Cyril Lobont

Independent commission into adult social care: terms of reference

The terms of reference for the Casey Review have been launched today, with a focus on building consensus over tangible recommendations to improve adult social care over the next ten years. A few takes from me and @cglobont.bsky.social .social & @natashacurry.bsky.social:

www.gov.uk/government/p...

Great indicator by NT's Malina showing, for example, big, and poorly understood, disparities in % of men and women aged 65+ with a dementia diagnosis. Report by @camille-oung.bsky.social, Natasha and I looks at how social care must improve to support growing + diverse population living with dementia

New report today by @billypalmer.bsky.social, Nadia and I. The mix of professions in the NHS has been an especially thorny issue as of late. We try to take a step back and understand what does and doesn't work when introducing or expanding roles in the health service. A huge thanks to all involved!

14: ⏰ The government is keen to emphasise that it is committed to long-term reform, though we are yet to see a plan for how. However, it should be mindful that if it fails to take urgent action to stabilise the sector now, there may be little left of it to reform.

13: Providers going out of business means people seeing their care and support disappear or be heavily disrupted. This will mean more pressure on family members and other unpaid carers, who are often forced to step in when social care fails.

12: 📉 Some larger providers may be able to absorb the costs (at least for a while). But other providers, including many not-for-profits, have dwindling financial reserves and are predominantly reliant on local authority fees - and could be at risk of closure before long.

11: So this is really concerning for the sector. If fee rates from local authority commissioners aren’t going to cover costs adequately, the main other option for increasing income is putting up rates for people that pay for their own care. They are already too-often relied on to ‘cross-subsidise’.

10: 🏙️ Local government budgets are set to rise by around £2 bn next year (which includes the £600m for social care and assumes they raise council tax by maximum rates). But most of this is not reserved for adult social care and will need to cover the rising cost of other council responsibilities.

9: 🧑‍🧑‍🧒‍🧒 The Chancellor committed to an extra £600 million for children’s AND adult social care. It’s obvious that whatever proportion of this reaches the independent adult social sector isn’t going to touch the sides.

8: ⚖️ We’ve estimated that local authorities pay for around 71% of the care independent providers deliver. So to keep the books of providers ‘balanced’, we would have to see local authorities spending around £2 billion more on care.

7: 🚨 We estimate ENI changes could cost independent sector social care providers over £900 million extra in 2025/26. Combined with the minimum wage changes, independent sector providers could see staffing-related costs grow by £2.8 billion in 2025/26.

6: ↩️ The more generous upcoming Employment Allowance for employers will help to soften the blow slightly. Under the new regime, from April 2025, employers (regardless of size) will not pay the first £10,500 of their bill, up from £5,000.

5: ⬆️ ENI is going up from 13.8% to 15%. This is paid directly to government by employers and levied on each employee. ENI is only payable when an employee’s earnings hit a certain level. Until now, the first £9,100 someone's earnings were exempt from ENI. From April '25, only the first £5,000 will.

4: 📈 The National Living Wage (the legal minimum for those aged 21+) is going up 6.7%, to £12.21 per hour in 2025/26. We can expect average pay in the independent social care sector (all roles) to rise roughly in line with this. We estimate a total wage bill of around £29 bn, a rise of over £1.8 bn.

3: Most social care is delivered by independent providers, many of whom provide care and support to a mix of state- and self-funded people. Independent sector providers are required to pay ENI (whilst the public sector is not), so we wanted to understand the cost to them, specifically.

2: 💷 One of the Chancellor’s key announcements in the budget was changes to employer National Insurance (ENI) contributions. Alongside increases to minimum wage rates, our analysis finds local authorities need an extra £2bn to commission care at a rate which doesn’t risk bankrupting providers.

Will the Autumn Budget push the social care sector beyond breaking point? While the recent budget brought better news for hard-pressed public services, social care was not so lucky. With many organisations fearing that changes to the Employer National Insurance Contribution...

1: 📢 Our new analysis (www.nuffieldtrust.org.uk/news-item/wi...) finds that the new budget could cost social care providers £2.8 billion: a thread