The emerging findings and conclusions of the engagement exercise were presented to the Secretary of State last week. The Secretary of State and the Minister for Care Services released the presentation with clear interest in the recommendations, accompanied by an obvious enthusiasm for care reform. Those who claimed that the reform of adult social care was in the long grass, should start booking the mowers in for a service, just in case!
The engagement exercise found that there is consensus that the social care system is no longer fit for purpose. Based in the expectations and norms of post war Britain, the system is no longer right for the care and health needs of today; is compromised in its own right, and is a risk to the NHS. We heard plenty of evidence that the current system is failing and needs urgent reform. The risks that an unreformed system poses to the finances of citizen and state and the NHS were clearly articulated. The case for change is well supported and widely understood and is underscored by the commitment of the government in the coalition agreement.
Through the engagement exercise and the work that people are doing to cope with and change the system there is an emerging shared vision of the future for care. Its not based on the previous demands just to close the financial gap between demand and resources. There is appetite to respond to the care crisis in ways that also change both the way we pay for care and the amounts we throw at reactive crisis events and distressed purchases of high cost care.
We acknowledge that together we face an unprecedented fiscal position. This also creates a new opportunity to recognise the value of peoples own contribution, and in particular the role of informal care. Contributions that currently exist in spite of, rather than because of, the model of the current entitlements based system.
We have heard widespread commitment from the sector to new approaches that would change costs and demand within the system. At the same time there is also scope to improve quality. There is substantial evidence that poor quality within the care and health system costs. Much of the claims for prevention are not yet supported by evidence, not least because this requires a new framework and approach. There is however a chance worth taking to create a new win-win position.
The introduction of a capped costs system is a game changer when allied with a new offer from the state to maximise wellbeing and therefore minimise the costs to all. Historically, this would incentivise prevention, health promotion and the strength of the informal community offer. It builds upon some of what is already emerging as best practice.
We have shown that we are a sector committed to the reform of care from the bottom up, which will only truly succeed when it is supported by the transformational power of legislative reform. However, the way forward will require further new thinking and agreement if we are to see the process through to a White Paper and new legislation.
The engagement process has lived up to its name - we have had the chance to think about the nature of the commitment that we might make to a new world. We have also thought about how we manage all the tricky things that wreck relationships and managing the demands for money is right up there! We have begun to outline what might be different if we are to make this work. The sector now needs to reflect on whether it can continue to commit to the co-production of reform. I certainly intend to allow ADASS space to do exactly that.
It is my personal view that we should take that next step. There are some who will claim that this relationship of top down and bottom up reform is an odd one and certainly some sages say it wont last. While reform continues in the current spirit welcoming to, and reflective of, the many contributions that came through the engagement exercise - then it stands a chance. Given there were no voices in favour of staying where we are, and we appear to have a critical mass of support aligning behind the proposals for reform and resources, then its a chance I am prepared to support.