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Richard Humphries: Could social care finally become truly local?

Richard Humphries
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Had T S Eliot been thinking of social care when he wrote The Wasteland, November not April would have been the cruellest month.

First came the first secretary’s announcement that the much-anticipated green paper would be published by the summer of 2018, later than expected. Allowing time for consultation and the government’s response means any actual change will be at least two years away. Given the febrile state of national politics, this is not so much kicking the can down the road but sending it into orbit.

Further consternation in the social care sector came with confirmation that the focus would be on older people, with a separate parallel work stream on care and support for working age people to be led by the Department of Health and the Department for Communities & Local Government. Weeks later there is no further clarity about content or timescale of this work, which is critical for local government because much of the budget pressure is coming from younger people with disabilities.

Then came the Budget. Not only was there no more money for social care, but the issue failed to get a single mention, not even in the red book.

With the political psychodrama of Brexit continuing to suck most of the oxygen out of the policy atmosphere and dismal projections by the Office for Budget Responsibility on economic growth, it is clear no cavalry will be coming over the hill from Westminster any time soon.

It remains to be seen whether Ms May’s administration will become the fifth government in the last twenty years that have over-promised but under-delivered on social care reform.

In the meantime, the funding gap for social care is set to rise to £2.5bn by 2019 and the extra money announced by the chancellor for the NHS will not deliver the £4bn it needs next year just to stand still.

So, it is clear local government will have to deal with these challenges on its own. Councils now have little choice but follow the example of their peers who have already begun to embrace an uncomfortable realignment of spending with services and public expectations. What is achieved with the public pound is now even more important than how much is spent. Whatever the distant outcome of the green paper, its content will almost certainly feature a renewed focus on wide variations in council performance in how much they spend, what they provide and the outcomes they achieve.

Echoing the view of former House of Representative’s speaker Newt Gingrich, who said all politics is local, all policy solutions are now local too. The new big idea in social care is that there is no big idea, but a host of small ideas that work well in some places but have yet to be implemented at scale. Examples include shared lives schemes, reablement services, and housing-based models of care. Similar strictures apply to wider health and care economies where sustainability and transformation partnerships will continue to be the only show in town. Has localism’s hour finally come?

Richard Humphries, senior fellow - policy, The King’s Fund

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