Failure to deliver social-care plan could 'destabilise' health reforms, MPs warn

Select committee members say they will be “extremely disappointed” if a 10-year social-care plan does not appear by the end of 2021
'Badge of honour' unveiled by health secretary Matt Hancock for social-care workers last year. Photo: Stefan Rousseau/PA Wire/PA Images

Lengthy delays to social-care reform could “destabilise” and “undermine” care systems, MPs have said after a long-awaited white paper failed to set out a fully-funded plan for reform.

The government’s health and social care white paper was published in February and set out plans to create integrated care systems throughout England to deliver care services.

The integrated systems will bring together the NHS, local government and other partners to deliver social-care and public-health services, according to the white paper. They will be established under the upcoming health and social care bill, which members of parliament's Health and Social Care Select Committee have been scrutinising.

The white paper had been expected to give more detail on Boris Johnson’s promise to "fix the crisis in social care once and for all" when he became prime minister in July 2019.

But it included no long-term plan for social care – an omission that “concerned” the committee, its report said. Meanwhile,  the Queen’s Speech this week pledged only that “proposals for social-care reform will be brought forward”. The speech gave no details or timeframe in which relevant legislation would be passed.

The lack of a social-care plan was one of the “concerning omissions” the MPs identified in the white paper, despite welcoming the overall “direction of travel in the government’s reform of health and social care”.

“The absence of a fully-funded plan for social care has the potential to destabilise integrated care systems and undermine their success,” the report said.

The MPs added that they will be “extremely disappointed” if the government does not deliver on the prime minister’s commitment – made to the committee in March – to producing a 10-year social-care plan by the end of 2021.

The plan must be “fully costed and funded”, they said, adding: “Without secure, long-term funding, the problems that have bedevilled the care sector over the last two decades will not be solved.”

They also called for the health and social-care bill to include a requirement for the health secretary to produce a fully-costed, 10-year plan within six months, to give the social-care sector “reassurance that both the structural and financial problems it faces will be tackled by the government in a timely way”.

Call for 'full transparency' around appointments

MPs also said they had concern about the way appointments to NHS boards will be made in future.

The report – which comes at a time when public appointments are under particular scrutiny –noted that the upcoming bill will give the health secretary ultimate responsibility for appointments to NHS boards.

While the MPs said the health and social-care bill provides a “timely” opportunity to reform the criteria for appointments, they stressed that appropriate safeguards must be put in place.

“Given the concerns about the potential politicisation of the NHS, there will need to be full transparency in the appointment process,” the report said.

The bill must therefore set out the criteria by which the health secretary will make and veto appointments, the committee said.

Other recommendations in the report included giving the Care Quality Commission “powers to give Ofsted-style ratings for local-authority social care”, and giving integrated care systems a “core duty on ICSs to have regard to public health and mental health”.

The report also called for “flexibility” on the timing of the bill, given the “unprecedented strain” both the NHS and care sector have been under during the coronavirus pandemic.

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