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Make tough choices? They won't even write them down. Health Policy Today, 9 July 2009

HPI associate director Tom Smith discusses the reclusive green paper on social care.

This week, the Telegraph reported that internal rows in the Department of Health are delaying the publication of the green paper on social care.  The story is that Andy Burnham and Yvette Cooper cannot agree on the options it should contain and whether their release makes political sense so close to the Norwich North by-election.

Publication of the green paper has been delayed several times and twice within the last week.  Last week, the Health Service Journalexplained the first was because Andy Burnham wanted to make his personal mark on an area important to him.  This week, the launch was put off without an explanation.  The parliamentary recess starts in 12 days, and the government is running out of time to publish.

Surprised? Bovvered?
Given that it won't the proposals will not even reach White Paper stage in the lifetime of this Government, should we be surprised and should we care?

We should care because this is one of the most pressing social issues in a generation.  We should not be surprised, however, because the solutions require radical action and while both political parties talk about tough choices and the need for action neither seems keen to spell out plans.

Labour's political fear is that plans will be portayed as a raid on current benefits. The Telegraph says the DH stands accused of getting policy and politics badly 'out of line', whatever that may mean - coming up with unpalatable options perhaps?  While health ministers have always said the content would involve tough choices the DH are accused of failing to spot the potential for deep controversy .

The accusers are not named; though the article goes on to say it is Yvette Cooper who is blocking the plans. She is presumably politically in-tune with her husband, Ed Balls who is keen to position the Labour Party on traditional ground.  He would be nervous about the Party being seen to embrace non-public solutions, particularly ahead of the Norwich North by-election on July 23rd.

Lest we forget, the Telegraph reminds us that, 'the green paper is intended to kick-start a debate on how to provide, and pay for, the care and support of the rapidly growing population ofolder people and the swelling numbers of younger people with disabilities. One aim is to try to stop people having to sell their homes to fund residential care.'

In case you failed to notice, last year we 'enjoyed' a debate on social care.  It involved a couple of King's Fund reports and lunchtime seminars.  (The orange juice was very good).

The policy options within the very green paper are said to include two radical options: (a) a social insurance levy on people in work and (b) a one-off payment of £12,000 that can be paid in different ways - upfront, at death or through saving schemes.  It also includes a technical third option of (c) repackaging current benefits into 'social care grants' - and never mind the bigger options, this is causing the immediate political difficulty.

Until recently, Yvette Cooper was Chief Secretary to the Treasury (until 6 weeks ago to be precise).  Her concerns relate to the technical option of converting two benefits - attendance allowance and disability living allowance - into a discretionary 'social care grant'.  This would see money transferred to local authorities, who would make the grants.

Balls and Cooper's political concern is a repeat of the protests at the end of the 1990s, where wheelchair users chained themselves to the Downing Street gates.  They would be accused of removing benefits (even though they plan to redistribute them).

The Telegraph story makes me think that Andy Burnham is not proving a strong secretary of state so far - but then at least he has plenty of time to make his mark!  The Telegraph reports 'dismay among some health department officials that Burnham has proved unable to force publication of the green paper'.  And while Gordon Brown had been expected to front the launch of the document (this week), his involvement is now unlikely.  The launch of the paper at all is not certain.

So much for politicians embracing the 'tough choices' all parties say we need to make. They can't even bring themselves to write any down on a bit of paper - not even if it's green.