He chose to speak (on March 20, 2018) to the British Association of Social Workers, and told his audience he felt the “weight of stalled reform programmes” on his shoulders and pledged a “relentless and unswerving focus on providing the highest standards of care – whatever a person’s age or condition”.
The paper marks the government's latest attempt to grapple with a system of social care that is already on its knees and facing the neglected challenges presented by an ageing population.
Will this time be different? Will an effective and sustainable blueprint emerge from a £1 million pilot scheme across three counties in which everyone who receives social care will be provided with a joint health and social care plan?
What will come of a new 10-year strategy to eventually align the health and social care workforce? And will a cost-capping/risk-pooling solution to the inequalities of ageing get off the ground?
These are always interesting times. The increasing availability of technology and a greater move towards consumer choice gives some hope for major improvements in outcomes for individuals if the money is there and commissioning performance is improved.
The seven principles are:
1 Quality and safety embedded in service provision
Despite a recent improvement in care quality - with 81 percent of registered adult care providers rated as good or outstanding by the Care Quality Commission (‘CQC)’) - Mr Hunt acknowledged ‘unacceptable’ variations in standards around the country. He is now examining whether or not regulation (in terms of quality and outcomes) should be extended to both commissioners, as well as providers, of social care.
Regulating commissioners could provide greater transparency on commissioning practice - thereby increasing investor confidence and more robust funding solutions. It would mean that councils would be rated for the quality of care and commissioning in their areas, putting extra pressure on budgets and resources, and perhaps leading to providers facing punitive measures from commissioners in areas where providers are struggling.
2 Whole person, integrated care with the NHS and social care systems operating as one
Integrated health and social care has long been heralded as the answer to providing the holistic support many people need. Over the next two years that will be put to the test, with pilot schemes in Gloucestershire, Lincolnshire and Nottinghamshire that will ensure every person accessing social care will get a joint health and care assessment, a joint care plan (where needed) and a joint personal budget.
3 The highest possible control given to those receiving support
Mr Hunt clearly wishes to turbo-charge progress on integrated healthcare budgets, so that they become the ‘norm’ and not the exception. He recognises that the key to provider choice is information, allowing a meaningful comparison of services by individuals. He cites the recent Competition and Markets Authority (‘CMA’) report that found the current social care market lacks transparency. Greater choice and more information, he believes, will spur a consumer-based approach that will increase quality and innovation.
4 A valued workforce
Low pay and lack of career progression have now been recognised for some of the sector’s problems – but already there is a gulf emerging between the settlement announced recently for NHS staff and the relative lack of pay and benefits to those who work in social care. Mr Hunt is now saying it’s time to promote social care and halt the crisis in recruitment by providing similar career paths and ladders that exist within the health service. He is pledging a drive to promote social care careers, pathways into nursing and committing to a new, fully aligned, 10-year NHS and social care workforce strategy.
5 Better practical support for families and carers
The Green Paper will recognise the burden on carers and their families. It’s likely that Tracey Crouch, newly appointed as Minister for Loneliness in the wake of the Jo Cox Commission, will have an active role in building better links between the individual, state and wider and civil society. Mr Hunt also discussed carers needing better support from employers (including flexible working schemes), greater use of volunteers and harnessing new technology.
6 A sustainable funding model for social care supported by a diverse, vibrant and stable market
The Green Paper will look at how the Government can jump-start innovation in a market that has a perennial problem around funding and sustainability. The desire is to build new models of funding and care - at scale - in a market that is largely publicly funded but with private provision. £98 million in funding has already been announced for a ‘healthy ageing programme’ that will drive the development of new products and services, help people to live in their homes for longer, tackle loneliness, and increase independence and wellbeing. There is a clear emphasis on the role that technology can play in supporting innovation, cost effectiveness and creating more suitable housing and other accommodation.
7 Greater security for all – for those born or developing a care need early in life and for those entering old age who do not know what their future care needs may be
News headlines following the event centred on Mr Hunt’s pledge to re-instate a cap on the amount people pay for social care so they can avoid ‘punitive’ costs. He acknowledged an inherent lack of fairness for dementia sufferers and others who have to use their savings and the equity in their home to pay for long term residential care. This is likely to be a catalyst in the development of more risk pooling insurance schemes that work well in other countries.
In some parts of the country, New Models of Care are already proving successful – where innovation and technology have resulted in much reduced levels of hospital admissions from care homes. In other areas, however, the care system is said to be near collapse, and the fundamental reforms Mr Hunt envisages may not arrive in time.
But at least now there is some optimism that health and social care can be put on a sustainable footing, based on the idea of shared responsibility for care between the state and the individual, albeit that younger adults might be expected to start insuring against care costs in later life.
Whilst the seven principles are to be welcomed, the key question is how much money will be put behind any reforms announced in the Green Paper in the summer.
Since local authorities are already transparent in their commissioning practices they may rightly be sceptical of any proposals to regulate commissioners of social care. What may be more helpful is a national minimum expectation of standards of social care, with clear resourcing to support that level of care, if the concern is around the quality of care and outcomes. The resourcing needs to reflect the demographics of the population, the cuts to local government funding (50 percent cuts in central government grant since 2010) and the increasing health and care needs of the elderly population that are living longer with more complex conditions.
The needs of the elderly population transgress other local authority services as well as social care including housing, transport, leisure and recreation - all of which have been subject to significant cuts in funding.
Greater integration of health and social care services is clearly a step in the right direction, but will not necessarily address long-term inequalities in funding and outcomes. The government needs to recognise and better reflect the role that local government can play in meeting the nation’s health and social care needs and seeing local government as an equal partner, rather than the poor relation.