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Tell me your dreams

21 March 2018

Vic Rayner

Executive Director

The weight of ‘stalled reform’ sits on Jeremy Hunt’s shoulders as he pronounces his seven principles by which any recommendations for reform should be judged. This focus on social care was appropriately delivered on World Social Work day, and represented his first major announcement on the sector since his role title was broadened to acknowledge his existing responsibilities, at the start of the year. 

What are we to make of these principles, and how should they be viewed? I grew up to the creations of Andrew Lloyd Webber and Tim Rice, as I suspect did Jeremy Hunt. He may remember the famous rendition of the Pharaoh’s song – a la Elvis style – where he talks of his dreams, which revolve around the number seven. In it, Pharaoh recalls seeing seven fat cows coming out of the Nile (uh huh!) – these were followed by the seven other cows that were skinny and vile (uh huh!). Then, perhaps my defining moment of vegetarianism, the thin ones ate the fat ones – which pharaoh thought would do them good, but it didn’t make them any fatter. Apologies for the extensive allegory – but as representations of the care sector goes – this seems to work. We are most definitely in the skinny cow phase – and whatever ‘fattening’ the government has attempted to do over recent years has not had the transforming effect that everyone had hoped – be it Spring budget £2bn, Better Care Fund, council tax precept or before. 

So it seems appropriate that now Jeremy Hunt focuses on sticking with that apocryphal seven as a marker for his key stones of any further transformation – and that whilst funding is most definitely part of these, there are other attributes by which change and reform must be measured. 
The principles are interesting in themselves, and there are some definite areas where many will see hope – whilst recognising that at this stage hope stems in a sense from the acknowledgement of the issue – rather than any evidence of action. 

The full seven are as follows:-
  • Quality and safety embedded in service provision
  • Whole-person integrated care with the NHS and social care systems operating as one
  • The highest possible control given to those receiving support
  • A valued workforce
  • Better practical support for families and carers
  • A sustainable funding model for social care supported by a diverse, vibrant and stable market
  • 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 might be
Now, those with a cynical eye to reform (and many with extremely good reason) would look at this list of principles and suggest – not unfairly – that these are not in fact principles of reform – they are in fact the law. Choice and control, carer support and quality are the founding tenets of the Care Act 2014. This is not to say that they are either universally understood, and definitely not universally available – but let’s be clear – these should not be areas that should be subject to the vagaries (also known as ‘long grass’) of reform. These are hard fought legal rights which all partners in the sector should be abiding by. Access to carer assessments, for example, have not been universally applied – and we do not need a reform agenda to address that element of carer support – we need the law to be applied fairly and equitably across the country. 

What is new, and to be welcomed is the commitment to a joint workforce strategy for health and social care. Those of you underwhelmed by the first iteration of this, Facing Facts, Shaping the Future (my thoughts on this can be found here) – will feel that this cannot come fast enough. The real value of the social care workforce was also acknowledged, which are welcome words to a workforce more often pilloried than praised. However, the very first test of this ‘joint’ approach came on 21st March 2018. The pay deal for NHS staff was announced, with a £4.2bn price tag attached and a potential implementation date as early as July. The full impact of this will be absorbed by the Treasury with the government using funds outside of the NHS budget. How the Secretary of State will square this anomaly will be of great interest. Social care providers will rightly feel aggrieved by this disparity of treatment – and it is one – that post green paper – and post joint strategy – should be impossible to justify. We must demand that the default proposition going forward is, as a famous statesman once said – ‘we are all in this together’.

The funding question is of course, where much of the energy and attention will go. The confirmation of a cap is important, and the rather pointed commentary around risk pooling suggests a mixed model for the future, with a sustained belief in personal contribution.  

I was refreshed by the golden thread of innovation that runs through the principles, whilst not naïve to the potential for ‘pilot’ fatigue. The announcement of three solid test beds which will test the ‘whole system’ reform agenda purported within the principles is positive. If you are active in Nottinghamshire, Lincolnshire and Gloucestershire, then we will hope to hear great things coming forward.  

I leave you with a final thought about Jeremy Hunt and his burdened shoulders. I was in a meeting the other day when someone made reference to the vision enabled by standing on the shoulders of giants. I would suggest that the Secretary of State uses the many and varied attempts at reform that have gone before, in which the sector has fully engaged, as the aforementioned giants. He would find that his view is greatly enhanced, and perhaps would help him fulfil his dreams.  

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