Show me the money!
by Claudia Wood
Criticisms of the Social Care White Paper were piling up days before it was published. As a steady trickle of its contents leaked in the run up to today’s publication, so more care and health organisations and charities issued their response, decrying the government’s inability to tackle the central care funding question. This is a real shame, as much of the content of the White Paper is very welcome: well thought out, innovative and visionary.
Discussion of the merits of the paper are likely to be pushed aside by criticism on the lack of progress on funding, but the fact is, it was made public several months ago that the White Paper would not tackle care funding. We knew it would be hived off in a separate ‘progress report’ published alongside the White Paper. While the latter includes draft legislation and concrete commitments, the former is vaguely worded and has a central message than can be summed up as ‘yes, we probably should sort out the funding’.
This is, of course, bitterly disappointing, dismaying, frustrating – but not surprising. Apart from a short spell of optimism in the months following the publication of the Dilnot report in July last year, most people recognised the familiar loss of momentum by early 2012. Because one quickly realises- when dealing with care funding- that not having the right model or the right evidence is never the obstacle to action. It is always the lack of political will. The Government now has at its disposal several – perhaps dozens – of potential care funding models, and any one could be adopted by government and made fit for purpose according to its priorities and budget.
But herein lies the crunch – the department holding the purse strings, the Treasury, recognises neither the priority nor a budget for social care. Social care is not a system buckling under its own weight, requiring urgent resources. It is simply another demand for spending, competing alongside aid, schools, or defence. Andrew Lansley said as much in his statement to the Commons when he confirmed decisions on care spending would need to wait for the Spending Review to be weighed up against other priorities.
Part of the problem is the care system itself. It’s not conducive to provoking grand gestures. Whilst the Care in Crisis campaign has won much coverage, it is somewhat misleading. The care system is not in a single ‘crisis’ – rather, it is suffering from millions of individual crises occurring simultaneously, every day. These are played out behind closed doors, often in people’s homes and without much fanfare.
As a result, inaction on care funding won’t ever create a ‘big bang’ style collapse. Instead, we will see the gradual deterioration of hundreds of thousands of lives – disabled and older people, their families, carers, care staff, and social workers. This sort of terminal decline is harder for the Government to react decisively to. The fact is, we have been witnessing it for years - but as each year passes, eligibility for support tightens just a little more, just a few more services close, and a few thousand more older and disabled people lose support: a catastrophe for each individual family, but a small annual trend for the Treasury. One might forgive it for thinking it has a few more years yet to draw a line in the sand.
And this means that today’s White Paper shows how one department’s ambitions are outstripping its means. If a funding model had been settled on, this White Paper could have been history in the making. It is, in its intent, truly visionary. The single, modern social care statute it proposes will put us ahead of most countries around the world. It enshrines all the hallmarks of a world class care system: a minimum entitlement for care, a single eligibility criteria and portable assessments, recognised rights to assessment and services for informal carers – all of which provide transparency, consistency and certainty.
And the paper also hints at some new innovative thinking – an evolution in our understanding of ‘community care’ built through social networks and informal care, some real structural change to promote integration between care and the NHS. In a sector where one can easily confuse the platitudes of the 2005, 2007 and 2010 strategies, new material is always noteworthy. It signals a real advance in thinking, and the incongruity between these bold ideas and the hesitancy on how to pay for it could not be greater. The White Paper risks being a shining vision of what could have been, if only we’d sorted out the money.