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Analysis: Instability puts radical social care reforms on the slide

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There are multiple reasons why significant anxiety exists over whether a Conservative minority government will now choose to - or in fact be able to - act decisively on social care.

The party’s careless handling of the issue in its manifesto marked a turning point in the campaign, as significant cracks appeared for the first time in what had hitherto appeared to be a successful strategy of relentlessly promoting the prime minister as reliable, competent and trustworthy.

There is general consensus social care will still be on the agenda - Department for Communities & Local Government’s former permanent secretary Lord Kerslake told LGC social care funding reform is an “unavoidable” issue which would not be “put on the back burner” despite the lack of majority government.

But the political toxicity of the specific Tory manifesto proposals for a £100,000 capital floor on care costs, initially presented without a cap and powerfully labelled the ‘dementia tax’ by critics, means there are now serious doubts about whether that will survive in its current form.

Richard Humphries, assistant director, policy, at The King’s Fund, told LGC there is a possibility that the principle of a floor could remain on the table, as opposition parties are unlikely to argue against protecting assets worth four times more than the current means test level of £23,250.

But he said he would be “amazed” if the introduction of property value in the means test for domiciliary care for the first time was maintained.

“I imagine this is dead and buried, but it does not alter the fact we need a rational debate about how we use property to pay for care,” he added.

But Mr Humphries said the short-term prospects for decisive government action on social care were now “pretty grim” as the Tories “were so badly burnt by the dementia tax that there will be huge nervousness about radical reform”.

He added that this will be compounded by the likelihood that social care would get squeezed by the “bigger tectonic plates” of Brexit, the need to strike a deal with the Democratic Unionist Party and the complex politics of being a minority government.

Mr Humphries said “the best hope” is a continuing commitment in the Queen’s Speech to a green paper on the future of social care which focuses on points of cross party agreement, such as a cap on care costs.

But a cap in isolation would essentially take money out of an already severely cash-strapped system and offers no benefit to the poorest people who require local authority-funded care.

The controversial proposal to introduce means testing for winter fuel payments, which would have provided significant funding for the system, is unlikely to be maintained - particularly as the DUP is committed to maintaining a universal system.

Mr Humphries said: “I am worried local authorities will be left holding the baby and central government will say, ‘You’ve had £2bn [from the Budget], get on with it’.”

Colin Noble (Con), leader of Suffolk CC and County Council Network spokesman for health and social care, said the government should now initiate a national conversation about how social care can be funded to meet increasing demand for support as the population ages.

But he said this was “quite separate” to the importance of local health and social care systems integrating and independently devising new ways of working in order to improve services.

Cllr Noble said: “I don’t think radical reform is needed. It is about local healthcare systems being given the freedoms to find a solution through new ways of working together. That’s not done by national legislation or big levers in Whitehall, that’s done at the local level.”

The momentum that had built up behind social care in the run-up to the election being called created a sense of cautious optimism that a long-term sustainable solution could be found.

But as the Conservative manifesto marked a shift in fortunes for the prime minister, the prospects of the kind of bold, comprehensive reform needed to address severe and rising pressures in the social care system also began to slide.

As political instability in Westminster continues, it is difficult to see how this trend will be reversed.

Policy survival rating: 3/10

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