LGC commentary on the Adass Spring Seminar
Adass Spring Seminar: CQC chief calls for ‘borderline illegal’ audacity
The Damian Green paper on the future of social care was published as the Association of Directors of Children’s Services Spring Seminar was set to start on Monday.
When questioned on the proposals, which would essentially institutionalise a two-tier care system by enabling those that can afford it to purchase added extras to a centrally-funded universal basic offer, delegates’ responses ranged from a shrug of the shoulder, a shake of the head, or the rolling of eyes.
The intervention of a former cabinet minister, albeit one who as de-facto deputy prime minister at the time was put in charge of the green paper’s initial development, perhaps should have piqued more interest as a useful insight into the thinking at the heart of government, providing clues to what will be in the final draft – when it arrives.
Some of the delegates who felt compelled to discuss Mr Green’s proposals bemoaned a lack of detail or dismissed it outright as a vanity project. However, others made it clear that it was well understood Mr Green was kite-flying policy proposals for health secretary Matt Hancock, whose repeatedly-stated “ambitions” to publish have hitherto ended in disappointment.
It was generally accepted by delegates that the chaos in government had not only delayed what should be a bold step to at last place social care on a sustainable footing but - as the Treasury struggles to quantify the cost of Brexit to public finances and memories of the political toxicity around the issue that poisoned the Conservative’s bid for election glory in 2017 remain fresh - that whenever it does come the green paper will be disappointing.
Gossip about drafts of green paper circulated the seminar, with the general consensus being that agreement on funding is yet to be reached and proposals on important issues such as housing, technology, workforce and the care market lack flesh on the bone.
In a typical performance characterised by political nous and bullish charm, NHS England chief executive Simon Stevens later on Monday played the role of an interesting and useful friend who you like but just can’t fully trust.
He continued to back the need for a sustainable funding for social care and insisted this was not just due to the benefits for the NHS. Mr Stevens also raised the issue of funding for children’s social care, and support for children with autism specifically. A welcome, and perhaps surprising, intervention but some delegates remained sceptical that Mr Stevens truly acknowledges the importance of wider council services that promote wellbeing in communities, rather than those he perceives can alleviate demand on health services in the shorter term.
In her inaugural speech on Tuesday, Adass president Jule Ogley alluded to this perception when she described “other partners trying to set the adult social care agenda”.
By drawing attention to the impact of welfare reforms and homelessness on people’s lives, Ms Ogley also raised an issue that cropped up during many discussions: what is social care and who is it for?
She also challenged her colleagues to consider whether social care services are fit for purpose and how they can be improved through a greater focus on housing and technology.
This need for service development was a continuing theme and a spirit of constructive challenge provided a welcome edge to proceedings.
During one session John Bolton, Adass associate and visiting professor at the Institute of Public Care at Oxford Brookes University, told delegates: “It is the way in which we help somebody that makes a difference, not the assessment itself.
“The variation in what councils have available to help people is immense,” he added. But warned the places with the best options and practice, such as Leeds City Council and Thurrock Council, had been making the necessary investment for decades.
The call by Care Quality Commission chief executive Ian Trenholm this morning for councils to act with audacity and in a way that is “borderline illegal” to create its own solutions to the social care crisis added to a sense of potential new horizons, in spite of the government’s limited perspective.
The final session of the seminar this morning asked why successive administrations have failed to get to grips with social care.
Bob Hudson, honorary professor in public policy at the University of Kent, highlighted the move last century from universal social services to adult social care “which is a safety net for the poorest and a commodity to be purchased by the rest”.
He said the market model of provision was now perceived as “a self-evident truth that you need more choice and more competition”, but it did not work for providers (Four Seasons had announced it had called in the administrators the day before), commissioners, the workforce and users of services.
On a similar theme, Sarah Pickup, the Local Government Association’s deputy chief executive, said the problem of low prices and low pay meant governments do not know what to do with the market, and a continued focus on a means test model focuses minds on “catastrophic care costs” - with no prospect of pooled risk looking likely to materialise.
There appeared to be a consensus in the room that the government could find the money for the radical overhaul of the system required, but simply chooses not to. Mr Hudson pointed to cuts in income, fuel and corporation tax currently costing the public purse £40bn annually.
The political climate, and a lack of bravery and vision in Westminster, means the green paper appears doomed to mediocrity at best. The Spending Review may offer some relief but the seminar showed it is the social care sector that has the forsight and conviction to adapt, improve and evolve.
Jon Bunn, senior reporter