After a hectic morning chairing a Select Committee, fielding Prime Minister’s Questions, and meeting with everyone from the BBC to the Fire Brigades Union, Dame Caroline reflects candidly on a sector that, for decades, has faced political inertia. “Care is one area I’ve lived and breathed,” she says, both professionally and personally.
A crisis deferred
Dinenage pulls no punches when it comes to governments’ long-standing failure to reform adult social care. “Successive governments have looked at the issues of adult social care and put them in the ‘too difficult’ pile,” she says, describing the recurring cycle of reports, reviews and rhetoric that have led nowhere.
While she helped publish a landmark white paper during her time in office, she points out that the opportunity to implement meaningful change was missed. First, it was delayed by the pandemic and now, continued government hesitation. A fresh review has been commissioned by Dame Louise Casey, but it will not finish reporting until 2028.
For Dinenage, this timeline is not only frustrating but also irresponsible. “It’s too late,” she says. “We’ve had all the words. Now is the time for action”. This delay, she warns, is contributing to growing pressures on the NHS, housing and local government.
“No one’s grasping the nettle,” she says, “and that is causing a huge amount of expense, worry, and unnecessary time in hospital for people who don’t need to be there”.
Making progress, then losing it
One of Dame Caroline’s most notable achievements as Care Minister was launching the Carers Action Plan in 2018, a cross-departmental document with more than 60 deliverable goals. However, as she explains, the initial draft focused too narrowly on carers within the Department of Health. “There was nothing in there for young carers, for carers in employment, or for those navigating the benefits system,” she recalls.
She says she subsequently convened a roundtable of ministers across departments including Education, Work and Pensions, and Business. She also ‘broadened the scope to include issues ranging from employment rights to carer wellbeing’. The plan was monitored and reported on annually until 2020. After that point, she notes, it simply “disappeared”.
Frustrated by the lack of follow-up, the All-Party Parliamentary Group on Carers, which she is an Officer of, conducted its own audit. “We found most of it had actually been delivered, but without fanfare, and in some cases, quietly dropped,” she says.
One such initiative was the Carers Innovation Fund. It was initially recommended at £500,000 and subsequently increased to £5 million. “We had the money; we had the plan and then [the pandemic] happened. It never got delivered”.
Still, she sees the legacy of the plan in recent progress, such as the legislation on carers’ leave championed by Wendy Chamberlain. However, for her, the real prize remains a long-term, holistic strategy. “The action plan was good,” she says, “but now we need something bigger, something enduring”.
No time for political games in social care
Dinenage is a long-time advocate of a cross-party approach to care reform. She argues that political point-scoring has stalled meaningful change for too long.
We’ve had all the words. Now is the time for action
“Every time someone proposes a fix, it gets weaponised”, she says, referencing the infamous “dementia tax” debate that undermined efforts for funding reform. “Unless we stop using care as a political football, nothing will ever change”.
She is also firm that any discussion of social care must go hand in hand with NHS reform. “The two are completely interlinked. You can’t address one without impacting the other”.
That belief underpins her view that a new ministerial title would do little to solve the problem. “You don’t need a new role. You need the minister responsible to grab the bull by the horns and get on with it”.
She argues that urgency is essential, particularly given the personal sacrifices made by millions of carers. “They save the NHS billions … but they do it at the expense of their own health, careers and relationships”.
Speaking from personal experience, she recalls watching her mother care for her grandmother, who was living with dementia, while also helping to look after her infant grandson. “She was part of that sandwich generation, trying to balance everything. It’s unsustainable without support”.
Fixing the system
On pay reform, Dinenage is pragmatic. A national care wage might seem ideal, but she warns that it is important to allow local flexibility. With such variation in demand and supply across the country, she argues that imposing a single framework could backfire.
That said, she is clear that workforce issues cannot be ignored, particularly the strain that inadequate social care places on the NHS. “We all know about delayed discharges. People stuck in hospital beds not because they need to be there, but because there’s nowhere else for them to go”.
Her solution lies in better intermediate care options, such as step-down facilities, which help people transition out of acute care settings. “Right now, everyone’s guarding their little pot of money. We need to shift the focus to what’s best for the individual”.
Technology, too, plays a critical role. While AI and advanced digital tools were less developed during her time in office, she saw innovation as a vital force for improvement. She recalls visiting care homes trialling acoustic monitoring, wearable tech and behavioural sensors.
“One place had acoustic listening in every room. Not only did it help keep residents safe, but it picked up that night staff were talking in daytime voices and wearing clumpy shoes. Small changes followed, and sleep quality improved dramatically”.
She is particularly excited about the use of AI-powered apps in home care. By recording daily observations, carers can help predict risks like dehydration or infections. “It’s not about robots replacing people. It’s about spotting problems early and keeping people out of hospital”.
Collaboration over competition
A recurring theme for Dinenage is the need for shared responsibility, not siloed decision-making. She is especially concerned that care providers are still treated as second-class citizens within the integrated care system. “Too often, care providers are seen as the poor relation in the health and care system. That’s fundamentally wrong”.
Although Integrated Care Boards were still in their early stages during her tenure, she believes the government must now set clear expectations to ensure social care is properly represented. “If not, it’s just a new name on the door and more of the same inside”.
Looking ahead, she fears the current course may lead to crisis. “We talk about people living longer as if it’s a problem. It’s not. It’s a triumph. But if we don’t help people live those extra years well … then it becomes a crisis”.
For Dame Dinenage, the answer lies in joining up care providers, local authorities, technology, and the people who deliver and receive care every day. “Everyone has to be part of the conversation. We cannot afford to leave anyone out”.
She closes with a dose of realism and a message of cautious optimism.
“The system is complex. It's bureaucratic. But there are so many people with brilliant ideas. We just need to get the right people in the room and have the courage to act”.
