Ed Jones is a healthcare consultant. He was Chief of Staff to Jeremy Hunt, and Special Adviser at the Department of Health and Social Care from 2013-2018.
Another party conference and another promise to sort out social care funding. I drafted a few of those promises myself, all of which sadly proved empty.
The Prime Minister must now break the deadlock and set down a new social care settlement as a cornerstone of his “new Jerusalem”. But it won’t happen until government confronts the political choices previous leaders have ducked.
This is the opposite of the usual pleas from those of us who self-identify as centrists and policy wonks. Self-reported experts and moderates normally demand “evidenced based policy” in all things. We tend to criticise decisions motivated by naked politics or crude ideology.
But there are some issues which will only be resolved if you start with the politics, and the urgent need to sort sustainable social care funding is one of these. We failed in my time in government because we never truly faced up to the stark political choice needed, or we were unwilling to see it through.
Hearing talk about “cross party consensus” and “removing the politics” makes me worry that this Government hasn’t faced up either.
Finding more funding, from somewhere, is a moral and economic priority. The evidence on this is clear. Moreover, it is also about human dignity. But the possible solutions (the shape of the offer) and the question of funding (who pays for it) are intensely political choices and it does nobody any good to pretend otherwise.
My own years in government saw an inability or unwillingness to confront those choices. Endless options appraisals and reviews, expert contributions, industry consultations, and academic exercises were undertaken but we never formed a view, with conviction, about who we were actually willing to upset in order to get this sorted.
This is one area where a Prime Minister has to start with a clear political choice, and work back from that to the policy mechanism which delivers on it. Simply passing around the same slide decks and evidence reviews which have circulated through Whitehall for more than ten years, expecting a new and easier way through to emerge, is futile. A political call must be taken. One political constituency will have to win out over another.
This has proved particularly problematic for Conservative governments as the stark political choices divide the party. In the memorable “trilats” we had with the former Prime Minister and Chancellor to agree a resolution for health and care funding, Theresa May and Philip Hammond’s views neatly exposed this divide. Hammond argued the purpose of saving and building assets in life (whether in cash, property or other forms) was to be self-sufficient in old age. Treasury officials pointed to the nearly half a trillion pounds amassed in the property assets of older people.
In contrast May, burned by the failure to deliver the original 2017 manifesto reforms on social care, argued that hardworking people who paid taxes all their lives and did the right thing did not deserve to lose the value in their homes. Both of these positions have a conservative ethos in some respects, but they are contradictory. Meanwhile the Treasury rightly oppose simply adding to government spending/debt, and the public oppose new taxes on income, especially if those taxes are targeted at particular age groups.
The 2019 election adds a further complication perhaps: that the Red Wall electorate, in areas where housing stock is less valuable, has less to gain from the Dilnot-style cap which many in government had recently favoured. Furthermore, the impact of Covid-19 will have right prompted more fundamental thoughts in Government about reform of the whole sector.
Indeed, a sad consequence of our unwillingness to confront the choice on funding is the failure to significantly progress the wider reform agenda, from technology adoption to care quality and consumer rights. Our 2018 Green Paper, never published, outlined reforms in these areas but was held up by our failure to get collective agreement about the one chapter on funding.
So, enough of wheeling in the same weary academics and experts, asking them to repeat the assessments they have given to all the previous politicians they saw come and go. Let’s draw a line under forlorn attempts to seek cross-party agreement with the Opposition (the clue is in the name). The definition of political leadership is to strike out with conviction and make a choice when the options are unenviable and the path ahead is dimly lit, and then to take people with you as best you can.
This Prime Minister is better equipped for the task than many others. But we have yet to see this, which can only mean that either the Government hasn’t yet faced up to the choice, or they don’t think the public is ready to hear it.