Policy paper

Next steps to put People at the Heart of Care

Published 4 April 2023

This was published under the 2022 to 2024 Sunak Conservative government

Applies to England

Ministerial foreword

The government is reforming adult social care to improve the lives of the 10 million people who draw on, work in, or provide care and support.

I want everyone who needs care in England to have outstanding, quality care that empowers them to lead fulfilling lives and have the greatest possible independence. I want care to be personalised to meet individual needs and give people choice and control. I want joined-up services so that people’s experience of health and social care is seamless. These are the things that carers and people who draw on care and support have told me they want. Our reforms are about achieving those aims.

Adult social care depends on the dedication of millions of people providing care. I want everyone who works in care to feel valued and recognised as professionals. I want to build a workforce of the right size with the right skills to meet the growing need for care and support. And I want unpaid carers to be supported in what they do and to achieve their own life goals.

For decades adult social care has not had the attention, resource or support from government that it deserves. But we are changing that.

The People at the Heart of Care white paper, published in December 2021, set out our 10-year vision for adult social care - a vision created and shared with people who draw on, work in, and provide care and support. This government remains fully committed to that vision, supported by historic increases in funding. This includes over £2.1 billion over the next 2 years in funding specifically earmarked for supporting and improving adult social care and discharge in England. This plan sets out the next steps on our reform journey, including how we will invest £700 million of that funding.

Of the £1.7 billion the white paper committed to reform, up to £600 million remains to be allocated, which will be invested over the next 2 years after we have drawn on lessons learned from our investment in improving discharge. This will make sure we are effectively targeting the areas that matter most to people. I want you to have confidence that things are getting better and will continue to do so - not just for next winter, but for the long term.

Front and centre of these reforms are my ambitions for the adult social care workforce. I want to support care workers to develop their skills and their careers, and to be recognised for those skills. That’s why we are setting out our plan for the care workforce, including the care workforce pathway, a new Care Certificate qualification, funded training for care workers and registered managers, and funded continued professional development training, as well as a digital skills passport. Our plan will help care workers pursue their careers and get the professional recognition they deserve.

I also know that new and innovative ways of providing care and support can improve outcomes for people. Therefore, alongside the Minister for Housing and Planning, we are launching a new Older People’s Housing Taskforce that will help unlock investment in retirement housing, as well as a new Department of Health and Social Care (DHSC) innovation and improvement unit to enable innovative local projects.

I am pleased to confirm that Care Quality Commission (CQC) assessment of local authority social care responsibilities will begin in April 2023, and this plan sets out my 5 priorities for these assessments. It will increase transparency and local accountability, enabling us to better understand the quality of care and support in local areas.

Excellent care involves being cared for in the right place. That’s why we are also tackling the problems of delayed discharge and unnecessary admissions to hospital. The delivery plan for recovering urgent and emergency services sets out how the NHS, local government and adult social care will work together to improve hospital discharge and access to social care over the next 2 years.

If our reform activity is going to make a difference for people, then it must be accompanied with investment. At the autumn statement in 2022, having listened to the concerns of local government, we made the difficult decision to delay reforms to the charging system. All of the savings from this delay are being retained by local authorities to help them meet cost pressures, in addition to £2.7 billion in new grant funding and further flexibility on Council Tax. This is the biggest funding increase in history for adult social care in England, with up to £7.5 billion over 2 years.

We also published the guidance and final conditions for our new Market Sustainability and Improvement Fund (MSIF) last week. Local authorities will be able to use this funding flexibly to make tangible improvements and increase capacity in adult social care services.

By 2025, we will have achieved real change for adult social care. We will have shifted the dial on recognition and support for the skills of care workers, driven digitalisation and innovation in social care provision, and changed how social care is planned for and commissioned. This will be backed by increased accountability through better data insights and local authority assessments.

We have always acknowledged that reform is a journey and that our vision will not be achieved overnight. However, this plan sets out our crucial next steps towards that vision. I am exceptionally grateful to everyone working in and providing care and support for your ongoing dedication and commitment. I look forward to working with you over the months and years ahead.

Helen Whately MP

Executive summary

The People at the Heart of Care white paper, published in December 2021, set out a 10-year vision for adult social care. It was shaped by national and local government, care providers, care staff, the NHS, people who draw on care and support, their friends and family, charities and the voluntary sector. The vision puts people at its heart and revolves around 3 objectives:

1. People have choice, control and support to live independent lives.
2. People can access outstanding quality and tailored care and support.
3. People find adult social care fair and accessible.

This plan sets out how we are building on our progress over the last year by implementing the most impactful proposals, along with some new commitments. It includes key milestones for reform and sets out the change we will see for people who draw on care and support, unpaid carers, and people who work in social care. Some of the key activities include:

• improving access to care and support: we are helping local authorities to increase their adult social care capacity and make tangible improvements to services by investing £562 million in 2023 to 2024 and £845 million in 2024 to 2025 through the Market Sustainability and Improvement Fund. We are also launching a programme in summer 2023 to help local areas establish support arrangements for international recruitment in adult social care to bolster the workforce. We will expand the NHS Volunteer Responders programme from this year to create a joint health and social care volunteer programme. Improved capacity and better support for international recruits and volunteers will enable more people to access the right care, in the right place, at the right time
• recognising skills for careers in care: we are improving recognition of the skills and experience of people working in care and supporting career development through our plan for the care workforce. This includes the introduction of a new care workforce pathway for adult social care, a new Care Certificate qualification, a skills passport to provide a verifiable record of training and qualifications and a range of new, funded training schemes. We know that the capability and compassion of care workers makes all the difference to the lives of the people they care for and we want to better recognise these skills
• digital transformation in adult social care: we are supporting the testing and scaling of new technologies through 2023 to 2025 to improve care quality and safety; and increasing uptake of digital social care records by 2025, which enables your care information to be shared securely and in real-time with authorised professionals in the NHS and social care. We are also developing a scaled-up future digital learning offer, so that digital skills are embedded in core training and development opportunities for staff
• personalising care through stronger data: we are introducing person-level data collection from April 2023. Better insights into care journeys and outcomes will help to show which interventions work best and we can improve how people move between health and social care. By the end of 2023 we will finalise our roadmap for improving how data is collected, used and shared. In February we published a draft of Care data matters so that we can involve people who draw on, work in or provide, or are supported by adult social care in the development of this roadmap
• improving transparency and accountability: we are introducing CQC assessment of local authorities’ adult social care delivery from April 2023 to better understand the quality of care in local areas. This will enhance transparency, improve local accountability and help to identify good practice so that more people can benefit from high quality care and support
• supporting people to remain independent at home: we are launching a new, independently chaired Older People’s Housing Taskforce that will make recommendations to ministers on how we can unlock investment in retirement housing to provide more choice of suitable housing for people in later life. We will also provide additional funding for people to make adaptations and repairs to their homes so that they can stay independent for longer and return home from hospital more quickly
• driving innovation and improvement: we are launching a 2-year targeted fund in 2023 to test and scale ways to innovate and transform local authority processes. This will provide targeted support for local authorities and establish a new innovation and improvement unit within DHSC. We will work with sector partners to shape the strategic direction for improvement and innovation, helping tackle operational challenges and overcome the barriers to adopting and scaling new approaches
• joining up services to support people and carers: we are supporting our recently established integrated care systems (ICSs), and the organisations within them, to better join up care through the expansion of our Better Care Fund (BCF) Support Programme and the launch of a new national leadership programme for local health and social care leaders. We are also investing in additional support for unpaid carers in recognition of the enormous contribution they make, which is reflected throughout this plan

This is just some of the activity included in our comprehensive package.

This plan is a crucial step towards our 10-year vision. We will continue to engage with all those people and organisations at the heart of providing and drawing on care as we implement our reforms and make further progress towards our vision.

Improving access to care and support

Our priority is making sure that people have access to the right care, in the right place, at the right time. For that reason, we are focusing our investment on improving accessibility and quality of care. That means enough staff, equipped with excellent skills. It means better management of resources to avoid delays in accessing care. And it means healthy, dynamic local care markets, where providers are paid a fair fee and deliver exceptional quality support.

As set out recently in the delivery plan for recovering urgent and emergency care services, joint working across health and care is important to ensure patients and service users can access the best care, including safe and timely discharge from hospital. This year, new approaches to step-down care will start to be implemented - for example, people who need physiotherapy can better access care immediately after discharge while their long-term care needs are being assessed. We have announced 6 new ‘national discharge frontrunners’, which will pilot innovative approaches to discharge, with 3 focusing on intermediate care. The plan also highlighted how local government, the NHS and the social care sector will work together to improve systematic discharge planning from the point of admission, including through multidisciplinary, integrated ‘care transfer’ hubs.

While the local operations of the hubs will always need to be tailored to specific local services and arrangements, we will support teams to adopt, ahead of next winter, the core elements that we know are working in the most effective hubs. This includes a shared process to work with patients, their families and carers, and all professionals from admission, with all staff (in and outside the hub) sharing responsibility for delivering safe and timely discharge. We are also improving the availability of data to assess the effectiveness of hospital discharge with new data and metrics based on a patient’s discharge ready date and around reasons for delays in transfers.

We are now taking further action. As part of the historic funding increase for adult social care announced at the autumn statement in November 2022, the government is directly supporting local authorities to expand their care capacity. Through MSIF, we are making available £562 million in 2022 to 2023 and £845 million in 2024 to 2025 for local authorities to use flexibly, which can include improving access to care and support. Across our MSIF grant conditions and the Better Care Fund framework, published last week and today respectively, we are asking local areas for the first time to report the capacity they will be putting in place to meet demand across all of their residential and community-based services.

We know that effective local authority market shaping and commissioning practices are strongly linked to improving workforce capacity. They are crucial for raising fee rates, improving workforce terms and conditions, and embedding personalised care and support that delivers good outcomes, such as enabling people to be independent. We expect our support package set out in the ‘innovation and improvement’ section of this plan to improve commissioning and market shaping, in turn increasing workforce capacity. Additionally, increased transparency around how local authorities commission for good outcomes will be one of 5 ministerial priorities for CQC assurance, which will give us insights into the market shaping practices happening on the ground. We can use these insights to better understand how commissioners are currently managing their workforce capacity and target improvements to the right areas.

We know that commissioning integrated services makes an enormous difference to people’s lives by helping them stay independent for as long as possible and delivering an improved quality of care with higher satisfaction. The changes introduced by the Health and Care Act 2022 bring together local authorities with the NHS and wider system partners as integrated care systems (ICSs). The integrated care board (ICB) is the commissioning arm of the ICS and local authorities are mandated members of this board, strengthening the voice of social care in collaborative arrangements.

Local authorities are clear that one of the main barriers to expanding workforce capacity is the availability of staff. That is why we have been supporting employers to attract and recruit staff, through running a major national recruitment campaign, supporting jobseekers into the care sector and funding sector partners to advise employers on good recruitment and retention practice. We will continue to provide this support, alongside our additional investment in workforce recognition and career development, detailed further in the next section, which will help the sector move towards a more sustainable domestic supply of care staff in the future.

Ethical overseas recruitment has an important role to play. There has been a strong uptake of international recruitment in the care sector since we made care workers eligible for the Health and Care Worker visa and we added them to the shortage occupation list in February 2022. Registered nurses, occupational therapists and social workers are also on the list. We are now making further support available to the sector to improve international recruitment.

We also know that many people may want to volunteer to support individuals with care and support needs in their local community; the pandemic demonstrated the huge appetite across the country for volunteering in health and care settings. While volunteers should never be a replacement for our paid workforce, they can complement and enhance the support people receive and strengthen local communities. Alongside our workforce programme we will make it easier for people to identify local volunteering opportunities, and for care providers to access potential volunteers.

We are investing over the next 2 years to:

• provide local authorities with £562 million in 2023 to 2024 through the Market Sustainability and Improvement Fund - this gives local authorities the flexibility to make improvements to services and increase capacity in adult social care. There will be £845 million made available in 2024 to 2025
• support care providers to access international recruitment and build a sustainable workforce by investing £15 million - this will bolster the workforce and improve accessibility of care
• support volunteers and the people who work with them by investing up to £3 million - this will help to increase the amount of volunteering in adult social care. It will also make it more attractive and easier for volunteers to sign up, as well as reducing the administrative burden care providers often face when recruiting volunteers

Supporting local capacity planning through new funding

MSIF will enable local authorities to make tangible improvements to adult social care. It will give local authorities flexibility in how they invest this funding, in line with their Care Act duties, but with a clear set of priority objectives. These objectives are:

• reducing waiting times so people are assessed and receive their care more quickly
• improving workforce capacity and retention, to the benefit of staff and those they care for
• increasing fee rates paid to adult social care providers

The government will monitor progress in each of these areas through performance metrics. Guidance and example activities to support local authorities to make best use of the fund was published last week. Local authorities will need to provide an initial report against these metrics on 24 May 2023. They will also need to demonstrate tangible improvement in at least one priority objective, and that none have deteriorated, on 22 May 2024. As a condition of this funding, the government will, for the first time, require plans from all local authorities on current capacity, future demand, and how any gaps will be bridged across long-term care. Alongside demand and capacity planning for intermediate care through the BCF, this will allow us to better understand local need and support local authorities and integrated care boards (ICBs) accordingly.

Supporting employers to recruit and retain the staff they need

As the NHS and social care are facing acute pressures, we are acting now to bolster immediate workforce capacity through all routes available, both at home and abroad. Firstly, we are running a national recruitment campaign, Made with Care, until 31 March 2023. The campaign has reached millions of people this winter, highlighting the amazing work staff across the adult social care sector do and encouraging people with the right skills and attributes to apply for roles. Plans for the continuation of the campaign in 2023 to 2024 are under consideration.

We are also working with the Department for Work and Pensions (DWP) to promote adult social care careers to jobseekers, and funding sector partners to advise care employers and commissioners on good recruitment and retention practices. Skills for Care and Partners in Care and Health published a top tips for retention guide to support the sector to implement staff retention measures.

We recognise the vital contribution that international recruitment provides. There has already been strong take up of international recruitment, with Home Office figures showing there were 56,900 visa grants for care workers and senior care workers under the Health and Care Worker visa in 2022. We are therefore supporting its use in adult social care through a £15 million regional fund for the 2023 to 2024 financial year, along with a programme of engagement, guidance and support products for the sector.

The regional fund will help local areas establish support arrangements for international recruitment in adult social care. This will promote close collaborative partnerships between local authorities, care alliances and providers, and, where appropriate, with the NHS. The partnerships will create practical forms of support to providers to reduce the complexity and cost of the process while helping to ensure ethical practice and promote positive experiences for international recruits.

At a national level, we will promote collaboration and sharing of best practice between the regional support hubs and run a programme of engagement with the sector and with international recruits. We have already published a code of practice on ethical international recruitment in the health and care sectors, with an easy read leaflet for candidates. We will be making a range of further support products available to providers to improve the end-to-end process of international recruitment.

We will also ensure that international recruits are supported upon their arrival with strong pastoral and onboarding support, enabling them to have a positive experience working in social care in our country.

In September 2022 the government commissioned the Migration Advisory Committee (MAC) to review the shortage occupation list and it does not intend to make any changes to the provisions for care workers before receiving this report.

Supporting volunteers and the people who work with them

We recognise the positive impact volunteers can have on the wellbeing of people who draw on care and support, and we want to build on the legacy of volunteering across adult social care following the pandemic. Over the next year, we intend to expand the NHS Volunteer Responders programme into adult social care to create a long-term joint health and social care volunteer programme that can benefit both sectors.

The dedication of our volunteers, supported by this programme, will continue to improve the quality of life for people who draw on social care through volunteer roles that support their wellbeing. Volunteers will complement the existing workforce, through roles such as befriending, tackling loneliness, and supporting care recipients to participate in their communities. We will continue to work with the sector to identify how the expansion of this programme into adult social care benefits people who draw on care and support, as well as the paid workforce.

Improving access to care and support - key milestones

Market Sustainability and Improvement Fund

Spring 2023:

• detailed grant conditions and guidance are published
• local authorities submit baseline spend and performance metrics for 2023 to 2024

Summer 2023:

• local authorities submit capacity plans for 2023 to 2024

Spring 2024:

• local authorities submit updated metrics for 2024 to 2025

Domestic recruitment

Spring 2023:

• the current national recruitment campaign will run until 31 March 2023

International recruitment

Summer 2023:

• regional support funds are awarded and in operation
• a range of support products for the sector are launched to enable better and smoother international recruitment

By the end of 2023:

• data on care worker visas published on a quarterly basis
• formal sector engagement conducted
• regional partnerships funded and local support networks are facilitated

Volunteering

2023:

• NHS Volunteer Responders programme expanded into adult social care

Late 2024 to early 2025:

• publication of an evaluation of the expansion of the NHS Volunteer Responders programme into adult social care

Recognising skills for careers in care

The adult social care workforce is one of our greatest assets. Yet there are long-standing challenges in recruiting and retaining a workforce of the right size with the right skills, as recognised in the People at the Heart of Care white paper. Currently, a significant proportion of the adult social care workforce do not hold a relevant qualification or have access to good quality learning and development opportunities, which contributes to high turnover of staff.

Tackling these challenges and improving the perception of social care as a career is our priority. Our workforce reforms, which will see us invest £250 million over the next 2 years, will provide the workforce with more support to develop and progress within their careers and will improve the quality, safety and personalisation of care.

Specifically, we will publish a new, national workforce pathway which sets out the knowledge, skills, values and behaviours that are needed to work in adult social care and a career structure which shows people how they can develop and progress in their social care careers. We are supporting the workforce to develop and progress along this new pathway through additional funding for training and professional development, enabling better peer support, funding new qualifications and improving portability of training.

We are investing at least £250 million over the next 2 years to:

• better recognise social care as a profession - by describing the knowledge, skills, values and behaviours that people need to work in adult social care, we will improve career pathways and opportunities for progression
• empower the workforce to deliver high quality, personalised care that supports people drawing on care and support to lead independent and fulfilled lives - this will increase opportunities to develop skills and expertise, and undertake learning and development

Recognising adult social care as a profession

We want the social care workforce to be recognised as the professional workforce it is, and to improve people’s perception and experience of a career in care. This means supporting people to work at the top of their competence, to feel empowered to deliver high-quality care, and to develop and progress in their careers.

We are doing this by clearly defining what a career in social care means - creating universal definitions of roles and the knowledge, skills, behaviours and values needed to perform them with competence. Following the care workforce pathway call for evidence, which is being published alongside this plan, we will work with sector representatives to co-produce the content of a new, national care workforce pathway. We will publish the first version of the pathway in autumn 2023 and will continue to work with the sector to implement it across the country.

The pathway will set out how we expect expertise in different skills and responsibilities to develop, from someone entering the workforce through to someone with many years of experience and specialist training. We will also define new or enhanced roles to increase opportunities for career progression.

The pathway will also link to work underway with the sector to develop guiding principles to support and enable safe and effective delegation of healthcare interventions to care workers. Delegated healthcare activities are usually of a clinical nature that a regulated healthcare professional, such as a nurse, delegates to a paid care worker. Examples of a delegated healthcare activity include wound or catheter care, PEG feeding or supporting someone to use a crisis plan for their mental health. Accountability for delegation remains with the registered professional, who must ensure the care worker has the right skills and knowledge to undertake the activity. Following publication of the principles, we will continue to work with our partners to support implementation and assess the impact on staff and people who draw on care. By setting out where delegation is appropriate, the principles will support person-centred decision-making, improving their experience of care and its impact on their health and wellbeing.

Supporting career progression and development

To support the implementation of the care workforce pathway and to help people develop expertise and progress, we are providing funding for hundreds of thousands of training places. Our training offer will include funding for:

• a new Care Certificate Level 2 qualification - over time we want this new qualification to become the baseline standard for all new care workers to work towards when they join the profession
• learning and development including training courses on healthcare interventions to support delegation, learning disabilities including autism, dementia care and leadership
• continued professional development for registered nurses and other eligible regulated professionals
• digital skills training and development of a new digital leadership qualification based on the recently updated Digital Skills Framework (from Digital Social Care) - further detail is set out in the ‘Digital transformation in adult social care’ section of this plan

In alignment with our wider technology investment, we are working with delivery partners to make it easier to access funding for the costs of training. There will also be flexibility for employers and members of the workforce to access training specific to their individual roles and the people they support. Likewise, individual employers will be able to access funding for training to support the development of personal assistants.

We are continuing to fund Skills for Care’s package of support across workforce training and development. This funding supports a wide range of services aimed at social care employers and the workforce. It includes guidance, accreditation and assurance of training and skills standards, and development and leadership training. It also includes specific support for social workers, occupational therapists, nurses and registered managers.

Social workers play a crucial role in assessing and supporting people with multiple complex needs, such as homelessness and mental ill health, and it is essential that they are equipped to support those who will most benefit from social work support. Alongside other initiatives, we are committed to recruitment and retention of social workers through our Think Ahead programme, a graduate fast track programme to become a qualified social worker working to support people with mental health needs. We are also providing further support for social workers through the Education Support Grant and Social Work Bursary. Our investment will ensure we lay the right foundations to meet future demand for social workers, and for the continued success of the social worker profession in the long term.

We continue to engage and work closely with the social work sector including through the Chief Social Worker for Adults, Lyn Romeo, and through supporting the Principal Social Worker Networks for adults. The Chief Social Worker’s office will continue to promote the social work sector as a place to work and thrive, as well as helping to embed leadership and best practice guidance across the existing social care workforce.

Similarly, the Chief Nurse for Adult Social Care, Deborah Sturdy, champions and raises the profile of nursing in social care, including a joint initiative with the Florence Nightingale Foundation for a black and minority ethnic adult social care nursing leadership programme. Moreover, Skills for Care promote a career roadmap for the role of nursing and nursing associates, with a view to increasing student nurse placements in adult social care. In the 2023 to 2024 financial year, we will commission Skills for Care to produce new, expanded recruitment and retention best practice toolkits.

Building support and communication networks for people working in care

We are developing a website for the care workforce which will provide them with access to support, information and advice on careers in adult social care. This will include explanation of the newly developed care workforce pathway and other useful information about careers and career structures. We are also developing a verified record of their qualifications and training, which they can take with them throughout their careers. This will establish a foundation for registration of staff in the future and will reduce unnecessary repeat training, giving employers the confidence to invest in their staff.

Reform evaluation

All of our investment will be underpinned by an evaluation strategy which will see increased data collected through the Adult Social Care Workforce Data Set (ASC-WDS) and the launch of an adult social care workforce survey. This will create a new baseline of data against which we can analyse the impact of this and future investment in the workforce.

Workforce recognition and career development - key milestones

Recognising adult social care as a profession

Spring 2023:

• launch of the care workforce pathway call for evidence with a period of sector engagement

Autumn 2023:

• publication of the first care workforce pathway

Supporting career progression and development

Spring 2023:

• development of the new Care Certificate and digital leadership qualifications commences

Autumn and winter 2023:

• commencement of funding for new training places and contributions to the cost of continuing professional development for eligible, registered staff

2024:

• commencement of funding for places on the new Care Certificate qualification

By spring 2025:

• introduce a digital skills passport to improve portability of training

Digital transformation in adult social care

Although we saw rapid progress following the start of the COVID-19 pandemic, the adult social care sector lags behind the NHS in its digital working. This means that people experience disjointed transitions between NHS and social care settings, impacting on the speed, convenience and success rate of discharges into social care and the community. Low digital maturity also prevents adult social care providers and staff from sharing in the benefits of digital technologies, including reduced admin time for care workers. We recognise not all people will want to use technology as part of their care, but it is important that care teams have the right digital tools and data to enhance the quality of care provided.

The People at the Heart of Care white paper recognised the transformative power of technology in improving the quality, safety and personalisation of care, while helping people who draw on care and support to live the lives they choose with greater independence. When we published this white paper, only about 40% of providers had a digital social care record (DSCR). Cyber security compliance was also low, with 39% of providers compliant with the Data Security and Protection Toolkit (DSPT), which is the most basic level of cyber security compliance. We also know^{[footnote 1]} that as many as 62% of care homes do not have a reliable internet connection, and 45% of providers express concern that care staff lack the necessary skills to adopt digital technologies with confidence.

We have made good progress so far, spending nearly £50 million to support digitisation and ensure good data protection and cyber security practices. Provider uptake of DSCRs has increased by approximately 10 percentage points and compliance with the DSPT has increased by around 17 percentage points. We have developed an assured supplier list that supports providers to invest in a digital record solution that is compliant with interoperability and cyber security standards, with 12 software suppliers currently on this list. We recently published a Telecare stakeholder action plan to support the sector ahead of the move from analogue to digital and we will be launching guidance to help providers and local authorities understand ‘what good looks like’ for digital working in adult social care in spring 2023.

This year we have pioneered an integrated way of working with partners in local authorities through a collaboration with the Local Government Association (LGA) and the Association of Directors of Adult Social Care Services (ADASS). We are committed to working with partners to improve the confidence and capability of commissioners of care within local authorities. We expect that for people whose care is funded by the local authority, technology is considered from the very start and that commissioners of care understand the transformative potential of technology when integrated into care and support packages. We will continue to work with partners in ICSs, including local authorities, the NHS and other relevant organisations, to share and embed best practice and shape future national policies and projects.

We are investing over £100 million over the next 2 years to:

• drive rapid adoption of digital social care records - this will enable secure sharing of information across health and care services and will free up time for care staff and managers
• test, evaluate and scale technologies based on local priorities, building the evidence base for future investment - this will increase the use of technologies that improve the quality and safety of care, reduce avoidable hospital admissions, and promote independent living
• support care providers to boost their digital readiness, including digital skills, connectivity and cyber security - this will give the social care workforce the confidence, skills, support and infrastructure to effectively use technology to provide high quality care

Driving rapid adoption of digital social care records (DSCRs)

DSCRs enable information to be shared securely and in real-time with authorised individuals in the NHS and social care. This allows people to experience outstanding, safe, personalised care and support from care teams with the most accurate, up-to-date information at their fingertips. These records increase workforce capacity by freeing up time spent by care staff and managers on administrative tasks, releasing up to 20 minutes per care worker per shift that can be spent delivering high quality care and support.

All of these systems allow approved unpaid carers, including family members, to view these records, and several offer secure access for approved staff to view appropriate information from a person’s primary care record via GP Connect. We are continuing to extend this capability over time, as access to this information can reduce the risk of errors and create time savings for care teams who might otherwise chase information by phone.

Since the publication of the People at the Heart of Care white paper we have already supported over half of people accessing regulated care services to have a DSCR. We will ensure 80% of CQC-registered providers, and over 80% of people in receipt of care, have a DSCR by March 2024. This will mean hundreds of thousands more people will experience higher quality, safer and more personalised care as a result.

Our support offer includes matched funding for the up-front costs of adopting a DSCR and funding for ICS hosted staff who provide direct implementation support to providers adopting DSCRs and other care technologies. We have launched an assured supplier list to ensure care providers have the confidence to purchase a solution that meets security and interoperability standards. There are currently 12 assured suppliers on this list.

Our delivery approach is responsive to feedback and the needs of care providers. We will shortly trial a streamlined version of our support offer for providers on the CQC’s Market Oversight list who have experienced increased administrative burden in working across multiple ICS footprints to access support. This approach will offer a more limited package of financial support accessed through a central mechanism, reducing friction and offering improved value for money. We will evaluate this pilot to inform our approach for the next 2 years to ensure the largest providers are not disadvantaged in accessing support.

As adoption of DSCRs is quickly becoming fundamental in capturing and sharing information, the CQC will soon support digitisation through recognition in the single assessment framework, specifically by linking to best practice that improves the safety and quality of care. We will work in partnership with the CQC to communicate this approach to the sector.

Testing, evaluating and scaling care technologies

This year, our focus has been on supporting providers to implement remote vital signs monitoring and falls prevention and detection technologies. These have shown promise in reducing the number of hospital admissions.

To offer local systems increased flexibility over the outcomes and technologies they prioritise, we are enabling ICSs to have greater choice in identifying the right digital technologies for people drawing on their care and support services. We will do this by supporting local systems to test and adopt care technologies that address local priorities, providing implementation and evaluation support to develop an evidence base to scale technologies where there are proven benefits.

Digital technologies include specialist solutions to support delivery of care, technologies for providers to facilitate care, and consumer devices, smart home technologies or telecare that can help people live more independently. The use of smart home technologies can significantly improve an individual’s quality of life, enabling customisation of their home environment according to needs. AI-enabled sensor-based technologies, which identify changes in a person’s daily routine, can play an important role in supporting people to live more independently in their own homes and communities, alerting people’s care and support network to their needs. Medication management technologies can support people with their prescription, helping keep them well at home for longer. Other digital technologies, like reminiscence and arts-based solutions such as music therapy, can enrich the lives of people living with dementia. Simple games and memory exercises can be used via smartphone or tablet apps, enabling a person to conduct such exercises alone or with the help of a care worker or loved one.

Improving digital skills

Aligned with the wider workforce activity, we are delivering a comprehensive digital learning offer, starting with an updated digital skills framework to set out which digital skills staff need, and a training database to help employers and staff plan and access their digital learning.

We are also launching new e-learning courses, a new qualification in adult social care digital leadership and an improved website to host training and guidance on technology adoption. This offer will complement the wider support package for the adult social care workforce described in this paper, so that digital skills are embedded in core training and support career development.

Connectivity infrastructure and cyber security upgrades

Over the next 2 years we will support providers to improve their connectivity and take an approach to improving cyber security that encompasses the NHS and social care. To support national and local decision-making on care home connectivity we are developing a management information dashboard which will detail care provider broadband capacity and future likely dates of full fibre implementation.

We are also building on the Better Security, Better Care programme over the next 2 years to provide direct support to help providers take the necessary steps to improve their cyber security and become compliant with the DSPT.

Digital transformation in adult social care - key milestones

Digitisation (digital social care records and care technology)

Spring 2023:

• integrated care systems begin activity for financial year 2023 to 2024 to support the testing and scaling of care technologies
• guidance published on ‘what good looks like’ for digital working in social care

Winter 2023:

• all assured digital social care record systems will enable care provider staff to view primary care information, where appropriate, for people in their care

Spring 2024:

• all assured digital social care record systems will capture a minimum data set for social care providers, providing a standardised set of information that can be shared between care settings
• evidence base published following the testing of care technologies where they have demonstrated benefits to the safety and quality of care delivery
• 80% of CQC-registered providers, and at least 80% of people, have a digital social care record

Spring 2025:

• published update to the evidence base of care technologies that have demonstrated benefits to the safety and quality of care delivery

Personalising care through stronger data and local authority assurance

As the People at the Heart of Care white paper set out, we do not have sufficient data and information on how well care and support is delivering good outcomes and promoting wellbeing for people across England. Better data and insights across local authorities and care providers, together with a new way to assess how well local authorities are supporting people with care and support needs and unpaid carers, will help us know whether our social care reforms and investment have been successful.

Data matters in social care. Data can be used by people who draw on care and support and unpaid carers to make more informed choices and have control over their care. It can be used by the workforce who deliver care and support, to tailor care to meet people’s individual needs and deliver more joined-up care services. The sector has come a long way, and there are a variety of ways in which the sector currently uses national and local data. However, there is still much more to do to ensure we are collecting the right data in a streamlined way, while improving access to and insights from that data. Our roadmap for delivering data transformation is set out in ‘Care data matters’, which was recently published in draft and includes a series of questions posed to people who draw on care and support, unpaid carers, providers, local authorities and more to gather their views on the data they need to commission, deliver and oversee care and support.

Alongside our data strategy, the Health and Care Act 2022 created a new duty for the CQC to independently review and assess how well local authorities deliver their social care responsibilities. CQC assessments will, from April 2023, start to enhance transparency, improve local accountability, and help identify good practice so that more people can benefit from high quality care and support. They will also help identify where further support is needed and help shape our improvement offer to local authorities. Improved data can be used by local authorities to support them with meeting their social care responsibilities, such as monitoring safeguarding concerns in their area and enabling stronger oversight and shaping of the care market.

As set out in the delivery plan for recovering urgent and emergency services, we are also improving the availability of data to assess the effectiveness of hospital discharge. We are working with the Department for Levelling Up, Housing and Communities (DLUHC), local authorities and the Office for Local Government (Oflog) to ensure that discharge metrics are included in the wider set of metrics that Oflog will publish from later this year. The CQC will also consider this metric as part of its new assessment of the performance of ICSs, and of local authorities in carrying out their adult social care duties.

We are investing up to £50 million over the next 2 years to:

• streamline and improve data collection. This will mean that people will benefit from their local authority, their care providers and central government being able to better understand their care journey and outcomes and plan for their care
• establish new data collections and bridge data gaps. This will mean that we will have much better information about the experiences of people drawing on care and support, our social care workforce and unpaid carers, so support can be targeted more effectively
• improve access to data and produce better insights from this data. This will mean that, from next year, everyone will benefit from local authorities, care providers, and central government having a more joined-up view of all key data relating to adult social care. This will improve our understanding of people’s experiences and outcomes, decision-making and commissioning
• introduce CQC assessment of local authority delivery of their adult social care responsibilities, which will roll out from April 2023. Combined with improved data and insight, this will mean that, over the course of 2023 to 2024, people will be able to better understand the quality of adult social care in their area, increasing both transparency and local accountability

Streamlining and improving data collections

To better understand people’s journey through the health and care system - including people who draw on care and support and unpaid carers - we will collect person level social care data, referred to as the client level data collection. Working with local authorities, from April 2023 the client level data collection will allow social care data to be linked with health data for the first time to support joint planning and commissioning.

To give providers more time to focus on delivering high quality, personalised care, we are launching a streamlined care provider data collection. This will provide government and local authorities with greater provider insight and will remove duplication and burdens on providers as far as possible.

We are also strengthening the Adult Social Care Survey and Survey of Adult Carers in England so that people’s voices can be heard more clearly. This information can be used locally and nationally to improve our understanding of people’s experiences and outcomes in social care.

Establishing new data collections and bridging data gaps

We are launching a survey to better understand the experience of the adult social care workforce. It is being conducted by Ipsos, in consortium with Skills for Care and University of Kent, who will collect data directly from the adult social care workforce over 2 waves: one planned for summer 2023 and one planned for summer 2024.

The survey will include questions that aim to measure work-related quality of life in an adult social care context. It will be conducted on a sample of workers in care-providing roles, regulated professionals, and registered managers. The survey will contribute to our understanding of how factors such as working conditions, organisational characteristics and workplace culture affect work-related quality of life and wellbeing, and it will help us investigate the links between these factors and workforce retention.

Improving data access and producing better insights

In February 2023, we set out our roadmap for improving adult social care data in Care data matters. As part of that roadmap, we have asked for feedback about what data is needed for planning, commissioning and delivering care by 31 July 2023 - including by people who draw on care and support, unpaid carers, care providers, local government and others. We will publish a final version of ‘Care data matters’ in the winter.

A key part of our data strategy is improving how social care data is shared across the sector, making it easier for care providers and local authorities to access and use the data they need to support care provision. In 2024, we will launch a new digital product that provides the sector with a single point of access to social care data. Over time, this will improve the insights we can all draw from data, making it easier to increase our shared understanding of how care and support is being delivered. It will also support local areas to benchmark and improve their services.

We are also improving how we monitor people’s outcomes across adult social care, including people who draw on care and support, unpaid carers and the workforce. We are doing this by strengthening the metrics used in the adult social care outcomes framework (ASCOF) - through ‘Care data matters’, we launched a first update to ASCOF that will apply from April 2023. This will maximise the framework’s value at local, regional and national levels in monitoring the outcomes that matter most to people. From spring 2025, we will launch a further update to ASCOF that will make use of the new data sources mentioned above.

Finally, the Office for Local Government (Oflog) will also contribute to local government transparency and accountability. Oflog will be a new organisation which will provide an accessible source of information about the performance of local authorities and how well services are being delivered. Oflog will empower citizens to hold leaders to account, strengthen local leaders’ and councils’ knowledge of their services, and increase central government’s understanding of local government performance, and its ability to offer timely and targeted support.

CQC assessments of local authority social care responsibilities

Good quality care and support enables people to live fulfilling, independent lives. CQC assessment of local authorities will increase transparency and local accountability, meaning people will be able to hold their local authority to account. This will help enable access to the consistent, high quality care and support that everyone deserves - irrespective of where they live. The Health and Care Act 2022 created a new duty for the CQC to independently review and assess local authorities’ performance in delivering their adult social care responsibilities.

As required in the Health and Care Act 2022, ministers have set out their initial priorities for the CQC to consider as part of its assessments. The CQC will provide extra reports to ministers on the following areas:

• access to care for those who need it, including people who are discharged from hospital
• personalisation of care to meet the needs of individuals and their carers
• commissioning to support good care outcomes
• supporting a vibrant and sustainable local care system
• workforce support and development

Since the publication of the People at the Heart of Care white paper, we have worked with the CQC, local government and people who draw on care and support and their friends and families to develop the approach to these assessments, including the Secretary of State’s key priorities for them. We have laid the regulations that enable the CQC to carry out its new duty and set out which of their responsibilities local authorities will be assessed against. The CQC’s duties to assess local authorities will commence from 1 April 2023. Beginning from this date, the CQC will undertake an initial evidence-gathering exercise and complete a number of pilot assessments with around 5 local authorities. Between October 2023 and March 2024, the CQC will assess up to 40 local authorities. All 152 local authorities will be assessed over a baselining period of 2 years. Local authorities in England will be assessed against certain prescribed duties under Part 1 of the Care Act 2014, with the CQC forming judgements of quality, looking at:

• how local authorities work with people
• how local authorities provide support
• how local authorities ensure safety within the system
• leadership

Following assessment, the CQC will publish a narrative report containing an overall rating for each local authority. It will make good practice, positive outcomes and outstanding quality easier to spot and share nationally, and it will also enable DHSC to identify issues, targeting support accordingly to improve performance and outcomes. The pilots of the CQC assurance framework will help to test approaches which are proportionate, minimise burdens, rely on existing data collections wherever possible, and maintain the integrity of the single data list (SDL).

Assurance and data - key milestones

Streamlining and improving existing data collections

Spring 2023:

• all local authorities begin submitting person level data every quarter (client level data collection)

Winter 2025:

• develop and launch a national minimum provider-level data set

2025 to 2026:

• relaunch the Adult Social Care Survey and Survey of Adult Carers in England

Establish data connections and bridge gaps

Summer 2023:

• launch a social care workforce survey collected directly from the formal social care workforce

Improving data access and producing better data insights

Spring 2023:

• first update to adult social care outcomes framework

Winter 2023:

• launch a finalised publication of ‘Care data matters: a roadmap for better data for social care’

Winter 2024:

• produce a single digital product which gives the sector a single point of access to all available adult social care data

Autumn 2025:

• further update to the adult social care outcomes framework

CQC assurance framework

Spring 2023:

• legislation comes into effect so that the CQC can begin rolling out its local authority assessment framework

Spring and summer 2023:

• the CQC begins gathering intelligence and piloting the new local authority assessment framework with up to 5 local authorities

Autumn 2023:

• the CQC will begin baselining local authorities’ performance over the next 2 years, assessing up to 40 more local authorities between October 2023 and March 2024

Autumn 2025:

• all 152 local authorities will have been assessed by the CQC

Supporting people to remain independent at home

The People at the Heart of Care white paper highlighted the importance of the right housing in helping people to live independently in the community. We set out our ambition for local places to join up housing, health and care services. This included providing more choice in local communities and creating the local conditions to increase the supply of specialist and supported housing. Since the white paper was published, many local places have made significant progress to do just that.

By coming together to develop new partnerships and undertaking work to better understand the needs of their local community, many places have produced robust new plans and long-term strategies. This work will be crucial in helping to shape local markets in those places and improve services for residents. We will continue to work with local government partners to support this valuable work and will look to see it replicated more widely across England. We will also work with Homes England, the Greater London Authority, and the Regulator for Social Housing to understand the barriers to accessing capital grants to increase the supply of supported housing, and ensure value for money is provided for both self-funders and welfare spend.

The white paper also recognised that many people are currently living in homes that are either not set up to safely support them to live well, or may soon not be if their needs change. Staying independent and safe in your own home all starts with how the home is set up to meet your needs. This could be a significant feature such as a level access shower - but, equally, smaller changes such as grab rails, digital technology or fixing a trip hazard like a broken step could make all the difference. Services that provide the right adaptations, or fix those small issues around the home, have a crucial role in supporting older and disabled people to maintain their independence at home.

We are investing an additional £102 million over 2 years to increase the level of housing adaptation support available in local areas - this will help people stay at home for longer if that is what they prefer, or to get home more quickly after a stay in hospital.

We are also launching a new, independently chaired Older People’s Housing Taskforce that will make recommendations to ministers on how we can unlock investment in retirement housing to provide more choice of suitable housing for people in later life.

A home set up to meet your needs

The Disabled Facilities Grant (DFG) already provides funding for individuals to make substantial adaptations to their homes - with around 50,000 grants every year. But we need to complement this with agile, adaptive services to provide more modest interventions and assistance in quicker time.

Therefore, from spring 2023 we will be investing an additional £102 million over 2 years to increase funding and support for people to adapt or maintain their homes. This new money will be distributed as a capital top up to the £573 million per year DFG funding and managed in the same way through the BCF.

Local housing authorities already have flexibilities to use their DFG funding to fund supplementary services that are agile and help people stay independent, support hospital discharge and make minor adaptations. There are lots of examples of local authorities already doing this effectively - for example, through the commissioning and delivery of Home Improvement Agencies. We want to encourage local authorities to use this additional funding to provide more of these supplementary services, with the support of the recently updated guidance for local authorities to better assist their residents. This will better ensure safety, warmth and timely access to the right adaptations and small alterations.

Older People’s Housing Taskforce

The Older People’s Housing Taskforce will be a new, independently chaired taskforce jointly hosted by DHSC and DLUHC. The taskforce will have a particular focus on how to create the regulatory and market conditions to unlock private investment in new developments for retirement housing.^{[footnote 2]} We are currently working with DLUHC towards a spring 2023 launch. We expect the taskforce to complete its work in around 12 months, with interim findings available after 6 months. It will deliver recommendations to ministers for driving an increase in the volume and range of housing options for older people.

Building the Right Support Delivery Board

We recognise the importance of work to improve housing options for people with a learning disability and autistic people to enable people to live well in their communities. The Building the Right Support Delivery Board is chaired by a DHSC minister and brings together representatives from responsible government departments and local systems. Building the right support seeks to reduce reliance on mental health inpatient care for people with a learning disability and autistic people by improving community support. The board oversees implementation of the Building the Right Support Action Plan, published in July 2022, which includes commitments from across government and public services, including actions in respect of housing.

Supporting people to remain independent at home - key milestones

Home adaptations - to help people stay at home and get back home

Summer 2023:

• funding distributed to local authorities and managed through the Better Care Fund

Older People’s Housing Taskforce

Spring 2023:

• the Older People’s Housing Taskforce is launched

Spring 2024:

• the Older People’s Housing Taskforce concludes and delivers recommendations to ministers

Driving innovation and improvement

We have seen the way that new models of care, including technology enabled care, can improve quality of care and outcomes for people. For example, the NHS’ shared lives schemes have been scaled up across the country to offer greater flexibility and more community-based care. Embedding innovative approaches to delivering care can ensure that care is more personalised, supports individuals to live more independently for longer, and can adjust to the needs of future populations. However, while local authorities and the care sector have been innovating for decades, there is a tendency for impactful innovations to remain on the margins, rather than becoming the mainstream way of delivering care and support.

With the support of our sector-led improvement partners, local authorities and providers work hard to improve their delivery of care and support. We recognise the ongoing importance of improvement to the adult social care sector in the context of reform, including the introduction of the CQC’s assessment of local authorities.

We are continuing to fund improvement activity to ensure that the sector is supported to deliver the best possible care. For example, we are supporting local authorities to improve their commissioning to deliver more personalised care.

We are establishing a new social care innovation and improvement unit to develop and define clear priorities with our partners. We want to support local authorities to look beyond the immediate challenge of delivering good care now and have the capacity and support to trial, adopt and scale new approaches to delivering care. The unit will do this by bringing together experts and innovators and funding innovative local projects. We will also continue to invest in helping local authorities to lead their own improvement and deliver their statutory adult social care duties, including on how they commission and shape their markets. Supporting local authorities to deliver outcomes-based commissioning is key. That is why we are committed to strengthening commissioning capabilities, to ensure they are working in partnership with people who draw on care and support, providing them with choice, promoting their wellbeing and delivering them personalised care that maximises independence.

We are investing at least £35 million over the next 2 years to:

• support local systems to trial and scale innovative approaches to transform the quality of care - this will increase to access high quality, personalised care that empowers people to lead independent and fulfilled lives
• innovate and improve local authority strengths-based assessments and engagement with people and their carers - this will make the assessment processes simpler and more accessible for people and their carers
• work with sector partners and across government to understand operational challenges and regional variations to direct support to where it is most needed - this will better enable local authorities to have the capacity and capability to deliver personalised, high quality and financially sustainable services that meet the care needs of local people

Providing funding to support local systems to trial and scale innovative approaches to transform the quality of care

As part of its role in providing targeted support to the sector, the innovation and improvement unit will support local authorities to develop, commission and deliver innovative approaches to care and it will ensure that we build in consultation, engagement and co-production to ensure that any new models of care are person-centred. All of this will be underpinned by evaluation, so there is a framework in place to scale and embed models that work and facilitate peer-to-peer learning to help innovations become mainstream.

Innovating and improving local authority assessments and engagement with people and their carers

We have seen excellent examples of innovative digital solutions and new operating models being developed that increase local authorities’ ability to conduct more assessments for the people who need them. However, these approaches are not widespread and there is scope to go further to scale and embed innovative ways of working. To achieve this goal, we will work with IT suppliers and local authorities, supporting local areas to trial and invest in innovative approaches, share best practice examples and explore how successful approaches can be scaled up.

This activity will enable local authorities to drive efficiencies and improve their responsiveness by decreasing waiting lists, and will pave the way for charging reform implementation.

Working alongside our sector partners to direct support where it is most needed

We are working with delivery partners to provide a suite of improvement and support options to help local authorities lead their own improvement. The innovation and improvement unit will provide challenge and advice on the most effective levers for change and support local authorities to share best practice.

Where improved data, intelligence or the CQC’s assessment of a local authority’s performance identifies a serious and persistent risk to people’s safety and wellbeing, we want to take a more active role in supporting local authorities to improve.

Our priority will remain supporting local authorities to lead their own improvement wherever possible. Where a local authority has not been able to tackle sustained problems, new powers will enable the Secretary of State to intervene if satisfied the local authority is failing to discharge any of its functions under part 1 of the Care Act 2014. We expect these powers are likely to be used in the most serious cases - for example, where a serious and persistent risk to people’s safety has been identified, and other forms of support are insufficient to drive improvement.

Our new CQC assurance of local authorities will improve our understanding of how, and where, local authority commissioning practice supports providers to offer good quality care. To ensure this information results in better commissioning and outcomes for people, we are also developing specific support to strengthen local authority market shaping and commissioning. This programme will include:

• the design and delivery of a new package of support to upskill commissioners with taking strategic, preventative and outcomes-based approaches and making the best use of data
• the development of clear standards for commissioners
• improving local authority access to data and market intelligence by supporting data-pooling at regional levels. This will include tools and guidance on using data analysis to inform commissioning and market shaping decisions
• a central repository to ensure easy access and clearer signposting to guidance and best practice
• establishing strategic oversight for driving improvements in commissioning activity as part of the innovation and improvement unit

Innovation and improvement - key milestones

Innovation and improvement unit

Throughout 2023:

• developing a 2-year programme of work to test and scale the use of digital tools and new operating models
• innovating local authority assessment processes
• consultation with the care sector, led by the Chief Social Worker, to develop a set of principles around proportionate assessment approaches, which streamline the care and needs assessment process
• launching Care Act training to support local authorities to develop varied assessment approaches and to maximise the use of their non-registered local authority social care staff

Spring 2023:

• best practice examples, practical toolkits, training, and expert, tailored support to be made available, delivered by sector partners to help local authorities lead their own improvement

Spring and summer 2023:

• working with sector partners to develop a new approach to supporting local authorities where improved data, intelligence and the CQC assessment of performance identifies worrying performance. This includes publishing, in spring 2023, information about the operation of the new intervention powers

Joining up services to support people and carers

Care is best when it is centred on the person’s needs, and an integrated response to those needs across different services supports the person to have the best possible life. There are many outstanding examples across England of integrated services providing personalised care, and we have already set up systems and structures to support the integration of health and social care services. The Health and Care Act received royal assent in April 2022 and ensures that every part of England is covered by an integrated care board (ICB) and an integrated care partnership (ICP). This includes duties on ICBs to involve carers, where appropriate, in relation to any services for the prevention, diagnosis, care and treatment of the person they care for.

We have set out opportunities to progress even further with joining up health and social care at a local level in the Joining up care for people, places and populations white paper. These changes are improving the way NHS bodies and local authorities are commissioning care, enhancing appropriate information sharing and ensuring all needs are being considered when people are drawing on health and care services.

Not only do many people not live in suitable homes that meet their support needs, but there are some people who do not have a home to call their own. The People at the Heart of Care white paper recognised the need for health, social care and other services, such as housing, homelessness and community support, to be joined up to provide a seamless care experience of person-led support. ADASS in partnership with the LGA has recently published good practice on supporting people experiencing homelessness, including best practice on how adult social care can support people sleeping rough. The government will continue to work with local areas to embed housing in broader health and care strategies.

However, integrated care is not yet the norm for everyone. We are therefore providing targeted support and funding to local areas to improve outcomes across health and care, which includes funding for specific training for local leaders. Our investment will be tailored to the needs of local areas and will focus on joining care up around the person to enable them to live their lives independently.

In Data saves lives, the data strategy for health and care, we set out a vision for data that moves seamlessly across health and care and has transparency at its core, giving people access to high quality, timely data to help them make choices about their care and improve outcomes. In the white paper on integration of health and care, ‘Joining up care for people, places and populations’, we committed that care providers would be able to connect to their local Shared Care Record within 6 months of having an operational digital social care record in place, enabling staff to appropriately access and contribute to the record. The work described in the digital transformation chapter of this document will be instrumental in realising this vision for more integrated health and social care services.

We are investing up to £35 million over the next 2 years to:

• target support to local areas through the Better Care Fund Support Programme - this will provide tailored support to local areas to identify and tackle their most pressing challenges in a joined-up way
• better understand the impact of integrated support for unpaid carers - this will allow us to assess how effective current support is, to inform future action at a local and national level
• build leadership skills to support better integration of services - this will ensure that local leaders are equipped with the right skills and behaviours to successfully lead their organisations in a fully integrated way

Better Care Fund (BCF) Support Programme

Since 2015, the BCF has enabled local NHS services and local government to jointly invest in a range of preventative services. This has included supporting unpaid carers and providing housing adaptations via the Disabled Facilities Grant (DFG) to enable people to live more independently. It also promotes investment in improving safe and timely discharges from hospital, and funding for intermediate care services which provide support for a short time to help people recover from hospital and increase their independence.

The BCF will go further over the next 2 years to deliver these objectives through an expanded BCF Support Programme (delivered by the LGA in partnership with ADASS and Newton Europe). We will make best use of the available place-based data to target support to local areas to ensure they are delivering these aims, tackle particular pressures facing local social care or NHS services, and drive better outcomes for people navigating these services. Support will be tailored to local need but could include:

• equipping areas to manage and build sufficient capacity for intermediate care services
• embedding sustainable, local solutions to deliver safe and timely hospital discharge
• preventing avoidable hospital admissions
• supporting unpaid carers

The 2023 to 2025 BCF policy framework and planning requirements were published today, setting our requirements for local areas in more detail.

Building leadership skills to support better integration of services

The government is currently exploring options for a national leadership programme that will ensure leaders, particularly those at integrated care system (ICS) level, are equipped with the right skills and behaviours to successfully lead their organisations in a fully integrated way.

In recognition of the challenges facing ICS leaders to improve services, we are developing a national leadership programme to deliver training, share best practice and create a talent pipeline of future leaders across health, social care and the wider sector. Our intention is that the programme will address the skills required to deliver effective system transformation and promote behaviours that will influence cultural change within and across these sectors. This programme will also help to build locally the relationships and shared mission that we know is so important to successful integration.

Our integration leadership programme that is co-produced with system partners will ensure leaders are trained on understanding the importance and benefits of taking an integrated approach at the health and social care interface, to improve outcomes at place level and across the system. These outcomes will also be aligned with recommendations from the leadership review and will focus on setting greater cultural and behavioural expectations to tackle inequity across the system. Robust evaluation of the programme will take place including undertaking local surveys to assess the impact of the programme.

Understanding the impact of support for unpaid carers

There are key gaps in the evidence base surrounding the circumstances, experiences and needs of unpaid carers in England. We are taking steps towards implementing a new survey of unpaid carers which would capture the data and evidence needed to address these gaps. We will also strengthen the evidence base by working with National Institute for Health and Care Research (NIHR) to commission an evaluation of support provided to unpaid carers, funded through the BCF, including carer breaks and respite. In 2022 to 2023 this earmarked funding totalled more than £290 million.

The intention is that the evaluation will help inform local decision-making around what to commission and how to deliver effective support services for unpaid carers, as well as national policymaking. In the BCF policy framework, we are also requiring local areas to outline their plans to support unpaid carers. We will improve the clarity and transparency of spend on unpaid carers through BCF reporting requirements and activity data.

As part of the CQC assessments, local authorities will need to demonstrate how they are supporting unpaid carers, recognising their needs are distinct from those with care needs, and ensuring their wellbeing and independence are looked after.

We will also be investing up to an additional £25 million for unpaid carers, in line with our funding commitment in the People at the Heart of Care white paper. Further detail will be set out in due course.

Key milestones timeline

See a visual of the reform plan timeline

Spring 2023

For improving access:

• publish Market Sustainability and Improvement Fund (MSIF) detailed grant conditions and guidance
• local authorities submit baseline MSIF metrics for 2023 to 2024
• the current national recruitment campaign will run until 31 March 2023

For workforce:

• launch care workforce pathway call for evidence with a period of sector engagement
• commence development of the new Care Certificate and digital leadership qualifications

For digitising social care:

• integrated care systems begin activity for financial year 2023 to 2024 to support the testing and scaling of care technologies
• publish guidance on ‘what good looks like’ for digital working in social care

For data and assurance:

• all local authorities begin submitting person level data every quarter (client level data collection)
• first update to adult social care outcomes framework
• legislation comes into effect so that the CQC can begin rolling out their local authority assessment framework

For independence at home:

• launch of the Older People’s Housing Taskforce

For innovation and improvement:

• make available best practice examples, practical toolkits, training, and expert, tailored support, delivered by sector partners, to help local authorities lead their own improvement
• publish the 2023 to 2025 Better Care Fund policy framework and planning requirements

Summer 2023

For improving access:

• local authorities submit MSIF capacity plans for 2023 to 2024
• international recruitment regional support funds are awarded and in operation
• launch a range of support products to enable better and smoother international recruitment

For data and assurance:

• launch a social care workforce survey collected directly from the formal social care workforce
• the CQC begins gathering intelligence and piloting the new local authority assessment framework with up to 5 local authorities

For independence at home:

• funding is distributed to local authorities and managed through the Better Care Fund

For innovation and improvement:

• develop a new approach to supporting local authorities where improved data, intelligence and the CQC assessment of performance identifies worrying performance
• publish information about the operation of new intervention powers

Autumn and winter 2023

For improving access:

• publish data quarterly on care worker visas
• conduct formal sector engagement on international recruitment
• fund regional partnerships and facilitate local support networks
• expand the NHS Volunteer Responders programme into adult social care

For workforce:

• publish the first care workforce pathway
• commence funding for new training places and contributions to the cost of continuing professional development for eligible, registered staff

For digitising social care:

• all assured digital social care record systems will enable care provider staff to view primary care information, where appropriate, for people in their care

For data and assurance:

• launch a finalised publication of ‘Care data matters: a roadmap for better data for social care’
• the CQC begin baselining local authorities’ performance over the next 2 years, assessing up to 40 more local authorities between October 2023 and March 2024

For innovation and improvement:

• innovation and improvement unit develop a 2-year programme of work to test and scale the use of digital tools and new operating models
• innovate local authority assessment processes
• consultation with the care sector, led by the Chief Social Worker, to develop a set of principles around proportionate assessment approaches, which streamline the care and needs assessment process
• launch Care Act training to support local authorities to develop varied assessment approaches and to maximise the use of their non-registered local authority social care staff

2024

For improving access:

• local authorities submit updated MSIF metrics for 2024 to 2025

For workforce:

• commence funding for places on the new Care Certificate qualification

For digitising social care:

• all assured digital social care record systems will capture a minimum data set for social care providers, providing a standardised set of information that can be shared between care settings
• publish an evidence base following the testing of care technologies where they have demonstrated benefits to the safety and quality of care delivery
• 80% of CQC-registered providers, and at least 80% of people, have a digital social care record

For data and assurance:

• produce a single digital product which gives the sector a single point of access to all available adult social cate data

For independence at home:

• the Older People’s Housing Taskforce concludes and delivers recommendations to ministers

2025

For improving access:

• publish an evaluation of the NHS Volunteer Responders programme expansion into adult social care

For workforce:

• introduce a digital skills passport to improve portability of training

For digitising social care:

• publish an update to evidence base of care technologies that have demonstrated benefits to the safety and quality of care delivery

For data and assurance:

• develop and launch a national minimum provider-level data set
• relaunch the Adult Social Care Survey and Survey of Adult Carers in England
• further update to adult social care outcomes framework
• all 152 local authorities will have been baselined by the CQC

1. Ipsos MORI, Institute of Public Care and Skills for Care (2021), NHSX Adult Social Care Technology Innovation and Digital Skills Review. ↩

2. Care homes are excluded from the Older People’s Housing Taskforce. ↩