Do we want a wicket keeper running our health service?

Mrs May regards Mr Hunt as a safe pair of hands after the troublesome Andrew (now Lord) Lansley. He stops boundaries and even makes the occasional catch, so it is just a pity he does not score many runs. He implemented some things he inherited but what can you recall of national Department of Health and Social Care initiatives since he took charge over five years ago?

The mid-point between now and when he became Health Secretary and should have formed his vision takes us to “New NHS measures and initiatives in effect from 1 April 2015”. The first, of six, implements the 2014 Care Act with a 506 page user’s guide. Since no one was likely to read all that, the explanatory guide was explained by a Ladybird book on how to be a nice local authority, e.g. (p.8) “Local councils must have good information to help people choose the right care and support.” It has nice large primary school script and coloured pictures of girls and boys. No actions, no specifics. As an anthology of motherhood and platitudes, it is hard to beat.  Needless, perhaps, to say, little has changed because, primarily, councils do not have the resources to do the things we would like.

Space here does not allow discussion of the other initiatives but they all follow much the same pattern.  The big exception is that progress is being made with bringing NHS England and adult social care closer together. The Manchester experiment is important and may show that the horizontal (local) structures are far more important that the vertical (top down) ones. If the Manchester integration of health and adult social care works, it could be argued that national management of NHS England be replaced by NHS areas, defined by acute hospitals, merged with Local Authority adult social care units. As it happens there are about 150 of each so it would just be a matter of aligning borders.

The National Audit Office 8th February report on adult social care brings us up to date and could have been titled “plus ça change…”. Money remains short and the government still has no adult social care strategy: “2009 was the last time a national workforce strategy was published by the Department of Health & Social Care.” The Dilnot Commission 2011 report was exclusively about funding and was rejected. Health Education England, undeterred by their having no responsibility for adult social care, released a draft strategy, Facing the Facts, Shaping the Future – a draft health and care workforce strategy for England to 2027, for consultation until 23rd March 2018 if you feel strong enough. Only one of the eight questions for consultation related to adult social care: “What policy options could most effectively address the current and future challenges for the adult social care workforce?” One could say that was open ended but it also indicates the government does not have a clue. And the 10 year horizon suggests that it can all be left to the next government but one. None of the eight questions offers specific, here and now, options for comment.

The adult social care green paper, if it actually turns up, is now promised this summer.  It was originally due in summer 2016.  The unions are already grumbling that the “experts” are weighted to management and members of the establishment, such as the ubiquitous Martha Lane Fox whose CV, amongst a plethora of good works, does not include adult social care.  They argue that the front line carers and the cared-for are under-represented.  But we should judge the green paper when it appears and taking wide counsel is no bad thing.

The key National Audit Office paragraph is an indictment of the Department that has had responsibility for adult social care for more than seven years: “3.8 Instead of having a national strategy, the Department works principally with Skills for Care, the Local Government Association and the Association of Directors of Adult Social Services to identify and share good practice in recruitment and retention. Skills for Care developed a retention and recruitment strategy in 2011, and published a Retention and Recruitment Strategy 2014–2017. The latter strategy was more akin to a business plan, detailing the activity that Skills for Care would undertake to boost retention and recruitment. The strategies were not an adequate substitute for a departmental workforce strategy. Skills for Care has limited influence over workforce challenges such as levels of government funding for care, and pay, which is set by providers.”

The government response to this will be that an adult social care green paper is due this summer: “government will work with independent experts, stakeholders and users to shape the long-term reforms that will be proposed in the green paper.” The green paper was originally due in summer 2016 and there is no guarantee it will appear. The experts are weighted to management, number crunchers and members of the establishment, such as the ubiquitous Martha Lane Fox whose CV, amongst a plethora of good works, does not include adult social care. Who the other groups, stakeholders and users, will be and how their involvement will take place are unclear. But we should judge the green paper when it appears and taking wide counsel is no bad thing.

Norman Lamb MP and Lord Saatchi have been campaigning for a strategic review, whether by a non-party convention or Royal Commission, of this whole area for some time but Mrs May has been turning a deaf ear. She tried, but failed, to move Jeremy Hunt out of the DHSC and she must, presumably, have had a reason for that. The country wants action not someone who just keeps wicket however well he does that.