The Casey Commission Terms of Reference - what have we learned?

By Damian Green, Chair of the Social Care Foundation.

Under cover of the local election results, a Bank Holiday weekend and the VE Day celebrations, the all-important Terms of Reference for the Casey Commission were published. Anyone who has ever dealt with Whitehall will know that Terms of Reference sound really dull but are in fact hugely influential on the success of a particular project.

The task is divided into two, medium-term and long-term findings. There may well be some mutterings that a few short-term solutions would also be welcome. Another division, likely to be more universally welcomed, is that older people’s care and support for working age adults will be considered separately.

The Commission’s first task is to “set out the plan for how to implement a national care service”. It will first have to define what “national care service” means. Is it free at the point of use, which I fear is what the public will take from this echo of the NHS? Presumably not, as later in the TORs is the stern admonition that the Commission’s recommendations must “remain affordable, operating within the fiscal constraints of the Spending Review settlements for the remainder of this Parliament.”

For some people a national care service will mean a nationalised care service, which will hang over care providers unless and until it is discarded as a policy. For others, and I am publicly on record as supporting this, it means funding the parts of the sector that need public financial support out of national rather than local taxation.

There has been alarm expressed already that the longest section in the document is emphasising the NHS focus of the reforms, helping hit the 18-week standard for elective care and reducing unnecessary hospital admissions and delayed discharges. It may well be that social care can only attract enough attention at the heart of government because of its essential part of solving the NHS crisis, but it would be good to hear some acknowledgement that improving the sector is vital in its own right.

The long-term part of the review, which does not report until 2028, is to look at the model of care needed to address demographic change and to discuss alternative models that could be considered. This is the part of the review that will no doubt revive all the Dilnot-era debates about how much individuals must pay to guarantee the care that they may need as they grow older and frailer. I hope that it will also look at preventative measures, such as building more suitable housing and using technology to keep people longer in their own homes, to reduce the demand for the most expensive forms of care.
The task is long, although the need for solutions is urgent. We can only wish the Commission well in its important work.