The political will is now there for new legislation on integrated social care
Dods Monitoring's Daniel Laing writes about the latest developments on social care policy including a call from 21 select committee chairs and 98 MPs writing to the Prime Minster calling for a cross-party commission.
Health and social care is one of the few policy areas which has been able to stand its ground on most MP’s priority list vs Brexit. However social care remains a “Cinderella service” and the Social Care Green Paper where the Government expects to start the process of providing a solution. Promised in the March 2017 Budget “to set out proposals to put the social care system on a more secure and sustainable long-term footing”, the much-debated social care Green Paper will come with high expectations from councils, providers and those reliant on the care system.
Summer recess 2018 was the deadline set out in a written statement in November 2017 and Parliament continues to look towards the Green Paper as the centre piece for how the Government will address problems in a sector. Several policy issues are already pinned to the Green Paper and MPs along with stakeholders are looking ahead at how much it can really deliver.
Funding will normally be the first thing to surface in a debate on the subject and it will need to form part of the Green Paper. A quick scan of analysis in this area warns the current funding gap estimate will be close to £2.3bn in 2019-20 according to the King’s Fund, Health Foundation and Nuffield Trust. Further ahead the Institute for Public Policy Research (IPPR) recently published Lord Darzi’s interim report of health and care which stated an extra £10bn a year will be required for social care a year by 2030.
The question is complicated further when integrating social care with health is considered. Groups of cross-party MPs have regularly called for cross-party work on health and social care, with 21 select committee chairs and 98 MPs writing to the Prime Minster calling for a cross-party commission in March. Indeed this has not let up, only this month Norman Lab (Lib Dem, North Norfolk), Nick Boles (Con, Grantham and Stamford) and Liz Kendall (Lab, Leicester West) issued a set of ten principles for long-term funding of the NHS and social care. Perfectly timed, the cross-party principles landed on the same day the Secretary of State felt he needed to write to Conservative MPs asking for patience. The rebrand of the Department of Health and Social Care has not been enough to reassure, as Hunt told MPs to arrange meetings through his PPS to discuss concerns.
This is not the first time MPs and stakeholder have been asked to be patient wait for the Green Paper. In March 2018 Secretary of State for Health, Jeremy Hunt delivered a speech outlining the seven principles to guide the social care green paper including quality, integration with the NHS, control, workforce, carers, funding and security. Recognising the need to bring some elements forward Parliamentary Under-Secretary of State for Mental Health and Inequalities, Jackie Doyle-Price, announced in December 2017 plans to deliver a two-year support package for carers in the new year, however, like the Carers Strategy before it, the support package has not been published yet.
Other areas the Green Paper will need to cover include the social care workforce following criticism from the National Audit Office that the “number of people working in care is not meeting the country’s growing care demands and unmet care needs are increasing”.
Safety and consumer value will be another area of focus. The Government has already confirmed it will use the Green Paper as an opportunity to respond to the Competition and Markets Authority report on care homes. Only last month Minister of State for Care, Caroline Dinenage, described the UK’s inspection regime as “the toughest system of care home inspection in the world” and seeing this alongside Hunt’s personal commitment to patient safety might give some insight into what to expect in the Green Paper.
Nestled amongst the issues for families, patients and the workforce remains the survival of providers themselves. The sleep-in shift back payments could be an existential threat to services argue Mencap. It is unlikely to feature in the Green Paper the sector awaits the outcome of the Government’s talks with the European Commission on state aid rules.
However, while MPs are clearly craving detail on the much-needed plan for social care providing this detail has not always worked in the Government’s favour with the announcement that there would be a separate workstream for working aged people a concern. In November 2017 former First Secretary of State, Damian Green issued written statement announcing independent experts to advise, an Inter-Ministerial group to ensure alignment and the commitment to write to all chairs of relevant APPG. The consequence of announcing a parallel programme for working aged adults created a new concern that social care will be fragmented further.
Clearly the task ahead for the Government is not an easy one however the calls for a cross-party commission clearly illustrate the political will is there to support reforms. There are a number of items on the horizon in the health space including the 70th anniversary of the NHS; an increased appetite for legislation to back up new integrated care models; and, the Prime Minister’s telling the Liaison committee of a “multi-year” plan for health and social care. How the Green Paper interreacts with these ensure it will be eagerly anticipated.
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