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12 Jul 2012
John Adams, general secretary VODG

The white paper: another fine political mess

So what took them so long? The answer to why the government dragged its heels in publishing yesterday’s long-awaited social care white paper is, in a word, Dilnot.

John Adams'Caring for our future' blog seriesThat is not to lay the blame in any way at the door of the economist whose commission a year ago suggested a much-needed overhaul of the care funding system. Rather, it is a reflection of how his far-reaching and much-needed proposals proved far too difficult for the government to swallow.

I can imagine an army of civil servants at the Department of Health beavering away, day after day, polishing sentences in the draft white paper whilst the real action was happening elsewhere, namely between the Treasury and Number 10. The coalition government has earned itself a reputation for political ineptitude, and yesterday’s predictable publication followed a recent hat-trick, from the administration’s hapless handling of the health reforms to the daft pasty tax and finally this week’s divisions over the House of Lords reform.

Trying to agree on how best to respond to the sensible and fair long-term funding reforms proposed by Dilnot is yet another fine political mess the coalition has got itself into. The decision for now has been put aside in the ‘too difficult’ drawer. Fortunately for the government – but unfortunately for those in receipt of social care or who work in the sector – this latest debacle won’t have the same resonance with the public as reforming the NHS.

Andrew Dilnot: his powerful proposals were too far-reaching for policy makers to adopt.The reason I suggest Dilnot was the reason for the government’s delay is simply because it charged a far too clever and articulate economist to carry out the task, someone with the great gift of being able to simplify terrifically complex questions and the communication skills to garner wide support for his ideas. Secondly, some might say, they invited the ensuing political difficulty by offering him such broad ranging terms of reference along with the criteria agreed by which the commission would assess future options for the funding of care and support.

That’s not to say we are not huge fans of Andrew Dilnot and his commission’s set of proposals – even though their relevance is less significant for working-age adults, many of whom do not have assets to protect from catastrophic care costs, than to people needing care and support at the end of life. But Andrew Dilnot couldn’t rub shoulders with elderly and disabled people for all those months without saying something serious and helpful about the funding gap that currently exists in meeting people’s needs.

The political inconvenience for the government is that not only will Dilnot’s reforms cost more money – precisely how much will depend on where the cap and means test is fixed – but, because of the pressure on public finances, it has had to stick with its now established political line that the current “funding settlement for social care is fair and adequate.” ADASS, the LGA, carers organisations, disabled people, social care providers, the VODG and many academics disagree with this claim.

The King's Fund, Joseph Rowntree Foundation and others have already commented on the “vacuum at the heart of these proposals” which we will not rehearse again here. But we have argued elsewhere that if the history of the welfare state teaches anything, it is that successive governments have shifted responsibility for the cost of social care onto the shoulders of the individual. So we shouldn’t be surprised by yesterday’s announcements.

Under Labour, for example despite the fact that social care seemed to be a priority and public expenditure was on the up, it took the government three terms to publish proposals for social care reform and for the introduction of a National Care Service – and even then, publication came just weeks before a general election. While Labour appointed a Royal Commission into long-term care for the elderly, it rejected the commissions' suggestion for collective responsibility for social care funding through general taxation.

So yes, Paul Burstow is right to point out the progress that the coalition government has made in two years. And yes, we welcome that the governments accepts the principle of limiting the amount people pay themselves. But there is good reason to avoid pinning such high hopes on the eventual solution, which is probably years off yet, and we need to recognise that this alone will not fix the current and predicted funding gap.

So, let’s mirror what the government has done and put aside the funding issue for the time being – what exactly does the white paper offer? There is indeed much that we welcome, modernising and simplifying the current legal framework, for example, the proposed national minimum entitlement and assessment portability. These are both issues that the VODG has promoted and campaigned on – though we still want to see portability of funding. The new care and support housing fund, to support the development of specialised housing for older and disabled people is also welcome.

One particular area of concern are the proposals relating to quality, and we will blog separately on this and other specific aspects of interest in the next few days.

Yet the bottom line is our original question – what took the government so long? Somethings are worth waiting for but that old adage doesn’t apply when reading a white paper which offers little that is new. The idea of investing further upstream to avoid crisis interventions; minimum rights and standards, all though welcome, none of these are new ideas – indeed some elements echo Andy Burnham’s white paper put out in the final days of the last government.

We are not convinced, to use Andrew Lansley’s phrase, that what was outlined yesterday amounts to a, “watershed moment in how this country cares for older and disabled people”. Perhaps, to be optimistic, time will tell. More likely, it will be a case of social care histroy repeating itself and any hints at visionary change will end up gathering dust on the shelf along with all the other commission reports and government recommendations over the last 20 years.

What does seem clear after yesterday is that if you or a loved-one is in need of social care and support anytime soon getting the help you need – unless you can afford to pay for it yourself – will continue to be a huge struggle. With local government facing a 28% funding reduction, no amount of fine words or good intentions will change that reality for people – probably for years to come.

It was a full year ago that we argued on this blog that the government must find the courage to succeed where previous administrations have failed and exploit what Dilnot himself described as a “once in a lifetime opportunity” to create a fair and sustainable system of social care. Little wonder the economist was yesterday reported as saying his commission’s changes should have been implemented “immediately”, before adding: “It would have been best for all of us”.

* The VODG will be blogging on aspects of the white paper in coming weeks. We’re also keen to hear your views on the white paper – what do you welcome? Where are the gaps? Comment here or email and let us know your thoughts.

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