A blog entry by Patrick Hall,
Sustainable Care Research Associate
I was recently asked by Demos, the cross-party think-tank, to participate in a roundtable with MP Danny Kruger to discuss his recent letter to Secretary of State for Health and Social Care Matt Hancock. In his letter, Kruger set out a series of principles which he believes should shape the design of a new system. He opposes the establishment of a ‘single, centralised state service’ for social care (mirroring the NHS), and emphasises support for families, in an approach he calls ‘family-led care’. Kruger favours adopting a German or Japanese-style social insurance system to inject the extra funding needed to expand support, which he wants to see delivered with an option for care recipients to receive cash payments or services in-kind (although the Japanese system doesn’t allow payment to family members). Kruger claims this system would support the smallest scale of care first: through families, communities and small, flexible service delivery. Larger-scale state and market services would become the last resort. While the current system in England does enable flexible payment: through the Attendance Allowance and direct payments, Kruger doesn’t mention what would change about these systems, other than that payments to family members would be permitted.
In his recent (June 2020) report ‘Levelling Up our Communities: proposals for a new social covenant’, he sets out principles for sustaining the levels of mutual, community support which emerged in spring 2020 during the COVID-19 crisis. The new ‘social covenant’ he proposes would involve a shared commitment by the state, civil society and citizens to work to a common purpose, for the common good. He calls for a new ‘Community Power Act’, alongside a £500 million Community recovery fund and a £2 billion endowment for a ‘Levelling Up Communities Fund’ designed to target community renewal alongside the Government’s plans for physical infrastructure investment. While not articulating what this would mean for adult social care, the report raises some important questions about the promotion of a ‘common good’ approach to policy and provided an interesting basis for discussion alongside the letter.
Reflecting on the round table discussion, I noted that when stakeholders in the social care sector gather, we often advocate for our own sectional interest, rather than think about ways of reconciling our views or reaching consensus on what the ‘common good’ might look like. We bat for our own team: carers, disabled people, care workers, care providers and others. We emphasise our own contribution and under-appreciation. Many contributors seemed satisfied that ‘answers’ to the social care crisis have been well rehearsed already – and are easily available for the Government to adopt. Yet it seems to me that we still lack a common set of principles by which to design, implement and evaluate any reformed or new arrangements for social care. One of the emerging lessons of our recent study of reforms in the four nations of the UK since devolution has been the importance of seeing social care policy as an ongoing and iterative project. Not a one-off fix, but part of an ongoing national, regional and local conversation. For me, the starting point for this conversation should be – ‘what represents the common good for social care?’
Kruger’s interventions, I think, open the door to a genuine discussion about this question. They offer an important alternative to what, for me, are endless debates about a ‘National Care Service’, mirroring the NHS. In his letter, Kruger pointed out that the NHS has as much to learn from innovative approaches in social care as social care providers have to learn from healthcare provision. His vision for the future of social care locates the ‘problem’ of social care in a society-wide lack of concern and real ‘respect’ for older people and for those, ‘paid or unpaid’, who look after them. I’d argue that this lack of respect has been confirmed by the Covid-19 crisis. Older people have been hit hardest. It has been claimed that many have been failed by the health service’s approach to triage, and the early decision to discharge large numbers of Covid-positive patients back to care homes, likely led to a large number of excess deaths – despite the evident good faith of medical staff making these decisions. These older people are the ‘left behind’ of social care – the voices seldom heard and the budgets most easily cut.
Sadly, the Prime Minister’s response to Kruger’s June report offered little in terms of immediate action for social care, although it did say that Kruger’s ideas on ‘levelling up communities’ would be ‘actively considered’ by the Department for Digital, Culture, Media and Sport. While we wait for the Government’s long delayed proposals, and for our country to emerge from this awful period, we should focus our minds above all on older and disabled people and their carers – the very people most affected – and listen to voices from across the political spectrum. Perhaps then, we can avoid what – for me – has been the partisan bickering that has often characterised debate on adult social care reform in England over the past two decades.
Sustainable Care Research Associate
Patrick is part of the research team studying ‘Comparing UK care systems: prospects, developments and differentiation in the four UK nations‘ as part of the Sustainable Care research programme. Learn more about this research here.