One of the many challenges to an agreement between the Conservatives and Liberal Democrats after the general election was the issue of social care and specifically how to fund long term care. Like the Labour party before them, the coalition decided that the best thing to do was to kick any plans into the long grass – initially at least. A commission was duly established, headed by economist and broadcaster Andrew Dilnot, which is due to report in July this year on a preferred option for providing sustainable care and support system for adults.
Before Christmas the Government published its proposed framework for how social care will look in the new world of reformed health and care systems. The document entitled Transparency in outcomes: a framework for adult social care has two main drivers. The first is structural, to bring social care into line with the new health service; the second is financial and aligned with the Dilnot Commission’s work. In short, the Government knows that it has to move now to establish a framework through which a more efficient and affordable social care model, the remit of the Dilnot Commission, can be realised.
The document has, to date, created far less debate than the proposals to transform the health service. This is perhaps not surprising given that fundamental questions on how the new system will be funded remain unanswered.
However, this does not mean that the document does not contain radical proposals to change the way social care services are delivered.
The main proposals of the document are:
- The creation of social care outcome measures supported by a series of Quality Standards for social care, the first of which will be produced by NICE in 2012/13
- The creation of a single Quality and Outcomes Data Set (QODS) for social care to bring together all routine social care data
- Councils to publish a local account of their priorities for quality and improving outcomes in social care, replacing the Care Quality Commission’s annual assessment of councils as commissioners
- The local government sector to develop a system of peer review to challenge and assure one another’s results and support improvement
- The star rating system currently being used by the CQC to rate providers of social care to be replaced with an ‘excellence’ rating for providers
- Plans to introduce greater financial incentives for providers based on rewarding quality improvement, potentially based on the Commissioning for Quality and Innovation (CQUIN) system used in the NHS
The proposals – which will directly affect some of the most vulnerable people in our society – raise a number of questions about the regulation of social care in the new world. Scrapping annual assessments of councils, in preference for greater local transparency and accountability, may give users a greater say in service quality. But what about areas where users are less active and their local HealthWatch ineffective? The removal of the star system may bring clarity, but could it not conversely make it more difficult for users and their carers to distinguish between types of providers? How transparent will the peer review system for councils be and can it be truly effective? The idea of a local quality account from councils of their social care priorities sounds like a step forward for transparency, but given the lack of a central directive for what it will contain and the limitations of the initial NHS Quality Accounts (http://www.mhpc.com/ideas/trends-and-analysis/accounting-quality-what-extent-can-quality-accounts-deliver-information-re), will they really be that helpful for users?
Such questions may well start to get more attention when the health reforms are completed, the Dilnot Commission reports and the social care White Paper is published later this year. For now they remain absent from political debate. A year of potentially huge change in social care has begun with little more than a whisper.