Is the Green Paper on Social Care happening or not?

I spent some time yesterday in a long meeting with a local resident. He had cared for his mum for many years and sadly she died. The circumstances leading up to her death and the nursing home care she received tell a grim tale. My local resident called for an investigation and has written numerous letters demanding social care reform. He has written to MPs, Prime Ministers, Parliamentary Health Ombudsmen and the CQC. His activism and call for changes to the system has gone on for fourteen years.

I tell that story to highlight the recent Government announcement that the Social Care Green Paper, which was originally to be published in the summer of 2017, might not be produced after all. There is the suggestion that Boris Johnson’s government might publish a white paper instead.

I think it is all about a General Election – get the white policy paper out with strong proposals so that it looks like the Conservatives are taking action.

However, will it be the right action? The idea of a Green Paper is to bring together experts and have a proper consultation on proposals. One of the things my local resident is calling for is a high-level round-table, cross-party discussion on the best ways forward for social care. There are various views and proposals which should be given careful consideration. I personally like the idea of revisiting the Dilnot Report and capping personal contributions to social care; but I also think basic care should be covered in England as it is in Scotland.

And what about the integration of health and social care? My local resident tells me at length about the faults of the current system and insists money should not be poured into a broken system. The system itself needs fixing.

Studies have already shown the savings to be made by truly integrating health and social care. I spoke to my local NHS trust CEO about this recently and was told that one of the problems with current attempts to integrate care (so that the health and social care teams looking after someone can better work together) is the antiquated IT systems in use and the problems with these systems interfacing. We have the technology, but we need to invest in updating to systems which can better integrate health and social care.

Things are definitely heating up. We have the NHS Confederation writing a letter to the Prime Minister demanding action on the health and social care crisis. I was pleased to see that two signatories from Devon added their name to the plea to sort services out. The letter calls for

Cross-party talks to help deliver a more sustainable social care system, backed up by a long-term financial settlement

Immediate funding increases in the upcoming one-year government spending review that is being conducted this autumn to shore up care services in the short term

Genuine long-term funding alongside key reforms to help deliver a solution for social care that lasts a generation and more. This must include a widening of the eligibility criteria to ensure those people most in need get the care and support they require. 

The House of Commons briefing paper, published on 14 August 2019, “Adult social care: the Government’s ongoing policy review and anticipated Green Paper (England) can be downloaded from the link at the bottom of this page.

* Kirsten Johnson was the PPC for Oxford East in the 2017 General Election. She is a pianist and composer at

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  • William Fowler 28th Aug '19 - 9:39am

    “the antiquated IT systems in use and the problems with these systems interfacing. ”

    This seems a widespread problem in govn depts and I have the impression that you have civil servants sat in offices accessing multiple systems via several computers and screens on their desk whilst huge sums have been extracted from the government by “experts” trying and failing to solve myriad problems. It is probably because they look at things the wrong way round, radical simplification needed at the source of the problem rather than trying to combine disparate elements.

    Data privacy plays a part in this but is ignored anyway by the govn when it can make money out of searchable databases it holds…

  • Richard Underhill 28th Aug '19 - 10:32am

    The former Health Secretary persuaded the previous Prime Minister to keep him as Health Secretary with a job title that included Social Care, but she does not seem to have made the necessary structural and financial changes. He became Foreign Secretary and was the last Tory MP to stand against Boris Johnson. As Foreign Secretary he had the legacy of Boris Johnson’s problematic involvement with Iran. He is not in Boris’s cabinet. There may be multiple reasons why, but the length of his service at Health must mean that he has received lots of information in his red boxes. If there is a parliamentary debate it is likely that the Speaker would call him, so maybe there won’t be.
    His name is Jeremy Hunt.
    Is Boris Johnson afraid of “Blue on Blue”?
    A Politically Correct Police Constable can also be a Privy Counsellor.

  • David Warren 28th Aug '19 - 11:37am

    The failure to reform Adult Social Care is a national scandal.

    As a carer for a number of years I saw at first hand a broken system. Private ‘care’ companies interested only in profit, care workers exploited by those same companies, a useless local authority showing absolutely no interest and elderly people receiving a poor service. Many of whom had to sell their homes.

    The only answer is a National Care Service funded from the public purse and managed as a part of the NHS.

  • William Fowler 28th Aug '19 - 12:35pm

    Rather than trying to fund an integrated system by confiscating people’s houses or bank accounts surely a fairer way would be to have a levy on all inherited wealth, call it a social care levy, apply it to all inherited money with no exceptions and collect it via probate.

  • Gordon Lishman 29th Aug '19 - 11:31am

    I agree with Joe. The problem isn’t knowing what the options are – the Sutherland Commission, Dilnot, Barker and others have laid them out very clearly along with their preferred options. The basic problem is with HM Treasury and the Prime Minister’s office deciding on the options to pursue and the necessary investment to make it happen. Undoubtedly, the package is likely to include significant extra cost to the State and ways to encourage saving (which will diminish the cost to the State over time, but still be substantial), and a cap. So far, every attempt at coherent reform has fallen at those hurdles even when Ministers and Secretaries of State have supported a plan. See my essay in the SLF book “Four Go in Search of Big Ideas”.

    I spent over 20 years trying to get agreement on a solution and failing despite getting substantial support from Ministers and, briefly, a PM (although, in self-defence, I can point to other areas of campaigning success). It’s about money! It does seem possible that Boris can come up with something because, unlike all his predecessors, he is careless about the amount of money it will cost.

    Yes, of course, to greater integration, but it’s not a panacea. The dynamics of the NHS are loaded towards institutions and top-down responses neither of which are helpful to social care. Other initiatives, such as well-planned hospital discharge from the point of entry to a hospital, “intermediate care”, carer support and day support facilities can also have a significant effect.

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