)
Reading the runes of an imminent government White Paper used to be straightforward. Some months before there would have been a Green Paper, setting out the government’s broad thinking and consulting on key options. The subsequent White Paper would set out firmed-up proposals as a prelude to draft legislation. However the Equity and Excellence: Liberating the NHS White Paper turned that on its head, with consultation papers published afterwards and then the pause and listening exercise.
In contrast, many hope that the forthcoming care and support White Paper will not require a colour chart to detect more than a hint of green. Unlike the NHS reforms, there is universal consensus that the social care system is not fit for purpose and requires radical reform – which is not the same as reorganisation. The NHS will never work properly without it.
Much of the policy groundwork has been done, with the Law Commission’s proposals for a major legislative overhaul as a potential centrepiece, and a clear sense of purpose arising from the Department of Health’s engagement exercise last autumn. Much of this is relatively uncontroversial politically and everyone in the care sector supports change. It is the final piece of the jigsaw – Andrew Dilnot’s report on how care is funded – that was always going to be the trickiest to lever into place.
From the outset the government said it would publish its response to the Dilnot report as a separate ‘progress’ report and not as part of the White Paper itself. Since then, the economic climate has worsened, media coverage of concerns about the quality of care has proliferated and real terms spending on the care of older people is falling. A key challenge for government is balancing the demands of an underfunded system whilst protecting people from catastrophic care costs. This has got so much harder since that confident declaration in the government’s programme nearly two years ago when it recognised ’the urgency of reforming the system of social care’.
The balancing act the government now needs to pull off is similar to that facing the Blair government in 1999 when another independent commission recommended free personal care funded through taxation. It chose instead to pump extra money into the publicly funded system and introduce an element of ‘free’ nursing care. Then the economic sun was shining but this government has fewer choices about how it can balance these trade-offs. Cross-party talks are continuing and the next spending review will be the ultimate crucible in which social care takes its chances against other competing demands for diminishing public finance. The political mood music does not inspire confidence that social care has made it on to the ‘must-do’ list of government priorities, although it touches the lives of at least 10 million people – a quarter of the adult population of England.
A White Paper with positive proposals that could form a good story about the reform of delivery will be warmly welcomed. It would kick-start some serious implementation work in areas like information and advice, assessment and integrated care. Even if it has a greenish tinge, which seems likely in view of the scale of what needs to be done, a clear commitment to action should ensure that this aspect of care reform will avoid the tortuous and troubled trajectory of the Health and Social Care Bill. But it will need legislation, and the omission of a social care bill from the Queen’s Speech will cause disquiet. Further delay in tackling the reform of funding – an essential accompaniment to reform of delivery – will be greeted with deep dismay and disappointment.
In the absence of an unequivocal acceptance of the Dilnot framework, Kremlinologists will be busy subjecting the words of the government’s separate report on funding to forensic scrutiny. So the biggest question when both documents are published will not be about the colour of the government’s White Paper but the colour of its money.