The Green Paper Shaping the future of care together honours the government's commitment – made originally in the 2007 Spending Review – to bring forward proposals for reform of social care funding. This commitment was made in response to The King's Fund review of social care funding and the Caring Choices initiative.
Key proposals for consultation include:
- developing a National Care Service, which offers prevention, national assessment, joined-up services, information and advice, personalised care and support and fair funding
- three broad options for funding, each one based on a partnership between the individual and the state. (For a quick overview of these options, go to our summary of the key points in the Green Paper.)
A public consultation, described as 'the big care debate', concludes on 13 November and there is a commitment to publish a White Paper in 2010.
The right principles?
- The Green Paper offers a compelling analysis of why radical reform is needed, recognising funding pressures, demographic change, higher expectations and widespread dissatisfaction with the current system. The results of last year's national engagement process chime with the views expressed by participants in the Caring Choices events in 2007.
- The government's vision of a new system that is fair, simple and affordable fits closely with the four key tests developed by The King's Fund – that a reformed system should be fair, understandable, effective and enduring. The challenge will be how these aspirations can be translated into practical proposals for change that command broad consensus.
- The proposal for a National Care Service, with defined entitlements based on what people need rather than where they live, is a positive move – it should clarify what people can expect from the care and support system. Although the Green Paper envisages a positive, albeit more strategic, role for local authorities, it raises profound questions about the balance of responsibilities between central and local government, including finance and accountability, that will require careful analysis.
- The emphasis on more joined-up working will be of particular interest to the NHS and other public services. Better co-ordination has been a major objective of health and social care policy since the 1980s, but in many areas the ambition has not been realised. Imaginative new thinking is needed. The Green Paper offers several local examples of innovation but offers no new specific proposals other than setting up a ministerial group on integration. This may or may not signal that something significant will follow. Nationally defined assessment and eligibility arrangements are likely to change existing local arrangements between councils and primary care trusts (PCTs).
The right options?
- The funding options set out in the Green Paper are a variation on the partnership model developed originally in The King's Fund's social care review. The underlying principle of all three options is that funding should be a shared responsibility between the individual and the state – this is a sensible platform for debate.
- There are some options that have not been included for consultation. These include approaches that set a limit on an individual's liability, eg, raising capital limits for care home fees from the current level of £23,000 and similar options costed by the Joseph Rowntree Foundation earlier this year. These could offer short-term opportunities to give immediate relief to current users without compromising longer term reform options.
- The funding options focus on older people. The implications for those of working age are unclear. It is worth noting that the biggest current pressure on councils' social care budgets are from learning disability services; it should be clearer how the needs of those of working age will be addressed and funded. Funding reform should address resource needs across all parts of the social care system; it should also avoid creating anomalies and unfairness at a time when the retirement age is likely to change.
- Understanding the potential costs of each option – to the taxpayer and to the individual – will be crucial to achieving a better public and political awareness of the difficult choices that lie ahead. It is difficult to judge from the Green Paper how much additional money each option might bring into the system in order to address funding shortfalls, which by the government’s own estimates will be £6 billion by 2027. Full costings of the options will be essential.
The right way forward?
- The current recession and the huge levels of public debt mean that a public spending squeeze is inevitable from 2011. This, combined with the prospect of a general election at some point in the next 11 months, produces a highly volatile and uncertain environment in which to embark on radical reform. The need could not be greater; the timing could not be worse.
- The Green Paper marks an important milestone on the journey towards a transformed system, but there is still much more to be done. The time it has taken to produce the Green Paper means that no legislation can be passed in the current parliament. The spotlight therefore shifts to what the incoming government will do. Yet this is not an issue for one parliament - any settlement should be for at least a generation. It is vital that all the political parties recognise the urgency of reform and the importance of reaching some form of consensus. The challenge now will be to sustain this momentum provided by the Green Paper and to encourage a converging path, for example, through an all-party road map for reform.
- Last year's public engagement exercise on 'The Future of Care and Support' did not ignite a wide debate with a cross-section of society. There remains widespread confusion about what social care is and who pays for it. The forging of a new funding settlement and inter-generational contract between individuals, families and the state will be impossible without this. The 'Big Care Debate' is an ambitious attempt to rekindle public interest and deserves the full support of all who have an interest in a truly reformed system. It will not be an easy task.