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Editorial Wednesday 18 January 2012: Minister Who? And The Great Social Care Mystery

Fans of being underwhelmed who have some spare time should watch the recording of yesterday's evidence session to the Health Select Committee, which featured a star turn from Minister Who? himself, Paul Burstow.


Click here for details of 'Be jolly, bottom-up”, Comrade Sir David tells NHS - 'tis the season to, apparently', the new issue of subscription-based Health Policy Intelligence.


The Government's front-bench team on health is an interesting mob. We have Andrew Lansley (saviour, liberator) resolutely seeing  his plans of liberation and choice being turned into the Nicholson Health Service.

Mr Lansley is simultaneously a hard man to read and an open book. He is a sector expert front-line politician heading a major spending department who has told the world he is "not in this for the politics". He is a survivor and a man carrying the political Black Spot; a man who understands micro-level operational NHS detail, whose supporters are "absolutely right" and whose opponents are "completely wrong".

Enough for now; we will return to Mr Lansley soon enough.

The Earl Howe is the platonically perfect butler, currently tending to a managed tactical retreat on various policy areas of the Bill with the Lords Temporal and Spiritual. His manners are exquisite.

There is also former nurse Anne Milton, who seems adequate enough if you like that sort of thing. Her resemblance to Michael Jackson in the Thriller! video is occasionally off-putting, but you can't have everything.

OK, that's not completely true - because in the person of the magnificent Simon Burns, we are graced with the greatest politician in the universe. Burns is the sun around which the solar system of health revolves. He is a legend - THE legend. Burns is not of an age, but for all time. Devotees of picking the next Secretary Of State For Health need look no further. Got it, Dave?

And then we have Paul Burstow. Minister Who? has risen without a trace, and his performance at the select committee on social care was axiomatic of his style.

Which is to say there wasn't any.

Crashing in slow motion
Social care has been a policy slow-motion car crash for some time. Labour ducked it totally in its response to the Royal Commission On Long-Term Care, slid out alongside The NHS Plan in 2000. The great Stephen Halpern summarised this under the headline 'An apple a day, but a raspberry for Granny'.

Admittedly, Andy Burnham tried to get some traction under way in the dog days of the Brown Government - and Norman Lamb also had a hand in attempts to broker a cross-party consensus. Party political advantage was seen in marketing 'Labour's Death Tax'; Andrew Lansley (saviour, liberator) walked or was told to walk depending on whom you believe and the rest is politics, philosophy and economics. It's most definitely not history.

Minister Who? looks set to continue this proud tradition, bearing enough fudge to sugar-rush the committee into next April. He shared that cross-party talks on social care funding "are happening"; but participants won't "offer a running commentary". Running makes it sound far too dynamic. The Government has no date for a White Paper, but "will issue a process report, which will cover process". Fancy!

"Integration" got its obligatory mention, but definition came there none. Rosie Cooper observed accurately that his attempts at defining integration when repeatedly pressed were a description of voluntary co-operation, not integration.

He was quizzed about unmet need, but answered that "trying to get a definition of unmet need is very hard". And then admitted that unmet need causes costs elsewhere in the system.

Minister Who also told the committee that the Coalition's NHS reforms are designed to deliver integration using Health And Wellbeing Boards, pooled budgets and NICE standards. It was almost as funny as Bill opponent Lib Dem Andrew George saying that social care mustn't be part of a Stalinist centralised system.

Brewer's Dictionary Of Policy Cliche And Fable had clearly been raided hard, as Minister Who told a grateful nation that "this is as much about cultural behaviour as it is about structures".

He added that the move to CCGs would work better because of GPs having sense of local geography; seeing them as a much more fixed point than teams of PCT managers moving round the country. Roving PCT management teams will pause as they sprint through hedgerows and under motorways to acknowledge this priceless acumen.

Show us the funding gap
Unsurprisingly, committee members pressed again and again on the social care funding gap.  Open primary Tory MP Dr Sarah Woolaston GP (first and last of the kind) cited the situation on the ground in famously-integrated Torbay - her constituency.

Labour's Barbara Keeley pressed again and again on the funding gap. Minister Who's rephrasing of platitudes, although the limit of his range, was blatantly inadequate answer. Eventually he said that he didn't believe there was a funding gap, but that if there were one, it was down to the individual local authority.

It's a good thing they're not capped, isn't it?

Committee chair and former health secretary Stephen Dorrell nailed Minister Who?, asking "if there is no social care funding gap, then why is Dilnot Review suggesting extra funding? ... if reforms don't raise the funding Dilnot outlines, a finding gap will remain? ... is the Government's view that necessary to unlock individuals' own private resources to solve social care for the future?"

In a bibbling response, Minister Who? characterised current social care as a distress payment; adding that there is no reason people can't use own funds to supplement personal budgets. He added that we needn't accept current view of demographic need; and we have to bend the cost curve downwards. Fine. How?

Oh yes, he also told the committee that "Dilnot unlocks nudges". I kid you not.

Minister Who? also described care trusts as "an interesting experiment (that) didn't really get out of the lab". Torbay Care Trust was, he added, "a philosophy that worked, not a structure". Yes, there may be some conflict with his previous remark that "this is as much about cultural behaviour as it is about structures".

Confusion reigned supreme as he struggled to explain the niceties of Health And Wellbeing Boards' agreeing CCGs' commissioning plans. Apparently, HWBs will be the local system leader, not just a talking shop - and will deliver better commissioning with the Section 75 delegated commissioning flexibilities.

As usual, Mr Dorrell chaired the session acutely, stating that he did not understand how you deliver integration across boundaries without incentives. He added "do we not have to bite the bullet about being serious and pool the budget? Or we will never get the savings".

We ended with promises of paper - Dorrell asked Minister Who? for a crisp set of explanations why it's going to be different under the new system "because I think the committee is not convinced". He could have said that again several times; as could Minister Who, in acknowledging that his answers had not been particularly clear.