Andrew Dilnot's call for a £1.7bn injection of cash to reform social care came in a week where the funding shortages ravaging the current system were laid bare.
Two days after Dilnot's report came out on Monday, the Supreme Court upheld Kensington and Chelsea Council's right to withdraw night-time support to assist service user Elaine McDonald to the toilet and insist that she use incontinence pads itself, something for which McDonald did not receive an explicit reassessment.
The judgement sparked outrage from charities and social care organisations who warned that it raised significant questions about the social care system's ability to treat people with dignity, rather than simply meet basic eligible needs.
The one Supreme Court judge who dissented from the majority verdict, Lady Hale, captured this view, saying: “Logically, the decision of the majority in this case would entitle a local authority to withdraw this help even though the client needed to defecate during the night and thus might be left lying in her faeces until the carers came in the morning. Indeed, the majority view would also entitle an authority to withdraw this help during the day. The only constraint would be how frequently (or rather how infrequently) it was deemed necessary to change the pads or sheets, consistently with the avoidance of infection and other hazards such as nappy rash. The consequences do not bear thinking about,”
The following day - Thursday - Association of Directors of Adult Social Services president Peter Hay warned that the £1bn in cuts to adult care budgets made in England this year could be followed by greater levels of reductions in 2012-13.
Dilnot's central proposal - to place a £35,000 cap on the amount that any individual could pay for services - would not address the problems raised by Hay and the Supreme Court judgement.
Not only would Dilnot's plans not be implemented until 2014 or later, but they are about extending the writ of the social care system, not enabling it to better perform its current job.
Dilnot commented on this point too, calling for an immediate injection of cash for social care to meet current shortages, over and above his longer-term reform plan. Though Dilnot did not put a figure on it in his report, King's Fund social care expert Richard Humphries said £2bn a year was needed to meet immediate shortages.
However, the government's response to Dilnot did not mention his call for an immediate cash injection. Moreover, health secretary Andrew Lansley suggested that even Dilnot's longer-term reform plan could prove too costly to implement in full.
All of this means that the social care sector cannot expect any respite from its funding predicament for the foreseeable future, which makes a repeat of cases like McDonald's and the speech that Hay gave this week highly likely.
The week's coverage from Community Care
Special report on the state of adult social care Full coverage of the Dilnot report Supreme Court upholds councils' rights to cut care packages
Cuts to adult social care to worsen near year, warns Adass