As false dawns for social care go, the latest must be the most disappointing in years.
Reform was front and centre of the Conservative manifesto and a headline issue for the campaign. But based on its profile at the party’s conference, it has gone from box office to toxic in a few months. Even the concession of a green paper seems vague and distant.
We can safely conclude that failure to make progress is not based on any lack of awareness of the issues but a conscious sidelining of the difficult decisions required to make it sustainable and fair. It looks now like a casualty of the election post-mortem, short-termism and Brexit.
Delegates at the National Children and Adults Services Conference in Bournemouth did not expect anything of substance from the government. As at the party conferences, the real ideas and solutions were debated in fringe events by people trying to change the underlying models of care at a practical and local level.
Jeremy Hunt chose not to attend the conference. Instead he wrote to councils about the importance of meeting targets for delayed transfers of care, threatening those underperforming with further directions.
Tellingly Andrea Sutcliffe, the Care Quality Commission’s chief inspector, described relationships between social care and the NHS to be the most fragile and fractious she could recall.
The new care minister, Jackie Doyle-Price, continued her induction with a short, low-key speech to the conference. Her promise the green paper would be a once-in-a-generation opportunity to shape care provoked wry smiles.
In the policy hiatus, NHS England has been pushing forward with sustainability and transformation plans, rationalising commissioning bodies and encouraging accountable care systems in well-performing areas.
It is hard to believe we are only just over two years into the implementation of the Care Act. It is not fully in force, as the part about protecting the assets of self-funders has yet to be implemented. But recent studies from a number of sources also confirm the underlying principles of personalisation, prevention and wellbeing are struggling to push their way through the concrete consequences of rationing and budget pressures.
But stepping aside from the political context, there are contrasting signs that the social care sector is making its own adjustments. The acquisition of 122 of BUPA’s care homes by HC-One is eye catching, creating the single largest provider. At the same time, there is a growing movement of small, scale alternative models including home-share, self-managed care teams and other micro-solutions.
Social care’s advocates are no longer looking to the eastern skies for a big announcement. Real change is only going to happen under their feet at grassroots.
Andrew Cozens, independent social care and health specialist