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David Pearson: my four challenges for the green paper

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David Pearson

David Pearson

David Pearson

The closest we have come is probably the delayed “paying for care” provisions in the Care Act. Despite obvious political difficulties, ministers have committed to producing a green paper by the summer and this is still early days.

The green paper is still a cross-government ministerial endeavour, despite leadership passing from the Cabinet office to the Department of Health.

There is a parallel DH-led social care workstream on younger adults aged 18-65. It is essential the work is strongly linked to ensure we avoid drifting into an inconsistent and fragmented system between the generations.

My personal view is that the green paper must address four key issues.

Ensuring sufficient funding for the existing means tested system. The sector’s funding gap has been calculated at £2.3bn by the Local Government Association and £2.5bn by thinktanks including the King’s Fund. It is growing despite short-term measures including the social care precept and improved better care fund. The evidence of a system under immense pressure is clear from a plethora of surveys, reports and analyses. Academics published a study in the Lancet in May which suggests care needs will rise by 25% between 2015 and 2025 for the over-65s. A combination of remarkable innovation to drive efficiency, promote independence, prioritisation of adult social care spend by most councils and cuts to budgets has been the response. But it is impossible to run up the escalator the wrong way without falling over.

How much social care should the state (and therefore the population) pay for social care collectively and how much should it continue to fall to individuals and their families? The debate is often centred around the fairness of a risk for 10% that they will pay over £100,000 of their assets on care at the end of their lives, while others will pay nothing. But there is more to it than this. Older people and carers struggle to grapple with the mystery and complexity of purchasing social care at what is likely to be one of the most difficult times in their lives.

Opportunities for greater system reform. This needs to be addressed despite us only having recently implemented the most significant social care legislation in the past 70 years. This may not just be about social care but also about creating local and national environments that are age friendly and recognise the need to respond to a different demographic profile. This is not just about having our care needs met but also having good lives. Progress can be made on improving information and advice, prevention, technology, housing, support to carers, mechanisms to balance the market, a model for integration with health, and increasing choice and control.

How we pay for social care, now and in the future. It is inevitable that we as a nation will live longer but many of us will spend part of our longer lives with long-term conditions or disabilities. How to pay for this is the biggest political challenge of all and the major reason why previous attempts have foundered. The need for a debate which helps the public to understand and appreciate the choices is essential. Local government is uniquely placed help the public to consider these choices.  Local government has been diffident about entering into this arena, but if we don’t, solutions will be further away and the problems will worsen. In fact, this realisation may be one of the reasons why progress has to be made. 


David Pearson, director of adult social care and health, Nottinghamshire CC; advisor to government on green paper


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