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Brexit could ensure social care gets the reform it badly needs

10 October 2017

5:31 PM

10 October 2017

5:31 PM

Theresa May had planned to move the political focus this autumn from Brexit to domestic priorities. That was always a tall order when the next round of negotiations and this month’s EU council are looming, but it’s particularly difficult given the Prime Minister managed to lose, not gain, authority with her conference speech. It’s also made harder given that her statement in the Commons yesterday seems to have enraged Brexiteer MPs, who were willing her on before the conference speech fiasco. One senior eurosceptic MP told Coffee House after the admission that the European Court of Justice would still have a role during the Brexit transition that he and colleagues were ‘extremely surprised as this was quite the opposite of what we had been led to believe’. 

While those colleagues are trying to get their head around what May is actually aiming for with Brexit, others are trying to work out whether the government is going to do anything at all on the domestic agenda it was apparently so interested in for this autumn. Of course, there’s the racial disparity audit published today. But that cannot be the sum total of the Prime Minister’s ambitious domestic agenda. Or can it?

The problem is that once you start looking at what an ambitious domestic agenda should look like, you realise that it’s not the kind of thing that a naturally cautious Prime Minister who lacks authority in a minority government would really leap to take on. Take today’s Care Quality Commission report on the state of health and social care, which warns that the current system is ‘straining at the seams’. The CQC’s chief executive Sir David Behan also describes social care as ‘one of the greatest unresolved public policy issues of our time’ and says ‘the anticipated green paper on adult social care will provide the opportunity for Parliament, the public and professionals to consider how we can collectively develop an appropriately-funded social care system that can meet people’s needs, now and in the future’.

This sounds hopeful, except Coffee House recently reported that this much-anticipated green paper is likely to continue to tease people by taking a while to appear. It’s also likely to be very green in the sense that it will probably be far more consultative than it is definite on what steps need to be taken and when in order to put the system on a long-term sustainable footing. Cross-party talks are still nowhere near starting, and those agitating for reform are growing increasingly frustrated. I understand that the process and content for any talks or papers are still very much under internal discussion.

Social care is one of those policy areas where doing nothing isn’t the cost-free option. The CQC reports that the Better Care Fund, which was designed to help join up the NHS and local government, ‘is not providing the additional resource that social care requires’. 

The CQC’s report is about the system as a whole, and doesn’t just warn about the strains on social care. It also says that ‘deterioration in the achievement of the four-hour emergency access target is a reflection of the severe pressures that acute hospitals face; it is no longer just a winter problem’. 

This doesn’t sound particularly positive for the Conservatives, who, after all, have been responsible for the NHS and social care for the past seven years. It’s even less positive for a government which surely doesn’t have the strength either in its leader or in terms of numbers in the Commons to push ahead with the sort of reforms that the CQC and others are calling for.  The way politicians have approached the NHS for a long time means that change rarely happens until things appear to be on fire.

That said, there are a number of reasons why the political environment needn’t be an excuse for not doing anything. The status quo is so costly that the government cannot afford to maintain it ad nauseam. There is also a view in Whitehall that the public now understands the case for reform of the system – though it isn’t clear whether the public also understands that any reform will involve a lot more money.

Even Brexit, which campaigners for reform of social care view as a terrible distraction for the government, could be useful. It means that the political and public focus is necessarily elsewhere, and therefore the NHS can move on with reforms without too much airtime being devoted to it. And given Simon Stevens, the NHS chief executive, has used his Five Year Forward View to create space between the NHS and government, reform doesn’t necessarily need to be political, either. Even if it is, Jeremy Hunt isn’t exactly the most embattled member of the Cabinet. He is in fact one of the ministers that both David Cameron and Theresa May have really trusted to get on with the job and take flak for difficult reforms, such as doctors’ pay. This means that he is in a pretty strong position, too, to push for further reform. The question is whether Theresa May really is the woman who gets things done that she branded herself in the leadership contest. If she is, she doesn’t have as ill a wind for social care reform as she might think.

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