The government’s upcoming green paper on social care gives cynics many reasons for doubting it will amount to anything.
First, we have been here before. Many times. Each time, politicians’ desire to make things better for older and disabled people has lost out to the opportunity to score cheap points (Labour’s plans branded a “death tax” by Conservatives; Labour condemning the Tories’ “dementia tax”) or the Treasury’s particular aversion to pouring money into a sector it appears to regard, more so than others, as a leaky bucket.
The sector fought for Andrew Dilnot’s proposed solutions to funding social care, only to acquiesce to their postponement, hoping to benefit from the money saved. Social care cuts continued unabated and the postponement has become permanent. Some 1.2 million older people lack vital support, according to Age UK, up almost 50% since 2010, and, as eligibility thresholds rise, only those disabled people who have the highest levels of need get help. And then there’s the Brexit maelstrom.
Each of those problems is compounded by our failure to create for the public a clear and compelling picture of what social care is and could be. You will find more love in many social care services than in medical ones, but it is the NHS that is loved and social care that is more often feared. So we need this green paper. It is our only opportunity to create a vision worth investing in. That should be its focus and ours; not the “Who pays?” question, which has only ever had a few simple answers. Dilnot’s solutions will not be improved upon, however unpalatable their costs.
NHS England successfully galvanised its sprawling sector around new models of care in its Five Year Forward View. Some are complex and incompletely evidenced, but they made enough sense to protect the health service from the worst cuts. Social care can do the same: not with service reconfigurations, but by building a movement around the idea of living well with disability and in older age, showing people that issues such as loneliness or family breakdown from unmanageable caring responsibilities are the “giant evils” of our times, and demanding more caring, social kinds of social care to address them.
Those models already exist. Some, such as Homeshare and Local Area Coordination, need scaling. Others, including Spice’s Time Credits and Community Catalysts’ micro-scale approaches, reach thousands or, like Shared Lives, are national. When people hear about these approaches, with their human stories of small achievements that mean the world, they connect with them. They see the value of ordinary life chances for disabled people or a good last 1000 daysfor older people. A green paper based on those stories could finally persuade the public that social care is worth investing in.