Prioritised recommendations

The recommendations set out in the main body of this report follow the themes, in order, that formed the basis of our green paper. Every recommendation is important but they must also be considered in terms of their priority: both in respect of their timings, and in respect of their overall objective. Here we draw the recommendations from the report and prioritise them within two main objectives that span the period between now and 2025 and beyond.

The immediate priority must be to sustain the here and now and counter some of the serious immediate consequences of underfunding that are apparent across the system. Starting at the same time, but running for a longer period, we must lay the groundwork for delivering a social care and support system that we know could be better. Across both objectives, there are priorities to do with funding and priorities to do with changing the way we all think about care and wellbeing.

Realising a better system, such as we have outlined in our green paper, will require considerable input from Government. This will enable a significant expansion of what councils do in line with the very best of the 2014 Care Act.

We deliberately do not couch this as an ‘ambition’ or ‘aspiration’ because we know it is something councils, working with their local partners, can deliver. Therefore, this is a blueprint for realising the known potential of councils, and all parts of the wellbeing sector, so that we can all live the lives we want to lead.


Objective one: protecting the known potential of councils – stabilising and sustaining the short-term (2018-2019)

Funding

The Government must urgently inject genuinely new national investment to close the core social care funding gap that builds to £3.56 billion by 2024/25. This must include additional investment to that announced in the 2018 Budget to help address serious provider market stability concerns in 2019/20.
(Timescale: Local Government Finance Settlement, Nov 2018-Feb 2019)
Recommendation three, p.34

The above funding would help to stabilise the system as it currently delivers, but the Government’s ambition should go beyond this. Any new settlement must provide the resources to deliver the aspirations of the Care Act with a focus on prevention, wellbeing, personalisation and integration. This means ending a focus on an eligibility driven approach to needs to one focused on prevention and picking up unmet need early to prevent escalation. We estimate that providing care and support for all older and working age people who need it will require an estimated further £5 billion by 2024/25. The Government must take urgent steps to tackle this by working with the sector to agree a clear figure for the cost of unmet and under-met need in time to feed into 2019 Spending Review discussions.
(Timescale: Local Government Finance Settlement, Nov 2018-Feb 2019 and ongoing)
Recommendation four, p.34

The Government should prioritise investment in prevention, community and primary health services for the £20.5 billion additional expenditure for the NHS.
(Timescale: NHS Long Term Plan, Dec 2018)
Recommendation 12, p.67

A new approach to care and wellbeing

The Government should implement a new ‘duty to cooperate’, requiring the NHS, in particular sustainability and transformation partnerships, to engage with health and wellbeing boards as part of developing local plans to reshape and integrate health and care services that are genuinely locally agreed.
(Timescale: NHS Mandate, Dec 2018)
Recommendation 13, p.67

Through its Mandate to NHS England, the Government should ensure the NHS takes decisions based on (i) the needs of local communities as a whole and (ii) public spending as a whole.
(Timescale: NHS Mandate, Dec 2018)
Recommendation 14, p.67


Objective two: harnessing the known potential of councils – toward a better future (2019-2025)

Funding

The Government should invest significant new funding to: close the funding gap facing adult social care that builds to £3.56 billion by 2024/25; and ensure that all older and working age people who need care and support are able to access it.
(Timescale: Spending Review development, 2019 and Spending Review implementation, 2020-2025)
Recommendation five, p.45

Where additional funding is invested in adult social care, this should be made available with as few a set of conditions as possible so local areas have discretion to prioritise the most pressing local issues.
(Timescale: Spending Review development, 2019 and Spending Review implementation, 2020-2025)
Recommendation six, p.45

The Government should reverse the cuts of £600 million to the public health budget between 2015 and 2020
(Timescale: Spending Review development, 2019 and Spending Review implementation, 2020-2025)
Recommendation 10, p.61

As part of its Spending Review, the Government should consider wellbeing in the round, recognising the contribution that different council services, and those coordinated by other public sector and voluntary sector organisations that councils commission, make to wellbeing.
(Timescale: Spending Review development, 2019 and Spending Review implementation, 2020-2025)
Recommendation 11, p.61

A new approach to care and wellbeing

The Government should convene a core working group from across the sector, with people with lived experience at its heart, to develop a national campaign that seeks to raise awareness of what adult social care and support is, why it matters in its own right and what it could and should be with the right funding and investment. This should be genuinely co-produced, with Government acting as a convenor.
(Timescale: Government green paper care and support, Dec 2018 onward)
Recommendation one, p.22

The campaign should be clear about the local dimension of social care and support. It should strike the right balance between embracing the value of this local dimension whilst also being clear about the national framework in which social care and support sits.
(Timescale: Government green paper care and support, Dec 2018 onward)
Recommendation two, p.22

The Government should only implement its care cost cap and asset protection floor proposals if they are part of a wider set of reforms that secure the long-term sustainability of adult social care and support as a whole.
(Timescale: Government green paper care and support, Dec 2018 onward)
Recommendation seven, p.45

In consulting on the shape of, and sustainable funding for, social care through its green paper, the Government should make the case for increases in Income Tax and/or National Insurance and/or a social care premium.
(Timescale: Government green paper care and support, Dec 2018 onward)
Recommendation eight, p.54

Building on the campaign to raise awareness of social care and its value (recommendations one and two), the Government should make the case for national tax rises or other sustainable, long-term solutions and consult on clear propositions which explain the various options for how sufficient funding for social care and support could be raised nationally. The Government must set out how such increases would relate to the wider social care and local government funding system. The Government should also be clear about how nationally-raised increases for social care would relate to nationally-raised increases for the NHS.
(Timescale: Government green paper care and support, Dec 2018 onward)
Recommendation nine, p.54

Executive summary