How can Ministers ensure a new Royal Commission on Social Care is the last one we’ll ever need?

“Not another one!” The response from care leaders to newspaper reports the government will launch a Royal Commission on social care was a lot like Brenda from Bristol, the famous voter horrified to learn Theresa May had called another general election.

This is not surprising. Everyone agrees the care system in England is underfunded and exhausted. For many, more money and decisions on it now are what is required - not another review.

But this overlooks the core reason governments set up policy commissions: to change what is politically possible.

Social care is stuck in a political quagmire. Year after year, the local authority care system remains stretched to the brink with no sign of bold political decisions to fundamentally fix things or increase funding.

This is why the prospect of a new commission is positive. If it wants a ‘National Care Service’ to be transformative, but still win power at the next election, the new Labour government needs the politics of social care to change - and this is where a commission can help.

There have been four social care commissions of note. Two were launched by previous governments – the Royal Commission (1999) and the Commission on Funding of Care and Support (2011) – and two by the King’s Fund: the Wanless Review (2006) and the Barker Commission (2014).

It’s important to learn lessons from the past. So what advice can be offered to Ministers Stephen Kinnock and The Rt. Hon. Wes Streeting MP Streeting to ensure a new Royal Commission is the last one we’ll ever need?

• Ensure a ‘burning platform’ – the public need to understand that change is unavoidable. This step was critical to the success of the Pensions Commission: while it’s final report is remembered for proposing auto-enrolment into workplace pensions, it’s interim report changed what was politically possible by convincing the public we all need to save more for retirement.
• Know your audience – the real audience for a commission is the public. So it’s conclusions need to be in plain-English (the care system is full of jargon) and its recommendations need to be clear, to truly ‘do what it says on the tin’ and provide a compelling ‘retail offer’ – something the public can latch on to and be happy to pay for. No one will pay more for something they can’t understand. The commission needs to set out a vision for the future aligned with how the public thinks about social care. In particular…
• Give a new deal to carers – most care is informal and most families worry about what happens if they need to look after each other, but carers are routinely ignored in discussions of reform – and have been by previous commissions. A new deal for carers must be fundamental to wider system reform and the work of the commission. There is a reason Germany’s national social insurance fund directly pays support to carers as well as the cost of paid care – it drives public acceptance and engagement.
• Let a commission say the unsayable – we need debate on options to raise revenue for the care system, no matter how politically toxic they may be. A commission can say publicly things that Ministers find much harder, so let it do this job. The 2011 Commission on care funding was reportedly blocked from examining revenue-raising options and in the ensuing decade, commentators have repeatedly said it answered the wrong question. Don’t let this happen again.
• No limits – social care is everywhere so a new commission should be free to turn its gaze where it needs to, whether that’s the NHS, the benefits system, housing, labour market reform or taxation. And nothing should be off the table. For example, moving some or all of the care system out of local government would be the kind of monumental policy reform you can see from space, yet in many ways, the role of councils in the care system drives inevitably public confusion and ignorance. So this - and other radical options - need to be considered.
• Plan for the future - the world has changed immeasurably since the last time we had a commission on social care – and there is more change coming. Medical treatments, technology, disease prognosis, patterns of working and saving for retirement are all evolving. So all recommendations for a National Care Service needs to be future-proofed. This also means protecting new and exciting models of care provision - like the Integrated Retirement Communities I work with – that have been shown to reduce need.
• Build consensus - given the Liberal Democrats are pitching themselves as the party of social care and the weakened state of the Conservative Party, you are in a unique political position to bind Opposition parties into a commission by inviting a respected MP from the major parties to join it. There is nothing to lose. If the other parties refuse, they will not be able to criticise what you do.
• Lift heads – perhaps the hardest challenge of a new commission will be engaging providers, local authorities and service users. It is hard to dream, think big or consider radical change when you are focused on survival and still recovering from the scars of the pandemic. So many parts of the system are having to think short-term, not 10 or 20 years ahead. You and the members of a commission will need to inspire.

In the end, Brenda from Bristol was right to conclude the 2017 general election was going to be a pointless exercise. However, if a new Royal Commission is executed well, it could be the route to something so much better for the care system.

An edited version of this article appeared in the October 2024 edition of Care Markets.