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Into Perspective
Will social care reform materialise, and will it be worth it if it does?

The adult social care sector has been promised reform for decades, with numerous reviews, white papers, and commissions all generating new ideas for an improved system. All political parties recognise the need for change, and yet, despite repeated promises, systematic reform is nowhere to be seen.

Since 8th March 2017, the sector has been hanging on the lips of the then Chancellor, Philip Hammond, who stated in his Budget that Government would, ‘set out their thinking on the options for the future financing of social care in a Green Paper later this year’. Almost four years later, the Green Paper on adult social care reform is yet to materialise.

It is fair to say that this Green Paper has been one of the most highly anticipated publications the sector has awaited in recent history. Most will argue that reform is long overdue, going back at least as far as the Labour Government’s March 1999 appointment of the Royal Commission on Long Term Care for the Elderly. While some of the Commission’s proposals were enacted, fundamental change was not undertaken at the time.

A game of priorities

In its 2017 general election manifesto, the Conservative Party repeated its intention to publish a Green Paper, promising to ‘build a cross-party consensus to bring forward an answer that solves the problem, commands the widest possible support, and stands the test of time.’

Its publication, however, got pushed further back, and, on 31st July 2019, the Financial Times reported that ‘a consultative paper that laid out options for funding care for elderly and disabled people’ had been pushed down the pecking order in favour of Government’s attention turning to Brexit.

This shift in focus birthed the idea of a White Paper, designed to bypass the time-consuming consultation needed to publish the Green Paper and provide a direct pathway to reforming the adult social care sector.

Months passed until 14th January 2020, when the Prime Minister was questioned about social care reform during an interview on BBC Breakfast. The plan for social care reform that the Prime Minister said he already had back in July 2019 was confronted and its materialisation placed under scrutiny. The Prime Minister responded with an encouraging statement in that Government would be ‘bringing forward a plan this year, but we will get it done within this parliament’.

Running out of time

Responding to a question at the then daily coronavirus press conference on 2nd June 2020, the Secretary of State for Health and Social Care, Matt Hancock, implied that it may not be possible to meet the previously set timetable for the reform of adult social care funding in light of the coronavirus outbreak. Furthermore, at a time where the need for real change has been exacerbated by COVID-19, the promise of reform has been subject to yet more delay, this time, beyond the calendar year.

Questioned over the Government’s plans in the House of Lords on September 15th, Lord Bethell, parliamentary undersecretary of state at the Department of Health and Social Care, said, ‘I cannot commit to a social care plan before the end of the year’. This, combined with years of inaction by Government, the ongoing challenges presented by COVID-19 and the extent of political collaboration required to enact reform, has caused the sector to become sceptical that a progressive solution will ever be put forward.

Inaction is often plucked from the jaws of reform
 

The physicist Nils Bohr famously said, ‘predictions are difficult, especially about the future’. So, it would be brave to say with certainty that social care reform will happen in the next few years or that it will be the reform that’s needed.

There is some cause for optimism. COVID-19 has shone a harsh, uncompromising spotlight on the sector revealing to far more people not just its flaws and fragility but also its value. We have a government that has committed to fixing social care and included it in its manifesto. It is being urged on by a long line-up of senior figures, in all parties, calling for large-scale reform and investment.

Yet the history of social care shows that inaction is often plucked from the jaws of reform. Free personal care was recommended for England by the Sutherland Commission in 1999, but not implemented (in Scotland it went ahead).

The Care Act in 2014 was an outstanding piece of legislation, with its focus on wellbeing and personalisation, but it has never been properly funded.

A cap on care costs and a more generous means-test was due to be implemented in 2016, but was delayed and then abandoned (it still sits on the statute book, where it joins a 2010 Gordon Brown reform that would have provided free care at home to those with the greatest needs, had Labour won that election).

Sometimes the care sector has been its own worst enemy, dismissing limited but positive proposals and holding out for a big bang reform which has never happened.

We need to accept that the scale and range of issues in social care – not just funding and eligibility but also issues like workforce, integration and quality – will have to be brought in over time and that compromises will have to be struck.

We also need to acknowledge the financial challenges that will face the country after COVID-19.  Yet we can and must also expect a clear, long-term vision and plan for the sector that provides a route map towards genuine, large-scale reform.

Will we see it? With a nod to Nils Bohr, I can only say ‘perhaps’.

Simon Bottery, Senior Fellow – Social Care, The King’s Fund

We must not leave problems for our children to resolve

Not everything that is faced can be changed, but nothing can be changed until it is faced’. James Baldwin – American novelist, playwright, essayist, poet and activist.

We have had far too many false dawns on the promise of social care reform by governments of all colours.

So, if trust was the measure, the dial would be low. That might lead you to conclude that it may never happen. But by nature, I am an optimist. COVID-19 has exposed the fault lines with the current system; it has also shown the best at the worst of times. We now owe it to the public to seize the opportunity for transformation and not kick this into the long grass for our children to resolve.

Whilst we must have investment and a fair settlement between the state and individuals on paying for care, that is not enough. Successive governments have made the mistake of focussing on funding without asking what social care is for, or how it should work.

These elements of ‘form and function’ have been articulated by Social Care Future in a vision that has a growing alliance of supporters. This is simply ’we all want to live in the place we call home with the people and things that we love, in communities where we look out for one another, doing things that matter to us’.

Achieving this means recognising that social care is everyone’s business, as disability can affect anyone of us at any time. It must be inclusive, accessible and support people to lead their lives as best they can: a life not a service. As chair of Think Local Act Personal, I am doing all that I can to press for a more human and relationship-based way of ‘doing social care’.

We are not passively waiting for the Government to ‘fix’ a ‘broken system’, but are taking active steps to get there, for example, by learning from the experience of mutual aid during COVID-19 and reaching out to civil society, local economies and people from diverse backgrounds.

The Government needs to step up to the mark and match the momentum and energy. If they don’t, we will leave our children a burden rather than an inheritance.

 Clenton Farquharson MBE, Chair, Think Local Act Personal


Which statement do you agree with? Let’s keep the conversation going on social care reform. Comment below.

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