Adult Health and Social Care

Jeremy Hunt kept telling us, when he was Secretary of State for Health and Social Care, that an adult social care green paper was about to be published.  Matt Hancock has been repeating the mantra since he took over the job.  Both are now vying to be the next PM but if neither of them can deliver a green paper, neither of them is likely to deliver Brexit.  On 6th June Hancock announced a “prevention green paper, which we will publish soon,” (here we go again) which “will give people an opportunity to let us know their views on how we achieve this [the commissioning of care services] and build on the excellent local practice happening across the country.”

He is saying, in effect, that the government has no idea what to do. Furthermore it muddles prevention, i.e. the avoidance of the need for health care, with the provision of adult care services which is what the missing green paper was supposed to be about.

In what fantasy land is the DHSC living to believe that the need for adult care can be removed by some magic formula which only the general public knows how to construct? Is it credible that the general public have the answers when the DHSC and its myriad consultants do not? Why are we paying them? We have already had plenty of expert reports, notably from the King’s Fund, Sir Andrew Dilnot, the Local Government Association and the Care Quality Commission. The central reason for declining care is the shortage of cash available to local authorities to provide it. Inept ministers have failed to address the problem or even to propose possible solutions in a green paper. Of course imposing new taxes and/or making old people pay more towards their upkeep are electorally unpopular, as Mrs May discovered in 2017. And opposition parties are irresponsible in calling such things death or dementia taxes or the like but proposing no solutions. Failing to address difficult issues will not make them go away.

Whether the NHS has more money than is good for it is open to debate. It certainly does not use its resources optimally but, even if it did, that may not be enough to meet growing future demands. On the other hand, the shortage of funds available to local authorities for adult social care is universally acknowledged. “Spending on adult social care in England has fallen by 3% since 2009/10.” The Institute for Government’s 2018 report showed that of nine major public services, the public were most concerned about the support for adult social care and prisons.

In his June 6th announcement of the green paper to come, Hancock concluded that the answer was that the “NHS work much more closely with local authorities on public health so that commissioning is more joined-up and prevention is embedded into a wider range of health services.” The reality is that no amount of joint, with the NHS, commissioning will solve the adult social care cash shortage. It is more likely to distract the NHS from its own business. The senior partner of a Norfolk primary care practice put it like this: “Every minute spent working with/for local authorities is a minute NOT spent doing our core NHS medical work.”

A further example of kicking the adult care can down the road was the creation, two months ago, of the “Health Foundation’s new Health and Social Care Sustainability Research Centre” which “will find and undertake research on the long-term demand and cost trends affecting health and social care in the UK with the aim of improving the evidence base to inform policy.” Sir Andrew Dilnot is the Chairman of the Oversight Board. No one doubts his expertise but do we need new research to recognise that all the local English authorities simply need more money for social care?

How much more? The Local Government Association “said funding pressure and increasing demand for services like adult and children’s social care and support for homeless people, would leave English local services facing a £3.9bn funding deficit in 2019.” In order words, adult social care needs a £3bn top-up immediately – chicken feed compared to the £20bn given last year to the NHS – and probably a lot more thereafter.

The truth is that their relative funding is distorted by politics: the Tories give money to the NHS to keep the Labour Party at bay. There is no similar benefit from giving more to local authorities. Sir Andrew Dilnot, and another other ten members of the expert group the DHSC created to advise on the social care green paper, published a letter in the 8th June Daily Telegraph saying: “we are united in our despair at the failure of governments for the last 20 years to deal with the critically important issue of the funding of social care. The system is underfunded, unsustainable and unfair.”

We regularly hear calls for “politicians on all sides with the courage” to come together and address the problem. Nice words but it will not happen without a formal cross party commission finally to determine how much money is needed, what for, howit should be scrutinised, and how that money should be raised through progressive taxation and optional contributions from those who can afford them — and to mitigate tail risk in any private sector provision. Any of the major three political parties that refuses to participate should be held up to public ridicule by the other two. It would be a vote loser.

In the meantime the DHSC should stop pretending it is doing something.