No time for a honeymoon: Nuffield Trust commentary on social care reform and new Secretary of State

On Prime Minister Andy Burnham’s remarks on social care [1], Nuffield Trust Chief Executive Thea Stein said:

“It is refreshing to hear a Prime Minister talk about social care with this level of ambition. After 30 years of false starts, it is absolutely right that we move social care from being a neglected and incoherent public service to one that sits at the centre of government’s plans for a more prosperous, dignified and functional society.

“Enacting Burnham’s proposal to “operate on the NHS principle” of being free at the point of use would mean overhauling our social care offer from being one of the most threadbare in the developed world to one of the most generous, as our recent analysis shows [2]. One of the first tests for this reform will be about clearly defining what is in and what is out of any public offer. Even countries like Denmark, often seen as one of the most generous social care systems in the world, charge people for accommodation costs.

“Burnham is spot on about the need for more money for social care – and his honesty about this point is refreshing after years of obfuscation. But his hints that some of this funding will come from releasing savings from speeding up hospital discharges deserve close scrutiny. This is an important ambition – too many people are stuck needlessly in hospital and it’s vital to rebalance power away from the acute sector in the NHS.

“But not all delayed discharges are caused by social care, and freeing up hospital capacity may allow the NHS to treat more people rather than release cash that can simply be moved elsewhere [3]. So, all roads point to national taxation for a meaningful source of cash for these reforms.

“The government is right to want swift progress, but this reform will only last if the public are taken with it. The Casey Commission should be used to build a durable settlement, not rushed past just as the most difficult questions come into view."

On the task facing Yvette Cooper, the new Secretary of State for Health and Social Care, Thea Stein said:

“Even without the prospect of delivering a vast reform programme for social care, the new Secretary of State takes office with a formidable in-tray: the looming threat of further doctors’ strikes, a huge reorganisation of the NHS in England, the fallout from successive reviews on the shocking state of maternity services.

“And the Secretary of State will need to be clear-eyed about whether progress touted on the NHS is real or a mirage. There are some clear bright spots – improving public satisfaction, better experience of GP services, increased uptake of the NHS app. But progress on reducing the waiting list has repeatedly stopped and started and partly reflects list cleaning rather than a sustained increase in the amount of care available. Long waits in A&E are not improving and even show signs of worsening. There are sobering staffing gaps in crucial areas, with far fewer district nurses than we had fifteen years ago.

“Meanwhile the commitment to double medicines spending under the UK/US agreement raises tricky questions about whether this will mean continuing to pull funding from more efficient treatments to less efficient ones – and whether this is prioritising the extreme health care needs of the few over the core needs of the many [4].”