a liberal, that is at the heart of what I believe in. 

Unfortunately, while the Act remains a significant and well-supported piece of legislation, its full intent and ambition has never been fully realised. This is for a few reasons. First and foremost, there has been a failure to properly fund adult social care or consider how it is paid for. Second, the cultural change I wanted to see didn’t materialise to the extent I hoped for. This has held back proper implementation of the principles of the Act over the last decade, particularly in terms of prevention and personalisation. Finally, and related, there hasn’t been adequate drive and ambition from the centre on social care; nor has there been a consistently persuasive message about why properly implementing the principles of the Act – which at is heart is to empower people – matters to us all.

Funding

The continued failure to fund social care properly has prevented councils from being able to fully deliver on their statutory responsibilities under the Act. While there was clearly a need to get public finances under control during the Coalition era, cuts have done significant damage to social care budgets, particularly in the context of rising pressure and need. From my own experience, when I was MP for North Norfolk and after leaving government, I came across case after case of residents who draw on care having their personal budgets trimmed further and further back. 

These cuts to personal budgets meant that people, amongst other things, lost access to leisure activities and transport. This was not just the case in my former constituency in Norfolk, but all over the country. This completely undermines the whole underlying approach and principles of the legislation to empower and give people freedom through choice and control. Social care desperately needs a new income stream, and sticking plasters are not the cure for an ailing system. 

I have also been disappointed by the failure to reform how people fund the care and support they draw on. 

During the passage of Care Bill through Parliament it was amended to incorporate clauses to implement the Dilnot cap on lifetime care costs. As part of the coalition government, we secured a commitment to implement these reforms which were due to take effect from 2016. However, once we were out of government, the reforms were successively delayed, abandoned and then reintroduced and abandoned once more. Although introducing these reforms would not necessarily have transformed the system on its own, they were one of the potential building blocks to improving and modernising the system. It would have empowered people to be able to plan better for their future care and support needs. The Dilnot reforms, once implemented, could have led to financial services companies developing products which would have enabled people to save towards their future needs.

Cultural shift

Second, many of us hoped that the Care Act would have led to a significant cultural change with power shifting to people so that they could determine their own priorities. Unfortunately, while there has been some progress, it has not been nearer enough – partly because of constraints on funding. But we also need people at the centre of decision-making, and within the wider system, who genuinely believe that shifting power to people is the right thing to do and are ready to back this up with corresponding investment.

A cultural change is also needed that prioritises prevention and early intervention. This focus on prevention underpins the Act and remains crucial for how we deliver care across both social care and health. It requires councils to ensure the provision of preventative services, but it is another area where impact has not been fully realised as demand and funding pressures have tended to divert funding to areas of immediate need. Acute financial pressures across health and care more broadly has made it difficult to shift focus and funding to prevention and early intervention across the system overall. 

If we do not properly fund social care this will continue to impact the NHS and vice-versa. Back in 2015, I remember Simon Stevens raising the alarm over further cuts to social and public health and the extra costs this would impose on the NHS over and above minimum funding requirements. His was a powerful and influential voice, but was it heeded? Not adequately.

Championing social care at the heart of government 

Finally, there needs to be a clear message and vision from the centre about adult social care being ‘people powered’, supported by the principles of wellbeing, personalisation, choice, and control. This would not be about imposing an overly prescriptive approach on localities; rather it would be about a national commitment which local areas could buy into and then deliver in a way that was sympathetic to their unique circumstances and population. It would have been about central Government championing the Care Act and the principles underpinning it. Frankly, this should have been done consistently from when the legislation first came in, right the way through to our present day. 

A national vision, implemented and interpreted locally, should be the model. Because, despite the challenges faced by adult social care and local government, delivery of care is still best done locally rather than nationally. As co-chair of the Health Devolution Commission, I wholeheartedly support devolving powers and wholeheartedly believe in the potential opportunities that joint decision-making and single budgets for health and care present in taking a whole population approach to address the wider determinants of health. 

Ultimately, the Care Act was – and is – a good piece of legislation. But a failure to properly fund social care – and in the context of continued pressures on local government finances overall – have undermined any chance of it being transformative. That is not irreversible. We should take heart from, and draw on the lessons of, how the Act was developed; collaboratively, cross-departmentally, in coproduction with those who draw on care and support, and with strong engagement with local government and the wider sector. That happened before to deliver the legislation we now have; there is no reason it can’t happen again to kickstart a renewed effort to fully implement it.

Crucial to any such renewed effort must be a commitment to advance the social care debate in a sympathetic way, with politicians coming together and finding common cause, rather than focussing on that which divides them. Politically, there is a need for a reinvigorated and open discourse, which avoids political point-scoring and focuses on the role of great care in supporting people to live full and ordinary lives and how that is funded. This is an issue which needs to transcend party politics because it will impact generations to come.

Whoever forms the next government will have a real opportunity to deliver real change on adult social care. They should start immediately by listening; to those across the political spectrum, those from local government and the wider sector, and – most importantly – people drawing on care and support, including unpaid carers. I would love to see a cross party – and non-party health and social care convention established with the clear aim of delivering a new settlement for both the NHS and social care to deliver services fit for the 21st century.