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1 day ago
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The lack of action, or even a clear direction, on social care reform in England was a disappointment of Labour’s first six months in office. With the recruitment of Dame Louise Casey to lead a review, the government has now made up its mind on how to approach one of the stickiest policy questions. But the proposed timeline is far too extended. By ordering further investigation of the issues, rather than setting out proposals, the health secretary, Wes Streeting, and his colleagues have opted to preside over dysfunction for several more years.
The upshot is that the problems it causes will continue to mount up, both for the unlucky people who need the most expensive forms of care and for overstretched parts of the health service. Mr Streeting says that changes will begin to be set in train next year, when Dame Louise delivers interim findings. Failure to follow through on this commitment would be a shocking dereliction of duty by a government that was elected on the back of promises to strengthen public services, particularly in light of the impact on hospitals of social care shortages.
Mr Streeting is well aware of previous failed efforts at reform. It is only a few months since his cabinet colleague, Rachel Reeves, ditched a planned £86,000 cap on social care costs paid by individuals, because she wanted to save money instead. But attempts to come up with a fair and future-proofed service model that commands public support long predate the chancellor’s decision, and earlier ones taken by the Tories. It is nearly 25 years since Tony Blair’s government rejected most of the proposals made by a royal commission on social care that it initiated. Perhaps it was in light of this precedent that Mr Streeting decided against another commission and hired Dame Louise.
Her reputation is for a creative kind of toughness about seemingly intractable issues. As a high-profile crossbench peer who has also worked for Conservative prime ministers, she is seen as a big-hitter who could help to shape a non-partisan consensus. In the past she has spoken harsh truths to powerful interests – for example, in an uncompromising report about the racist and sexist culture of the Metropolitan police.
Mr Streeting’s aim is for social care entitlements to become regarded in a similar light to healthcare ones. As has often been pointed out, there is no ethical reason why the treatment that cancer patients rely on should be free while care for dementia patients is means-tested. The difference lies in the nature of the needs that these different conditions give rise to.
Key questions are the extent to which risk, in relation to social care, is pooled in the same (or similar) way that health risks have been pooled since the 1940s; how care that is not publicly paid for is funded; and how entitlement levels are determined. On all these points, a degree of consensus is essential. A new system will struggle to establish itself amid promises to scrap it. But as Mr Streeting knows, these are political questions on which parties of left and right will inevitably have disagreements. It is disingenuous to pretend otherwise.
Lord Darzi’s recent review of the NHS was completed in a matter of months. The hope must be that Dame Louise makes urgency a theme of her work this year, and recommends the bringing forward of her own deadline.
