Boris’ Barnacles get lift off?

So – the waiting is over. We know now that Boris Johnson is taking the helm as PM – and we find out shortly how his cabinet will look. What will any of this mean for the position of care in the government priorities – will the new regime see that social care is domestic priority number one?

Well we know that it figured in the hustings, and we heard some of the perspectives of the new PM – where he talked about the importance of social care and recognised the need for dignity in old age. However, we heard little more detail. It was of note that the DHSC did not choose to publish the social care green paper before the new team was put in place, even though they did push out the prevention green paper on the eve of the results. What does that mean – is this a carte blanche for the new incumbent to start again? Will all the work that has gone before hand in putting together a green paper – civil servant, people, provider and commissioner time be thrown to the wind – or will some semblance of the carefully crafted (but never revealed!) reform remain. We know that Matt Hancock, the current Secretary of State for Health and Social Care (accurate as of 12.02 on the 24th July 2019!) is heading up Boris’ transition team – is widely quoting the new PM’s desire to push forward on necessary domestic reform. This might give credence to media reporting telling us that the mooted over 40’s voluntary insurance scheme favoured (according to press coverage) by Hancock may yet be the offer on the horizon. Although Kings Fund experts – who have looked across the globe at different options to fund social care – note that a voluntary scheme has never worked. The other broadly extolled idea is that, in light of the need to appear active on issues of domestic reform, this might appear as a ‘white’ paper rather than the much delayed green – putting us in all in mind of a Bobby Ewing moment where we wake to find we dreamt the whole green paper debacle (with the exception of Matt Hancock who is probably too young to have been an 80s Dallas addict).

Boris and his transition team are promising immediate reform to areas where Theresa Mays government failed to grasp. He is said to have stated that we need to get the ‘two big policy barnacles of schools funding and social care off the boat now in case we have to go to the country in the Autumn’. However, with parliamentary recess on the very immediate horizon – and no consultative paper in the offing – it is hard to see what implement he will favour to wrench free the crusty challenge of care.

Clearly there are widespread concerns across the board about whether or not an insurance scheme will ‘work’ – in the context of whether it will bring in sufficient money. But I think there are also a range of other things that we will want to be assured of alongside the reality of the revenue that any such voluntary scheme might raise. For me – these include (but are not limited to) :

  •  That an insurance based model drives up the quality of care for people receiving local authority funded care – as well as those being paid for by insurance – it must not be the last among equals.
  •  That an insurance based scheme does not create perverse incentives around how cost allocations are divided between accommodation and care costs.
  • That an insurance based scheme (and the politicians mooting it) remembers that adult social care is not just about older people – but over 50% of local authority funding is focussed on working age adults – and any insurance scheme or narrative needs to acknowledge this
  • That a voluntary scheme – should one be on the table – would have to be backed by a significant shift in media, governmental and community narrative about the role of care.
  • That the need for reform in relation to workforce, technology and quality care becomes ever more urgent – reform can’t be driven by what an insurance company will pay for. We need to learn from the power of insurers in determining health care in this country – what is and isn’t acceptable – how long or short recovery should be etc… and how it has determined provision of social care in other countries such as the Netherlands – and recognise how it has influenced the ‘offer’.
  • That an insurance scheme cannot drive a division between the ambitions of health and care integration. If we are aiming for a seamless transition between health and care – the introduction of an insurance based ‘eligibility regime’ that might either further limit discharge – whilst organisations wrangle over what will and won’t be paid for – or that doesn’t recognise the connect between insurance funded re-ablement and community based multi-disciplinary teams.
  • That the debate about to insure or not is taken away from the question as to whether insurance would prevent you having to sell your home for care, and put firmly in the bracket of whether the insurance will enable you to access life changing quality care that we should all aspire to.
  • An insurance based scheme is only part of the jigsaw of the funding puzzle. In the short term it will not be able to address the immediate challenges facing care – that must be top of the in box.

Yes – we most definitely need the attention focussed on care now – but until the resolution put forward will suit the agenda of people rather than one of political expediency – we will continue to be the barnacles clinging on Boris’ boat for a long time to come.