The issue of social care has been noticeable by its absence from the Government’s NHS listening exercise. The relative absence of social care from the debate is made all the more curious by the Liberal Democrats’ long standing interest – and Paul Burstow’s undoubted expertise – in the issue. So why is this? Are the Government’s plans for social care perfect? Is legislation not required to implement the Coalition’s vision for the sector? After all, the Government’s Bill reforming the NHS is not called the Health Bill, but is deliberately referred to as the Health and Social Care Bill as the Government looks to bring health and social care closer together through the reform process.
In some ways the paucity of discussion about social care is not surprising. The debate has been somewhat stymied by the perennial problems of social care funding which are due to be addressed by the Commission on Funding for Care and Support setup by the coalition government on coming into office and chaired by Andrew Dilnot.
However, the troubles with Southern Cross and the Panorama expose of Castlebeck have finally put the social care aspect of the reforms on the political landscape. Stakeholders are turning up the volume, noting that the current system is at breaking point. A secure and sustainable funding system is crucial to delivering long lasting change, though so is an effective policy framework and regulation. The question the Government and stakeholders should be asking is whether its planned reforms do this?
I have previously blogged on the Government’s plans to reform social care and there are some very attractive proposals in the plans notably the idea of bringing health and social care commissioners together by creating health and wellbeing boards at a local authority level which analyse local commissioning decisions and develop joint health and wellbeing strategies. Similarly proposals to expand personal budgets and involve more voluntary and third sector providers are welcome in expanding user involvement and choice, which for too often have been lacking in social care. Plans to improve data collection and focus on the outcomes of social care users, should start to deliver improvements in care for those in a sector too often focused on minimum standards. Finally, the early evidence is that GP commissioners care about integration with social care and are serious about improving this. MHP Health Mandate’s report, The path to GP Commissioning, shows that integration is the most commonly identified priority by pathfinders.
However, the recent travails at Castlebeck expose some of the risks of the Government’s social care reform programme. These are primarily driven by the Government’s drive to ‘localism’ and attempts to cut costs and include:
- Plans to reduce the annual inspections of councils by the Care Quality Commission (CQC) and move to a more ‘targeted’ inspections regime
- No central audit of adult social care performance, instead encouraging councils and local groups to conduct peer reviews of one another’s performances against new outcomes data
- Issuing suggested guidance on how local authorities should account for their social care services through new local accounts, rather than issuing mandated guidance
- The removal of the existing CQC numbered ratings scale and replacing it with an as yet to be determined voluntary excellence rating, the criteria of which is to be developed following a consultation with stakeholders
Southern Cross’ travails show that the risks of provider failure extend into the private sector and that – much as with the banks – the Government cannot stand idly by and watch a major provider fail. The case for a robust failure has never been clearer, or more relevant. Southern Cross also reveals that localism is not always politically tenable. The Department of Health has had to step in and make a guarantee to Southern Cross residents because the politics of the situation would not bear leaving it to local authorities. It is easy to see how localism can quickly be eroded when vulnerable adults are put at risk.
The NHS reforms are (wrongly) seen by many as a solely Conservative creation. For the Liberal Democrats, social care could be an opportunity to ‘own’ a significant part of the health agenda, capitalising on Burstow’s track record and expertise, their own experience of local government and the clear and compelling need for a better system. In the longer term, reforms to social care could be even more controversial than those in health, but there is clear opportunity for the Lib Dems to stamp their mark on this area of policy. Over to you Nick Clegg…