Social care reform failings dubbed a ‘disgrace’ by former DH perm sec

Una O’Brien urges public to hold politicians to account for repeated failings in next month’s election

Una O’Brien Credit: Paul Heartfield / Dods

By Jim.Dunton

14 Nov 2019

Former Department of Health permanent secretary Dame Una O’Brien has launched a scathing attack on the failure of successive governments to progress proposals to reform social care.

Directing her comments specifically at England, O’Brien – predecessor to current perm sec Sir Chris Wormald – urged the public to hold politicians to account for lacking the drive to push through reforms.

O’Brien was asked for her observations on the state of the National Health Service as part of a Radio 4 interview last night, on a day when Conservative Party and Labour Party funding pledges related to the health service had dominated headlines.


As the perm sec for Andrew Lansley’s notoriously complicated coalition-era reforms, O’Brien noted tellingly that it was “absolutely clear” that attention could get diverted from patient-centred care by “focusing just on the management infrastructure and the organisations within the NHS”.

But her observations became scathing in relation to social care reform – left untackled both by the then Labour government following 1999’s Sutherland Commission that recommended free personal care, and subsequent administrations.

Under the coalition government, then-prime minister David Cameron commissioned former Institute for Fiscal Studies director Andrew Dilnot to make recommendations to reform the funding of social care – such as residential home places for the elderly that are not covered by the NHS.

But his 2011 recommendations, which included a “care cap” to protect people from catastrophic lifetime costs that was subsequently set at £72,500 went unimplemented by Cameron.

Less generous proposals to reform social care funding became a bane for Cameron’s successor Theresa May during her 2017 snap election, when they were dubbed a “dementia tax” before being dropped ahead of a social care green paper that has yet to materialise.

O’Brien told The World Tonight that while reform was necessary, the public did not trust politicians to take proper care of the NHS.

Asked what key points she would push reform for, given a free rein, she said she would prioritise solutions for services such as residential care, help with washing and dressing for older people, and assistance to help

“I would sort out the disgrace that is social care funding in England,” she said.

“I cannot understand why we’re still waiting for proper proposals and I think the public need to be very tough on the politicians in the election.”

Elsewhere in her observations, O’Brien said she believed more NHS care needed to be moved out of hospitals and delivered in the community. However she noted that hospitals were a “very visible emanation of the NHS” that people became “determined to protect” when it was suggested that local services were closed or changed.

Separately, NHS waiting-time statistics published today said more patients than ever before were on waiting lists in England, while delays in A&E had hit their worst level since records began.

The NHS England statistics for September said 4.42m people were on waiting lists at the end of the month, while A&E wait-time targets, which call for 92% of patients to be seen within four hours had not been met since 2015.

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