Adult Social Care: Let’s Get On With It

Adult social care, with one sixth of the NHS budget, is the poor relation in terms of government oversight. The Department of Health and Social Care (DHSC) has 19 quangos to help it run the NHS and none for adult social care – not that quango deprivation is a bad thing.  Nor does it manage the funding; the department for Local Communities does that.

It has had no shortage of advice: a Royal Commission in 1999, an influential King’s Fund report in 2005, and the Dilnot Commission in 2011. An untrailed and untried proposal for funding adult care introduced during the last general election campaign nearly cost the Prime Minister her job. A green paper is expected in 2018 but no date has been announced and there are few clues when it might be due. The section concerned is apparently too short of staff to clarify the time-line.

However, the relevant two Commons’ Select Committees have decided to press ahead with their own initiative. Good for them. They have set up a 45–50 person focus group, rather grandly called a “Citizens’ Assembly”, to devote two weekends to listening to alternative proposals for funding adult social care, and then making their recommendations. Citizens’ Assemblies have been used in Canada, The Netherlands, Ireland and Poland but this is the first time the UK government has adopted the idea.

The idea is one that the left proposed and saw its heyday in 2015 when the Greens, Labour, and the Liberal Democrats were all pushing for a 'citizen-led constitutional convention' on the future of the UK constitution. There's perhaps a reason why the left is so keen. After all, 45 people are easier to steer over a weekend than a whole electorate. But whatever the conclusions may be, what comes out of the consultation must be a valuable stimulus – whether government action follows or not.

Unfortunately, it could have been better planned.  The weaknesses are fourfold:

  1. It is widely agreed that adult care services should, in future, be better coordinated with the NHS. We're still not at the point where we know what the funding arrangement between NHS and social care will be. Citizens' Assembly members should be considering how to fund adult care as it will be, not as it is.

  2. The research and analysis has been delegated to Involve which is “a public participation charity that aims to put people at the heart of decision-making”. A more fatuous claim to fame is hard to imagine: in this pre-AI age, who else can be “at heart of decision-making”? Involve is actually a sub-quango, i.e. part of, and funded by, the National Institute for Health Research, one of the half dozen quangos within the DHSC umbrella which sponsor research activities. This project is not in their usual line of work and an independent professional market research firm would have been better placed to conduct it. Cost may have played a part in that decision: this arrangement uses DHSC funds, along with two outside charities, to finance the work. Perhaps a false economy.

  3. A 45 - 50 person sample is too small to produce reliable results for the analyses envisioned: “The members are being recruited with the help of ICM to be representative of the English population in terms of age, gender, ethnicity, socio-economic group, place of residence, and attitudes towards a small/large state. They will include people with direct experience of social care for both working age adults and older people.”  Contrast that with a much less fundamental (in terms of the numbers and costs involved) research project into why ethnic/faith groups are reluctant to donate organs for transplantation: “A total of 22 focus groups were held in six multiethnic areas of London with 228 participants from six ethnic/faith groups (who identified as West African Christian, black Caribbean Christian, Indian Sikh, Indian Hindu, Pakistani Islamic and Bangladeshi Islamic). There were separate focus groups for older people (> 40 years) and younger (18–40 years), and for men and women among older South Asian people.”

  4. We are not told if this work was put out to public tender. Quangos all too rarely encounter competition and so all too often quality is found lacking. There is little here to suggest Involve will break this rule. And there is a worry that a quango, which is not a professional market research firm, would not be so strictly impartial. 

In short, the Select Committees should be congratulated on putting their shoulders to this slow moving wheel.  It is just a pity the research is not being more professionally conducted.