Will Wanless inject hope?

The social care sector in England has enthusiastically welcomed the Wanless report, but how much of it will the government adopt, asks Janet Snell.

A former group chief executive of NatWest Bank might seem like an unlikely champion for social care.

But Sir Derek Wanless may prove to be just that. His latest report1 has been hailed as “a landmark” and “a defining moment” for social care. It is certainly refreshing, in these times of budget cutbacks and general reining in of provision, to have someone influential issuing a call for “more ambition” in services for older people while making the case for more resources to do it.

But Wanless has challenges for the sector in England too. He poses some fundamental questions such as just who should social care help in the future and exactly how should it help them? And he complains that there is no clear definition of what social care is, adding that until some of these questions are answered we cannot proceed.

Launching his report he said: “At the moment we have a safety net for poorer people but good social care should be about much more than that.”

He blames shortcomings in the social care system for older people on insufficient funding and at the heart of his proposals is a massive expansion of social care paid for by a huge injection of cash. He did it for the NHS and persuaded Gordon Brown to substantially increase investment. But can he pull it off for social care or will the government reject his carefully constructed argument for change as they did with the Royal Commission on Long-Term Care seven years ago when it called for free personal care?

Those on the Royal Commission were all experts in health and social care and so they approached the issue from a very different perspective from Wanless with his financial background. Yet they came up with a similar answer. They suggested a universal system of free personal care but with people asked to pay for their own “hotel costs”. Wanless’s partnership model could be viewed as free personal care but with a tighter cap on spending.

Robin Wendt, a member of the Royal Commission, says he is encouraged by the Wanless report and “moderately optimistic” that the government will take it up. “While our work was dismissed out of hand at least the government has agreed to set up a working group, with Wanless on it, to try and take things forward.”

Wendt rejects claims that free personal care is proving a failure in Scotland adding that research by Stirling University2 suggests the Royal Commission got it right.

“Yes, free personal care in Scotland has cost rather more than original estimates. But not so much as to break the bank. What has happened is that a lot more people have opted to have care
delivered in their own homes. It costs more but that is what they want.”

Wendt believes the issue boils down to political will. “If the government decided that universally available free personal care was the right thing to do then they could find the money.”

Paul Burstow, MP and Liberal Democrat spokesperson on older people, agrees but says that political will may be lacking. “After 10 years in this field my fear is that the government set up the Royal Commission as a way of managing a difficult issue and looking as if they were doing something until time passes. That could happen with Wanless and the new working group.”

Even if Wanless’s proposals are accepted Burstow believes the government’s determination to keep a tight grip on costs will always come first. “Wanless’s partnership model suggests the state should pay two-thirds of the cost of personal care, but that proportion could go up or down. So what’s to stop the government setting the level much lower, but then still claiming to have implemented Wanless?”

But not everyone shares Burstow’s cynicism. John England, lead chief officer for adult services at Leeds Council, one of the local authorities Wanless visited while compiling his report, says central government will end up with no choice but to get together with local government to reassess funding, not just for care of older people but services for all vulnerable adults.

“The financial pressures we are under are exponential and we just won’t get beyond the next five years without some fresh thinking along the lines Wanless is suggesting.”

Kent Council is another authority Wanless visited and its strategic director of social services, Oliver Mills, believes the only way forward is for a major public debate on what the country is prepared to pay for.

“It’s true we can’t carry on as we are. Many authorities have ratcheted up eligibility criteria to critical levels because the service is underfunded.

“The faultlines of the current arrangements, with a national system for health but social care coming under local authorities have to be addressed. It is important the government genuinely accepts we are equal partners with the NHS alongside service users and carers.”

The president of the Association of Directors of Social Services, Julie Jones, believes one move that should strengthen the notion of an equal partnership is the plan for social care and health to submit a joint bid for funds to next year’s comprehensive spending review.

“It’s always a dilemma whether to bang your own drum or join forces and we’ve opted for the latter. Yes, it carries risks. But with the joint white paper people said there was a danger we could be subsumed by health but we weren’t.”

Jones believes the move towards more care being delivered in people’s homes is gathering momentum. “But the vision can only be achieved if we work together with our NHS colleagues.

They are under huge financial pressure and so are we, so why don’t we face up to it together?”

Wanless implies that social care has been remiss by failing to define its contribution, but Jones does not accept that. She says nurses and doctors stop short of offering a holistic response.

“Social care is about sticking all the pieces together. You really can’t do without that and I’m very pleased Wanless has come up with proposals that could make that support available to a much wider group of people.”

It is probably too much to hope for that Sir Derek Wanless will turn out to be the saviour of a beleaguered social care system – no one report can be expected to achieve that. But he is to be congratulated for his systematic analysis of the current state of services for older people and his clear statement of the choices facing government. If his proposals for personal care to become a universal service are accepted it would be a massive boost for both older people and for the social care sector as a whole. It would need a huge expansion of the social care workforce and would certainly require a better trained – and better paid – workforce.

There is no getting away from the fact that this will cost more money, but Wanless suggests not only that this is a price that we can afford but also that it is a price we have no choice but to pay.
His report is also welcome for highlighting the fact that the sort of support social care offers is every bit as important as anything the NHS provides. Let’s just hope that the government – and in particular those behind the comprehensive spending review – see it that way too and can come up with a way of adequately funding it.

(1) Derek Wanless, Securing Good Care for Older People, the King’s Fund, March 2006
(2) D Bell, A Bowes, Financial Care Models in Scotland and the UK, Joseph Rowntree Foundation. 2006