A system under strain
For Danny Beales, the challenges facing adult social care cannot be separated from the wider health and economic picture. As a member of the Health and Social Care Committee, he has spent recent months examining what happens when reform is endlessly deferred.
“We reviewed adult social care, particularly through the lens of the cost of inaction,” he explains. “There’s been lots of reports about what has to change. We didn’t want to reinvent the wheel and go over that [old ground]. We wanted to look at the barriers to action and what the costs of not acting are.”
Those costs, he says, are both social and economic. “We know changing the social care system, making it either free at the point of use or providing a lot more services, costs money. But what is the cost of not doing those things?”
Beales acknowledges that successive governments have tried and failed to address the issue. “It’s been a politically charged issue for many years,” he says. “There have been different cases for reform that have often run out of steam. Politics has been part of that, but so has the piecemeal nature of changes ... tweaks at the edges rather than dealing with the underlying structure of the system.”
For him, the current Government’s approach must be about “fundamental reform” and building cross-party consensus. “The age and complex needs of our population are only going in one direction,” he says. “Getting people into work, keeping them there longer, supporting carers ... all of that depends on fixing social care. To fix our healthcare system, which is a key priority of the [Labour] Government, we have to fix social care. All roads lead back to it.”
Fixing what’s broken
The Committee’s report warns of worsening pressures if structural reform does not materialise soon. Beales believes short-term policymaking has held the sector back.
“We’ve often fallen at the first hurdle of social care reform because it’s been piecemeal,” he says. “There have been good intentions and good initiatives, but not much that’s fundamentally thought through how the system works, how it’s funded, and how you build consensus around it.”
He argues that reform must be done properly, even if that takes time. “I’m anxious for change like anyone else,” he says. “But a reform slightly later is much better than an abortive attempt that doesn’t deliver anything in five to ten years.”
That is why Beales supports the Government’s decision to commission a review led by Baroness Casey. “She’s keen to move forward with a series of stages, to make recommendations as she goes,” he says.
Critics of the review argue that reporting later in the Parliament risks delay, but Beales says the challenge lies in the absence of a ready-made solution. “If there was an off-the-shelf fundamental reform of the whole health and care system, someone would have produced it. We haven’t seen it [in the Health and Social Care Committee]. There are lots of ideas, but no consensus about the way forward.”
In social care, housing and health are completely interlinked. You can’t reform one without thinking about the others
He also stresses the need to spend existing money better. “We’re already spending quite a lot, but quite poorly,” he says. “Around four in ten hospital beds are occupied by people who are severely frail. About 60 per cent of healthcare costs go on six per cent of the population. Making that money work better for people has to be part of the solution.”
That means tackling what he calls “the silos that have appeared between social care, public health and the health system”. “We need to bring those budgets together,” he argues. “The Better Care Fund does a bit of that, but there’s a lot more opportunity to use the money we already have better. Whether in future commissioners of social care and health integrate, work differently or [operate] through a new body ... all of that needs to be on the table.”
Beales’s experience in local government shapes much of his thinking about reform. “When I worked in Camden, we were always aware that people’s lives don’t fit neatly into departments,” he says. “In social care, housing and health are completely interlinked. You can’t reform one without thinking about the others.”
From Camden to Westminster
Before entering Parliament, Beales spent a decade on Camden Council, including as Cabinet Member for New Homes, Jobs and Community Investment. That experience, he says, shapes his approach to reform.
“The types of housing we have and the flexibility of housing are major challenges for people,” he says. “From young families not having the right kind of accommodation to people with care needs, the lack of adaptability is huge. Adaptations are slow, getting assessments takes too long, and the system is really clunky.”
That disconnect, he argues, must be fixed nationally. “The interaction between health and care really doesn’t work in the housing space,” he says. “There’s no incentive for the local authority to invest because they don’t necessarily reap the benefits of keeping people out of hospital or more expensive facilities.”
The solution, he believes, lies in both refurbishment and design. “We need to invest in existing stock to make it more adaptable, but also future-proof new homes. Make sure they meet lifetime standards, include wheelchair-accessible accommodation, and are built with flexibility in mind.”
Having seen the pressures facing councils first-hand, Beales is cautious about assuming that simply moving social care funding from local to central government would fix the problem. “I don’t think there’s one answer,” he says. “There are options, but we have to start by using what we have better.”
Prevention, fairness, and the future of care
Across his constituency of Uxbridge and South Ruislip, Beales says inequalities in care remain stark. “The whole health and care system, the whole state really, has to focus on equity,” he says. “That’s not just about providing a standard service to everyone; it’s about working out who’s locked out from care, where the greatest need is, and focusing intervention there.”
He points to collaboration in his constituency as an example of reform already taking shape. “The GPs, the hospital trust, the community and mental health trust, the local authority and the voluntary sector have all come together,” he explains. “They’re establishing three neighbourhood health hubs across Hillingdon bringing a range of services together beyond general practice.”
The aim, he says, is to make care more joined up and locally responsive. “There’s a real commitment across the health and care system in Hillingdon to working that way,” he adds, “and I’m really pleased the Government has recognised that by making it a pilot site for neighbourhood health.”
Looking ahead, Beales says future reform must learn from the past. The 2012 Health and Social Care Act, he argues, “was a huge amount of resource and political capital that led us in the wrong direction.” Rather than integrating services, it “rearranged the deckchairs,” creating new structures but little practical change.
He contrasts that with what he sees as a renewed appetite for collaboration. “[Wes Streeting] is passionate about reforming public services,” Beales says. “He understands the system, he’s passionate about change, and he’s built positive relationships with health and care professionals. Previous governments often blamed those in the system for the system’s failings. This time, there’s more recognition that fixing public services is a shared endeavour.”
He finishes on a note of pragmatism and purpose. “There isn’t a single fix for social care,” he says. “But if we work collaboratively, spend better, and reform the system around prevention and fairness, we can make real progress. The longer we wait, the higher the cost of inaction.”
