Why is social care reform so difficult?

Francis Elliott reviews previous attempts and asks – what if the starting point was asking how people experience social care in their day to day lives?

Boris Johnson is expected to include measures to reform the social care system in England and Wales in the Queen’s Speech early next month (May 2021). He has previously said that he won’t wait  to “fix the problem of social care that every government has flunked for the last 30 years”.

Engage Britain’s Director of Advocacy Francis Elliott has spoken to politicians from across the spectrum to find out what makes social care such a notorious ‘wicked problem’ and why finding a solution has eluded so many of Mr Johnson’s predecessors.

With the failures of social care even more apparent in the light of the pandemic and a green paper finally due, this new report based on in-depth interviews with leading political figures from three different parties and five previous administrations who have led on previous attempts, shows common themes emerging.

Politicians point to a lack of public interest and understanding of the system when asked to account for why they did not succeed. But what if the problem is that policy-makers have never taken time to appreciate how people in Britain experience what the state calls ‘social care’?  The 2017 election was an extreme example but strongly suggests the real failure of each of the reform attempts was that they started with an overview of the system rather than from how people actually interact with it.

Download the full briefing on the report findings here

Read The Spectator article here

Summary

Engage Britain’s new report is based on in-depth interviews with leading political figures from three different parties and five administrations who have led on previous efforts to tackle social care. Interviewees include Nick Timothy, Andrew Lansley, Norman Lamb, Andy Burnham, Malcolm Chisholm and others.

Key findings from the report showed:

  • Political would-be reformers have seen the “problem of social care” as a series of inter-linked systemic failures. The nub of the political problem has been finding a way of increasing funding but also mitigating the impact of the means-test and individual costs which can be catastrophic.

“no-one understands what social care is”

  • Politicians also see NHS as delivering better rate of political return on investment, so when push comes to shove, it’s always the NHS that wins out. Norman Lamb: “[The NHS] is politically sexy, no-one understands what social care is… It’s not clear from what it says on the tin on what it actually amounts to.” When Cameron killed off the Dilnot plan which limited liabilities at £73,000, Lamb said the public didn’t blink. “No-one had any idea what the Dilnot cap was out there in the public so it was incredibly easy for the Tories to ditch once they got rid of us. It was hardly noticed..”
  • May’s proposals were approved after being subject to extensive focus-tests, according to one person closely involved. “It was tested in considerable detail… The feedback we got was that the public wasn’t across the issues didn’t really understand how social care works, but when it’s described to them, they liked it. May was told, ‘It’s fine, go with it. It shows you are being grown up’. Of course it was very much not fine – as Tory candidates quickly attested doorstep conversations on the financial consequences of a dementia diagnosis rarely ended well.

“address the fundamental questions of what we want from our care system”

  • Asked to give their advice to today’s reformers, those that have gone before all urged Johnson to be bold and several also said he should address the fundamental question of what we want from our care system: “It’s not just to sort of contain people in institutions, it must be fundamentally to give people a good life, and not to just extend life for the sake of it, but to give people the opportunity of a good death as well.”
  • Politicians point to a lack of public interest and understanding of the system when asked to account for why they did not succeed. What if, however, the problem is policy-makers have never taken time to appreciate how people in Britain experience what the state calls ‘social care’?  The 2017 election was an extreme example but strongly suggests the real failure of each of the reform attempts was that they started with an overview of the system rather than from how people actually interact with it.

“A richer understanding…might enable us to uncover what we value, what we are prepared to pay for and how.”

  • What do people want for themselves and their loved ones as they grow older? What do the transitions between the health and care services feel like?  A richer understanding of questions like this might enable us to uncover what we value, what we are prepared to pay for and how. These are not electioneering conversations. In fact it’s unlikely that they can be conducted within the typical Westminster verbal ping-pong.

Engage Britain is currently holding conversations about health and care all over the nation – to make sure that people’s real experiences can be heard by decision makers. We want to hear from people working in the industry and well as unpaid carers and people using health and care services – and there’s several ways to get involved.