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Instead of fixing social care, Lansley broke the NHS

Social care in England is broken – and the Health Secretary has delayed every opportunity to fix it

Before last year's election two things were clear. The NHS had improved greatly, and social care was broken. The primary purpose of a competent Secretary of State would be to swiftly formulate a policy to fix social care. After the election we had Andrew Lansley as the Secretary of State for Health and he has evaded the responsibility to fix social care, and enacted a policy that will break the NHS. The word "competent" simply cannot be used to describe him.

Before the election the NHS was respected throughout the world for its efficiency, equity of access and quality of care. Sadly the same could not be said for England's social care. Where the NHS has strived under difficult circumstances to provide high-quality care across the country with access to all, social care suffers from an unacceptable postcode lottery with different services provided at different rates across the country. It was clear that after the election both social care and the NHS would come under severe funding constraints, but it was social care that needed wholesale top-down reform, not the NHS.

Social care became a local authority responsibility in the reorganisation of 1974. Since then there has been an almost complete privatisation of the service. In the two decades, 1990-2010, 110,000 beds were opened in private and voluntary homes, and 95,000 closed in local authority homes. There are now many areas in England where there are no local authority owned care homes. The result is that public money is spent on unaccountable providers, leading to vast variation in the quality of care.

Pickles' slashing of local authority funding (and an associated prohibition of Council Tax rises) means that local authority funding of social care faces a huge shortfall. Age UK say that "in 2011-12, the net annual expenditure per person over the age of 65 is falling to £791 continuing a downward trend from £864 in 2010-2011 and £872 in 2009-10". The Kings Fund warns that social care will suffer a "cash gap of £1.2 billion by 2014/15". This shortfall in funding will put huge pressures on social care providers and quality will inevitably suffer. Social care is broken; it desperately needs fixing.

Recognising this, the last government produced a green paper – a discussion document – identifying the funding issues and possible solutions including an insurance payment option and an option for everyone to pay a contribution from their estate when they died. To address the postcode lottery the last government proposed a "national care service". The option in the green paper to pay a contribution for social care from death duties is the source of the so-called "death tax" campaign by the Conservatives, who proposed a £6,000 insurance scheme. This scheme was rejected by most experts (including the insurance industry) because the figure of £6,000 was far too low. However, the media latched onto the "death tax" and to make his point further, Andrew Lansley pulled out of cross-party talks on social care funding and petulantly refused to discuss the issue until the "death tax" option had been removed. Reform of the broken social care system was delayed by the man who would become Secretary of State.

So what did Andrew Lansley do when he became Health Secretary? The first thing was to delay the fixing of social care by yet another year by announcing the Dilnot Commission. He then produced the NHS white paper that announced a reorganisation that was neither necessary, nor promised. The Dilnot Commission, recently published, uses the same figures for the projected cost of social care that were used in the previous government's green paper, and his recommendation is adapted from one of the options in that paper.

After the election Lansley could have used the consultation from the green paper to produce a white paper, and we could have had legislation by now. Instead, it is becoming apparent that Lansley's white paper on social care funding will not appear until next year – effectively two years after the election – and legislation could take a further year. The new funding system may not even start until 2015 and yet this is just a reform of the funding system, Lansley has no plans for a National Care Service meaning that we will still have the broken system with different services offered by different councils, and charges varying across the country.

It was as if Lansley got his wires crossed. Where he should have pledged to reorganise social care and left the NHS alone, he has instead reorganised the NHS and left social care alone. These are not the actions of a competent Secretary of State for Health.

Richard Blogger writes about the NHS and social policy at NHS Vault.


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