Rt Hon Alistair Burt

Being a ‘former’ anything can be quite grim in today’s world, but it is a source of great pride to be known as a former Minister of State for Care Services.

Prior to entering government, I had followed the Care Bill’s passage through Parliament with real interest. I had a long-held admiration for people – paid or unpaid – who support our loved ones to live fulfilling lives, and I was honoured to be President of Carers in Bedfordshire. It was therefore a privilege to become the Minister responsible for adult social care just at the point of the legislation going live in 2015. Supporting ‘the workforce’ and ‘unpaid carers’ were strong motivations for me.

The Care Act was an opportunity to enhance the status of those working in adult social care and provide them with a better, more person-centred structure within which to operate. Of particular note, the many discussions I had with Lyn Romeo and her social worker colleagues remain indelible in my mind as conversations of real ambition and hope. Similarly with unpaid carers – people I had worked closely with as a constituency MP – I had high hopes that the legislation’s codification of their rights and entitlements would mark a watershed moment in their lives and those of the people they supported.

I remain of the view that the legislation is good legislation. Developed in the right way, sufficiently ambitious, focussed on ‘people’, and alert to the many different interactions between statutory and non-statutory organisations that collectively form ‘the sector’, it was good then and is good now. 

But it is impossible to escape the reality that legislation is nothing without the funding needed to turn its vision to reality. 

So, it is with the Care Act and I am left to conclude that – for now – we only have partial achievement of the legislation’s aims and therefore a patchwork of progress.

Take again the situation facing unpaid carers. Whilst the legislation helpfully ushered in a national framework for eligibility, it remains a subjective process and one conducted against the backdrop of an extremely challenging financial position for councils across the country. I suspect thresholds for eligible need will have therefore inevitably tightened, a consequence of which is greater reliance on unpaid carers. In Bedfordshire, for instance, Carers in Bedfordshire was supporting 6,000 unpaid carers pre-pandemic; now that number is around 12,000. Of course, we can’t leap to too much of a causal link, but I think we can fairly confidently say that the financial position of adult social care has meant more people becoming unpaid carers. I think we can also say that the increase in those numbers, coupled with financial pressures, means that not all unpaid carers are getting what they are entitled to under the Act, even if the quality of the assessment of their needs, and subsequent support, is high.

If the Care Act is about ensuring people of all ages can live the life they want, and ‘funding’ is such a key enabler of delivery, people may rightly wonder why adequate resources couldn’t be, or haven’t been, found. They may well go one step further and wonder why a system so predicated on the effective interaction between ‘health and care’ (again underpinned by the legislation) hasn’t yielded a more balanced funding allocation. After all, the notion that you can’t have a well-functioning NHS without a well-functioning social care system (and vice-versa) feels like a well-established truism. I would suggest the answer to both questions is twofold: the reality of politics; and the reality of our national media.

Taking the politics first, and irrespective of your own, it is hard to disagree with the idea that a sizeable chunk of the population associates the Labour Party with being the guardian of the NHS, holding it up as their post-war legacy to all people and an institution unrivalled in its sanctity. Likewise, and given the centrality of the NHS to Labour, our health service has often been (and may always often be) a potential banana skin for the Conservative Party, regardless of the many fine local and national Conservative politicians who feel nothing but genuine pride in the NHS and a desire to see it succeed. But this reality means that the Conservative Party will always be judged on its financial support of the NHS as a necessary demonstration of its belief in it. Like it or not, until the public ‘gets’ adult social care, the NHS will continue to benefit from the lion’s share of healthcare funding under a Labour government (financing their national treasure) or a Conservative government (financing an attempt to reassure the electorate of the Party’s commitment to that national treasure).

Our national media flows from the politics. Aided by the vast proliferation of performance indicators for the NHS, many of which resonate deeply with the public (think just of the words ‘cancer waiting times’ and how strongly they stir emotions), our media has ample evidence to take the pulse of our health service and provide a near-constant running commentary on its fortunes. Too often it’s simply a judgement based on how much a government is spending on the NHS, disregarding the more important question about the value of the money being spent.

Contrast this to adult social care. A local service, a far more diffuse service, a service with less clear lines of accountability; none of this is conducive to generating the sharp focus in media coverage needed to make it a public priority. And indeed, when such coverage comes, it is nearly always negative – the ‘burden of ageing’, the ‘crisis of care’, a ‘problem to be fixed’. In short, nothing that evokes pride or hope; nothing that could pique the interest of your average voter.

In recent years, the one time I think the public did become interested in social care was when we proposed a cap on care costs that people faced. But in keeping with one of the main threads here, funding – or rather the lack thereof – led to its delay. I vividly recall the phone call I made to the chief architect of the ‘cap’, Sir Andrew Dilnot, in 2015, shortly after being appointed post-election, telling him we would be pushing back its implementation date. 

This was a Manifesto commitment– about as big as it gets in terms of political commitments – so I made sure to get assurances from the then Secretary of State that the decision to delay had full Cabinet approval. It had. And that perhaps tells you something about the extent to which adult social care promises are often ‘jam tomorrow’. The delay was not unique; it came after Gordon Brown’s experience of the ‘death tax’ and preceded Theresa May’s experience of the ‘dementia tax’, all proving the unhelpful political toxicity that can surround adult social care when it finally has its moment in the national media spotlight. Problems that aren’t dealt with never go away and I would suggest that a decision on ‘charging reform’ needs to be made, and made early, by the next government.

Which leads me to reflect finally on the kinder, gentler politics we need to see on adult social care. 

Achieving the aims of the Care Act requires the public to buy into the role and value of adult social care to people and to our communities. 

National politics can do a lot in this regard, particularly because I think the public is growing tired of partisan politics. We need a sensible and transparent approach to building cross-party consensus on adult social care because the issue will last beyond any particular government. 

I know it can be done because, despite our many differences, Barbara Keeley and I made real progress on a shared position on care and support even though we wore a different coloured rosette. And that’s the truth about politics; there’s far more cooperation behind the scenes than people realise. We just need to create the conditions in which politicians can come out and say they are working on a cross-party basis and in the national interest.

This is one of them. With one eye on the general election, I urge all parties to make adult social care a national success story, rather than a matter for political glee for one party if another falls down on the job.