Opinion: what makes a reform?

Social care changes announced by government are a big change in the sector. But whether they meet the prime ministers pledge to fix a plethora of problems remains to be seen
Stefan Rousseau/PA Wire/PA Images

By Richard Johnstone

22 Sep 2021

Reform is a word that I possibly use too much. It is easy journalese, appended to everything from the development of a new subsidy regime after Brexit to changes to the communications service in government.

These are significant policy shifts, but they are very different. Using the word reform for both smooths over the messy business of change itself.

A “reform” has an air of finality to it. A date is set, a switch is flicked, and the light of a new government initiative appears where there was darkness before.

This, I know, is not how it feels on the inside, where there may be months or years of painstaking wiring between the setting of a date and flicking that switch. Then, of course, there’s the process of change which only begins when the policy light comes on.

But all too often the focus of the political class, and by extension the media, moves on. It then takes time to overcome political resistance to another rewiring, even if the light isn’t quite as brilliant as you hoped.

And so to the government’s plans for social care. The one-time work and pensions minister Frank Field has described the welfare state as a “never-ending reform”, and the provision of care for an ageing population might well be the defining policy problem of our age.

But Boris Johnson thinks he might have cracked it. In the press release setting out plans – which has eight “reform”s in it, stat fans – the prime minister stresses the completeness of his approach, including a £36bn cash boost for health and care. “You can’t fix the Covid backlogs without giving the NHS the money it needs. You can’t fix the NHS without fixing social care, you can’t fix social care without removing the fear of losing everything to pay for it, and you can’t fix health and social care without long-term reform. The plan I am setting out today will fix all of these problems together,” he said.

But, as Andy Cowper details in his column this month, the Build Back Better plan for health and social care is a bit short on actual planning. The major change (I strain to avoid the R word) is to introduce a cap on an individual’s lifetime care costs of £86,000, and this will undoubtedly be welcomed by many once it takes effect in October 2023.

There are a host of secondary decisions also needing consideration for this to be a lasting blueprint (thesaurus to the rescue). For one, the social care sector is not just a cash sink for many of its users. It also sucks the time and emotional energy of the vulnerable and their carers as they wait – and wait, and often wait some more – to be assessed for support. Then there is the quality of care which, although mostly good according to a pre-Covid evaluation by the Care Quality Commission, also has significant gaps in access, especially in mental health.

For these issues, the government promises an adult social care white paper, but as it stands the money won’t yet follow these intentions. Most of the cash that goes to the care sector will be used to meet the cap, and to provide additional support for those with assets of less than £100,000, rather than address these challenges directly.

My point is not to bemoan positive changes, but rather to mark this as the point of departure, not arrival. We are much closer to health secretary Sajid Javid’s description of “a vital first step in the reform of our broken care system”, than the prime minister’s one-plan-fixes-all ambition.
Even if Field is right, we’re probably closer to the start of the never-ending reforms than the middle.

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