The American investor James Lampert was fond of saying that an ‘exit strategy’ is more important than an ‘entrance strategy’. You need to plan for leaving a business even more than for going into one. (The advice applies to other areas of life, of course, like house parties and wars.)
That advice sprang to mind when the Labour MP Olivia Blake, during a recent Public Accounts Committee meeting, asked about the Government’s exit strategy for support to the social care sector during COVID-19. Would it stop and, if so, when? It’s a good question – and we’ll get to it in a moment – but it also begged one about whether there had in fact been an ‘entrance strategy’ to the Government’s support to the sector as the COVID-19 pandemic began.
You would have to say no. There was an initial phase of shock, confusion and bewilderment, followed by a flurry of policy and guidance, not all of which was fit for purpose and some of which – discharging people from hospitals without testing them for COVID-19 – was plainly mistaken. However, financial and other support did begin to emerge, taking on more coherent form with the social care taskforce recommendations. While some gaps and misjudgments have remained, guidance has become clearer, the type of support has widened and the funding has increased – the Infection Control Fund alone has now provided over £1.1bn of support.
A key objective of the financial support was to help care homes make often costly changes to their services that protected residents, and to avoid homes becoming financially unstable as a result. And, while causation is difficult to untangle from correlation, it looks like it has worked. There were far fewer excess deaths in care homes during the second wave of COVID-19 and we have not seen the wave of care home failures that some people feared. In fact, Ian Trenholme, the chief executive of the Care Quality Commission, told the Public Accounts Committee that fewer care homes are leaving the market.
Vaccination now offers hope that COVID-19 can be at least contained. Infection rates have fallen. Society has begun cautiously to reopen. Is Government now thinking about that exit strategy on financial support?
Certainly Sir Chris Wormold, the permanent secretary at the Department of Health and Social Care, indicated there would eventually be a need to ‘step off the escalator’, albeit with ‘a degree of care’.
But, as James Lampert might have predicted, it may prove harder to exit than to enter, for several reasons. First, COVID-19 will not disappear overnight and neither, presumably, will the extra costs of providers for measures like PPE and insurance. Second, we surely cannot return to the social care of endemic service failures and ‘care deserts’. Third, the relationship between Government and the sector has changed (as Sir Chris himself acknowledged). The Government has recognised – notably in its recent ‘Integration and Innovation‘ white paper – that local Government ‘shaping’ of the market is not enough; national oversight has to be stepped up.
So the Government cannot leave by the same door it entered. A new relationship with social care is inevitable. Only when – if – we see the promised social care reform white paper will we know exactly what it might look like.