The Week, 18 November 2022
Regular The Week readers and Reform aficionados may have observed that our snap analysis of the Autumn Statement yesterday didn't mention social care. That’s because we’re torn whether to put the announcements in the ‘good for’ or bad for’ category. So instead, here's our more nuanced reflections…
The headline increase in funding for adult social care is extremely welcome — the sector is woefully underfunded as everyone knows. The additional cash is made up of increased central grants worth £1 billion in 2023-4 and £1.7 billion in 2024-5, topped up to £2.8 billion and £4.7 billion respectively due to delaying Dilnot and allowing councils to further increase council tax.
More on the latest Dilnot delay in a moment, but first council tax hikes. As we pointed out yesterday, public services have to be paid for, and with limited growth and sky-high debt interest repayments (£120 billion this year), that means taxes. The problem with using council tax is that it’s highly regressive, with poorer households paying a larger proportion of their income than richer ones — an even bigger problem during a cost of living crisis. And the funds generated by council tax will reflect the local revenue base (with richer areas raising more), rather than the levels of unmet demand in that area.
So to the two-year delay to the Dilnot cap… We’ve never been a big fan of the Dilnot settlement (see here), though we did (strongly) welcome the fact that Boris Johnson's government were taking action after decades of procrastination/head-in-sand. In this instance, however, while not ideal to be kicking the reform can further down the road, this is a pragmatic decision.
The adult social care sector is already under remarkable strain, reflecting soaring inflationary pressures, growing demand and workforce shortages. As the County Council Network points out, if the cap were introduced, the sector would need 5,000 extra staff over the next 12 months alone to handle additional care assessments. With vacancy rates already up 52%, imposing the cap would have added even more pressure to an already struggling system. Moving forward, greater workforce funding would make it far easier to implement the Dilnot reforms in a sustainable way. Even better, let’s use the time to really come up with a fair and sustainable funding settlement (here’s one we made earlier).
Away from the Autumn Statement, there were two other interesting ministerial interventions this week…
One of these was a speech by newly (re)appointed Health and Social Care Secretary Steve Barclay, delivered at the NHS Providers Conference on Wednesday. Reform was delighted to hear him emphasise the importance of devolving decision-making: “It is far better that variation in the different needs of demographics and local healthcare systems is reflected in devolving decisions to local leaders, who of course are better placed to assess the trade-offs about where risk sits within those decisions, rather than it being determined in a one-size fits all way within a ministerial office.” Hear hear! Assuming the centre must take charge is a perennial problem, both in our health system and across government more generally.
Barclay also set clear ambitions around the use of technology. While this is a common refrain from ministers, we were pleased to hear him talking not just about advanced tech, but also the need to tackle everyday barriers to clinical efficiency, such as inadequate wifi coverage. Likewise, his focus on giving patients more opportunities to opt-in to sharing health data for research purposes is welcome — the scope to use data to transform our approach to health, drive more preventative care, lower cost and improve outcomes is huge, but for that we need people to share their data, which the NHS has a poor track record on.
The second ministerial intervention came from Michael Gove — restored to his position as Secretary of State at DLUHC — on the issue of social housing regulation. He was responding to the awful news that, according to the coroner in the case, two-year-old Awaab Ishak died due to the mould-infested state of his family’s social housing flat. This came after the housing association had repeatedly ignored their, and health professionals’, requests to improve conditions in the building.
In this context, Michael Gove’s statement to the House was characteristically powerful (”let me be perfectly clear, since some landlords apparently still need to hear this from this House: every single person in this country, irrespective of where they’re from, what they do, or how much they earn, deserves to live in a home that is decent, safe and secure”). Gove announced a new information campaign to ensure those in social housing know their rights, as well as “how to sound the alarm when their landlord is failing to make the grade”. Many tenants don’t know when their landlords are legally required to take action, meaning that poor conditions persist — risking physical safety and mental wellbeing. Coupled with the new inspection and enforcement measures in the Social Housing Regulation Bill, currently going through Parliament, it’s good to see serious action to hopefully prevent another terrible tragedy.
Onto the reads…
First up, a fascinating essay from Sir Geoff Mulgan (former Head of Policy in No. 10 and a member of our Reimagining Whitehall steering group) on the need for more imaginative and long-term policy thinking. Especially striking is his argument that the emphasis on research impact and peer review has led academics to focus on incremental policymaking, rather than developing the radical ideas we need. At Reform, we agree that tweaking around the edges is not going to solve the vast problems we face as a country — as Sir Geoff correctly writes: “crisis times… demand commensurate boldness.”
And it’s a bumper week for members of our Reimagining Whitehall group, with former Permanent Secretary Philip Rycroft CB publishing this guest paper for the IfG and Bennett Institute on the UK’s “erratic” approach to constitutional change. Among a series of novel policy recommendations to address this problem, he calls for an entirely new “independent extra-parliamentary body to advise on constitutional issues” and a “permanent constitutional secretariat in the Cabinet Office.”