There are good reasons why we should take seriously the new report from The Fabian Society on reform of adult social care.
Firstly, it was commissioned by Wes Streeting, who – if polls are taken at face value – stands a good chance of being the next secretary of state for health and social care. Second, it comes at a time when there is a market for new social care ideas, given repeated failures to get reforms focused around the introduction of a cap on care costs over the line. And finally, it comes when social care seems trapped in crisis, with more people asking for support but fewer getting it, record high levels of staff vacancies and plummeting levels of public satisfaction with services.
Into this space The Fabians have dropped a well-researched, well-informed and credible document that – whether you agree with it or not - hangs together as a coherent vision of how social care might be differently commissioned and provided in the future.
The report aims to strike a balance between two apparently contradictory positions: the desire for greater national oversight of adult social care to ensure consistency of funding, quality and development, and the desire for services to be commissioned and managed locally so as to best meet the needs of local people and integrate most effectively with health and other services.
It does that by proposing sweeping new powers for national government but also increased responsibilities for local government.
National government takes on responsibility for creating a strict framework within which local social care operates. There would be a ‘National Care Service’ with national branding, agreed rates of pricing for social care providers and fixed minimum rates of pay for social care staff. Any provider wanting any social care business whatsoever from a local authority would have to sign up to be a licenced National Care Service provider and abide by those nationally agreed prices and pay rates.
And in practice virtually all providers would have to because local authorities would take on responsibility for virtually all people using social care services: they would commission the care of people who pay for their own care, in addition to state-funded service users.
If these changes weren’t sweeping enough, the amount of money that local authorities have to spend on adult social care would be determined by national government under a new funding formula. The report proposes that this could either be funded as a ‘top-up’ to existing local authority finance or a designated grant to cover the whole of required social care spending. This, the report acknowledges, would require wider reform of local government finance.
These are massive changes, then, and the key question is around the likelihood of Labour adopting any or all of them as policy. Here is where local government (and the rest of the social care sector) can relax a little, at least for now. Though the report was commissioned by Wes Streeting, he has been careful to keep a clear distance between it and Labour policy. That is in part because Labour won’t go into the next election with a spending commitment of the scale required to implement these proposals (the report doesn’t give a number but acknowledges it will be large). But his reticence is also because Streeting doesn’t think social care is an issue that resonates on doorsteps. He’s made it clear that he doesn’t plan to talk about it much during the upcoming election campaign. As a result, there is a big gap between what is in the report and current Labour party policy on social care, which does talk about ‘building towards’ a National Care Service but whose only significant policy is a commitment to a ‘fair pay’ agreement.
What about post-election? If social care has not been a big campaign issue, there is less likely to be spending available for it. And history has shown that, when the going gets tough, governments in any case tend to shy away from widescale reform, preferring to channel any available money into stabilising the current system. Whoever wins the next election, that remains a serious risk.
Nonetheless, for a future Labour government, the coherence and credibility of the Fabian report should at least make reform harder to ignore entirely. That is no small achievement.
Simon Bottery is senior fellow at The King’s Fund
@blimeysimon
