Paying for social care is a politically toxic subject, and actions to address the problem have failed to live up to the lofty aspirations
Richard Humphries: Cross-party care cooperation has never been more vital – but less likely
The Conservatives have set a high bar for the green paper, proclaiming it as “the first ever proper plan to pay for – and provide – social care” in their 2017 election manifesto. “Where others have failed to lead, we will act,” the document stated.
Seven months on, it looks like our expectations that the green paper will deliver these lofty aspirations should be substantially downgraded. The specific pledges about social care in the manifesto – notably the so-called ‘dementia tax’ – were picked out as a major reason for the Conservatives’ failure to win an overall majority. Echoing the 2010 election row over Labour’s death tax proposals, paying for social care has become politically toxic, not an expression of the upbeat manifesto theme of ‘the good that government can do’.
Subsequent developments stoke fears of a policy retreat: the production of the green paper itself has been delayed until the summer; it will address older people only – a separate parallel programme will look at the issues for working age people; and there is inevitable concern that further momentum could be lost as a result of responsibility for producing the green paper shifting from the Cabinet Office to the newly branded Department of Health & Social Care. This carries the added risk of a narrower focus on integration with health at the expense of the wider purposes of good social care.
Clouds of well-intentioned rhetoric about innovation and best practice will not magic away the growing funding gap
The absence of any more financial help in the autumn Budget or the local government financial settlement reflects the trope that “it’s not just about money”, exemplified in care services minister Jackie Doyle-Price’s comment, quoting an unnamed council leader, that “austerity is the mother of innovation”. So the green paper will almost certainly have a lot to say about delivery, with well-signalled interest in why some local authorities perform better than others and the extent of variation in quality, spending and outcomes. Reinstating inspection of local authority commissioning is one particular kite that could fly.
Few would disagree that simply pouring more money into a broken system won’t work. The green paper would be right to articulate the potential of better models of care that reduce needs, promote independence and marshal the contribution of technology, housing and community assets. Workforce – now as big a problem as money in places – might be another priority area, given the feeble social care content of the recent draft health and care workforce strategy.
Cross-party cooperation has never been more vital – but less likely
But the reform of delivery and the reform of funding are not binary choices. Clouds of well-intentioned rhetoric about innovation and best practice will not magic away the growing funding gap set to reach £2.5bn by 2019.
One essential ingredient for a better system is a workforce that is much better paid, trained and supported – this will not be cheap. So a central test for the green paper will be how far it tackles head-on the government’s own exam question of how we pay for care. This is a real opportunity for the government to step back from the controversial and poorly communicated manifesto proposals and set out a wide range of options, along with their costs and trade-offs.
It is hard to see how the government can duck out of this having restated so many times its commitment to a long-term sustainable funding settlement. ‘Long-term’ might of course be a get-out-of-jail card – for example if a very pale green paper seeks to consult on broad principles rather than specific funding mechanisms and proposals.
In the meantime the clock is ticking on a system that is running out of time, money and staff. The policy-making climate is deteriorating. Hospital pressures engulfing the NHS now dominate media headlines. And all this in the shadow of the Brexit psychodrama that continues to suck political oxygen out of the atmosphere at the expense of urgent domestic issues like social care. With a slender Commons majority the perils facing the government in contemplating any kind of serious reform are enormous.
An ineluctable truth from the experience of every government in the past 20 years is that reforming social care is a long-term job – the green paper is an early foothill in a longer and steeper journey. Serious change will take longer than a single parliament and demands a step-change in public awareness of the inadequacies of the current system before any party can float the hard choices about where the money comes from. Labour is producing its own proposals but will face exactly the same challenges.
In such a daunting political and fiscal environment, cross-party cooperation has never been more important – and less likely. There is no shortage of commitment from the social care sector to help co-produce a better future for social care. Whether national political leadership will rise to the challenge is arguably the biggest risk of all.
Richard Humphries, senior fellow, policy, the King’s Fund