TThe lack of action, or even clear direction, on reforming the welfare system in England has been a disappointment in the first six months of Labour’s term. With the recruitment of Dame Louise Casey to lead a review, the Government has now made its decision on how to approach one of the most difficult policy questions. But the proposed timetable is far too long. By ordering further investigation into these issues, rather than making proposals, Health Secretary Wes Streeting and his colleagues have chosen to preside over dysfunction for several more years.
The result is that the problems it causes will continue to pile up, both for the unlucky people who need the most expensive forms of care and for overburdened health services. Mr Streeting says changes will begin to take place next year, when Dame Louise presents her interim findings. Failure to deliver on this commitment would be a shocking dereliction of duty by a government elected on promises to strengthen public services, particularly in light of the impact on hospitals of social service shortages.
Mr Streeting is well aware of previous failures of reform efforts. It’s only been a few months since her cabinet colleague Rachel Reeves scrapped the planned £86,000 cap on self-paid social spending because she wanted to save money instead. But attempts to provide a fair and sustainable model of service, which has public support, long predate the chancellor’s decision and previous decisions taken by the Conservatives. It is almost 25 years since Tony Blair’s government rejected most of the proposals made by a royal commission into social care that he initiated. It was perhaps in light of this precedent that Mr Streeting decided not to establish another commission and hired Dame Louise.
His reputation is based on a kind of creative tenacity in the face of seemingly insoluble problems. As a high-profile figure who has also worked for conservative prime ministers, she is seen as a heavy hitter who could help shape a non-partisan consensus. In the past, she has spoken hard truths to powerful interests – for example in an uncompromising report into the racist and sexist culture of the Metropolitan Police.
Mr Streeting’s aim is for social care rights to be seen in a similar light to health care. As has often been pointed out, there is no ethical reason why the treatment on which cancer patients rely should be free while the care of dementia patients is means-tested. The difference lies in the nature of the needs that these different conditions give rise to.
The key questions are to what extent social protection risks are grouped in the same (or similar) way that health risks have been grouped since the 1940s; how care that is not financed by the state is financed; and how duty levels are determined. On all these points, a certain consensus is essential. A new system will have difficulty establishing itself despite promises to abolish it. But as Mr Streeting knows, these are political issues on which parties of the left and right will inevitably disagree. It is fallacious to claim otherwise.
Lord Darzi’s recent review of the NHS was completed within months. It is to be hoped that Dame Louise makes urgency a theme of her work this year and recommends bringing forward her own deadline.
theguardian