Government plans to move back from local to central decision making in social care

BMJ 2010; 340 doi: (Published 11 January 2010) Cite this as: BMJ 2010;340:c133
  1. Adrian O’Dowd
  1. 1London

    Decisions on social care may be made more centrally in a notable change to the current UK government policy to encourage devolution in health care, MPs were told this week.

    England’s health secretary, Andy Burnham, told MPs on the parliamentary health select committee that people want clarity and fairness rather than too much local discretion on how services are provided.

    The committee, quizzing Mr Burnham as part of its inquiry into social care, asked about the forthcoming social care white paper, expected this spring before the general election.

    The government published its green paper, Shaping the Future of Care Together, in July last year with the intention of reforming the funding and delivery of social care by creating a new national care service on an almost equal footing with the NHS (BMJ 2009;339:b4515, doi:10.1136/bmj.b4515).

    Mr Burnham said, “There’s been a lot of fashionable talk in recent times about localism and giving people the ability to run things at a local level. I think often people don’t want that.

    “They don’t want a postcode lottery in health care, and when it comes to social care they want clarity about what they can expect and they want it to be fair across all areas. I think the case for national entitlement and national assessment is very strong.

    “What we are saying in the green paper is that there needs to be a more national approach to these important matters, both in terms of assessment and entitlement.”

    MPs asked whether suggestions were true that social care would, effectively, be placed under the control of primary care trusts so as to overcome the currently poor coordination between health and social care in some geographical areas.

    Mr Burnham replied, “I am an integrationist on health and social care. That doesn’t mean a takeover by health or a takeover by local government. I would feel very comfortable about primary care trusts increasingly merging functions with adult services.”

    The MPs asked whether Mr Burnham believed that the current limitations of social care services placed an unfair burden on informal carers. He admitted that the green paper did not talk enough about carers.

    Family and friends would always want to make a contribution, and rightly so, he said, but he added: “The state needs to do more to make life tolerable for them so that they can care, raise their own families, and work.”

    A fellow witness at the select committee meeting, David Behan, director general for social care at the Department of Health, said that the green paper consultation launched last summer had gathered a large response.

    There had been more than 24 000 responses, and contributions were also made at more than 38 consultation and listening events held across the country.

    “We have got a mass of feedback that we have received from a wide range of organisations, which we are analysing,” said Mr Behan. “We have asked [market research company] Ipsos MORI to undertake some of the high level analysis for us, and we expect to get the final report from them later this month.”

    Mr Burnham added: “I believe the reform of social care in this country is long overdue, and we can’t fudge it anymore. I want to create unstoppable momentum for a bill in the next parliament where we reform fundamentally the funding of social care in this country.”


    Cite this as: BMJ 2010;340:c133

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