Is consensus achievable?

Foreword by Cllr Izzi Seccombe OBE

We seem to like water-related analogies when it comes to health and social care funding. When Simon Stevens started his role as chief executive of NHS England he was clear that putting the two leaky buckets of health and social care together would not create a watertight solution. More recently, giving more money to the NHS without a similar increase for social care has been likened to running a bath with the plug out by more than one prominent sector expert. 



Given recent developments, many in local government will feel like the NHS is awash with money while social care may have to settle – at least for the immediate-term – for the drip, drip of incremental resource increases.



This is all compounds the sense that we’re experiencing another déjà vu moment for adult social care and support. The Government has announced significant new funding for the NHS – rising to £20.5 billion extra per year by 2023/24 – but nothing for care and support, other than the almost inevitable delay to the green paper. Feel familiar?



Yet again, a government has chosen to prioritise our health service over our social care service despite loud, visible and dire warnings from across the sector, and more widely, that both systems are unsustainable in the short- and long-term and each depends on the other for its stability. More than that, plenty of those warnings have highlighted that the pressures facing social care are in fact greater than those facing the NHS.

So why is it that governments find it easier to prioritise the NHS over social care, again and again, despite the fact almost all policy analysts point out this is irrational and counter-productive?

There are multiple answers to that question, but I would suggest that chief among them is the sense that the public ‘gets’ the NHS in a way that it doesn’t ‘get’ social care. That matters because greater understanding of any subject can often lead to greater, more impassioned opinion on it. And that matters, too. As George Eliot famously wrote in Felix Holt, the Radical:



“The greatest power under heaven…is public opinion – the ruling belief in society about what is right and what is wrong, what is honourable and what is shameful. That’s the steam that is to work the engines.”

Public opinion becomes doubly powerful when it becomes public consensus. And there couldn’t be stronger public consensus than that which we see on the NHS. In the most recent ‘issues index’ from Ipsos MORI, the NHS leads Brexit as the biggest issue facing the country. One therefore assumes there’ll be no shortage of viewers for the BBC’s season of programmes to mark the 70th birthday of the NHS, or to the dedicated NHS70 website that is bursting with celebratory content. This is all as it should be. Our health service is remarkable and is understandably heralded as the thing that makes us most proud to be British. But what helped achieve the creation of the NHS in the first place? Arguably at least in part, it was the consensus politics of the post-war period.



Of course, social care can be traced back to the 1948 Act as well. But since then, the political consensus has slowly eroded and in recent times it has broken down completely. In previous General Elections, parties have sought to deliver a knockout blow to their competitor’s proposals for resolving the long-term future of care and support. 



So what are the prospects for political and public consensus as we look, now even further ahead, to the care and support green paper? In the fourth of our think piece series, high profile sector experts consider that question. Politics comes passionately to the fore from Baroness Eaton, Barbara Keeley and Norman Lamb. But while their views are their own and distinct, they converge on the importance of building consensus as a principle worth fighting for. Looking more at public consensus, Ben Page and Michelle Mitchell remind us that the public are looking for answers too, and that the views of working age adults are just an important as those of older people. Reading between the lines, their message is engage, engage, engage. I am very grateful to all contributors for giving their time to share their views.



The public are capable of understanding the dilemmas and trade-offs facing our national and local politicians, and can and should shape the solutions of the future. But, as King’s Fund research shows, it takes time to explain, time to understand, and the initial reaction to understanding how the current system works is that it is wholly unsatisfactory. Only when we have explained this properly – and on a cross-party basis - can we convincingly make the case for difficult reforms.



There is no doubt that the further delay to the green paper is frustrating and disappointing. But we are where we are and if there’s one thing local government is good at, it’s getting on with the job. I think we must therefore use this pause to build greater momentum on social care; to further raise the issues at the heart of the debate about its future and to further highlight its inherent value. Effective campaigning to date – on a cross-party and cross-sectoral basis – is helping to raise awareness and change public opinion. We must keep going.

Cllr Izzi Seccombe OBE

Chairman, LGA Community Wellbeing Board