As the consultation on Shaping the Future of Care Together draws to a close, the big care debate begs the bigger question of what happens next. The energy and commitment of the Green Paper team in taking the debate to the public has been impressive; officials and ministers worked hard to make the case for change and canvas some broad options for reform. These included a strong shift towards a more national entitlement – the proposed National Care Service – as well as options for future funding.
The Green Paper has helped to inject some political adrenaline into an issue that has rarely got near the top of the policy hit-parade and has never been properly addressed since its omission from the post-war social policy settlement. Both Conservatives and Labour have made specific (though very different) pledges that suggest real political commitment to change, even if the policy substance has been found wanting. Better that senior politicians are saying anything at all about social care than nothing at all, providing it goes beyond the transient demands of a 24-hour news culture.
But it's not just down to the politicians. There is little evidence as yet that the big care debate has made much of an impression on the public at large; and discussions within the care sector suggest that while there is broad agreement about general principles, there are some big gaps in the consensus about the way forward.
Different preferences for taxation, insurance and partnership models of funding; the inclusion of attendance allowance and exclusion of accommodation costs; how services for working-age adults are paid for; the balance between national consistency and local flexibility; inter-generational fairness – all reflect some of the trade-offs and tensions that have emerged during the debate. We need to remind ourselves of the impossibility of designing a perfect system in an imperfect world. The challenges facing the architects of a new system have never been starker.
Looking forward, a White Paper has been promised for early 2010 but it seems clear that legislation will now have to await the next parliament. The nature of democratic politics is to accentuate policy differences between political parties at election time rather than to build consensus. Yet consensus will be fundamental to achieving effective and enduring change after the election.
And the election campaign itself will present fresh opportunities to remind politicians and the public that the challenges of paying for care in a complex and fast-changing society will not go away and will affect most of us at some point in our lives. So the end of the consultation should mark the beginning of the next stage of the change process.
I sense a growing realisation that we may be approaching 'now or never' time for reforming adult social care. So we need to redouble our efforts to achieve a system that is simple, fair and affordable, to consider how those tensions and trade-offs are reconciled, and to use the opportunities of the general election campaign to ratchet up public and political interest so that there is cross-party commitment to change early in the lifetime of the next parliament.
In an essay for the Future Agenda programme, Dr Jack Lord’s argues that we can’t choose between reducing health costs and investing in health – it has to be both or we won’t have either: futureagenda.org/?cat=9