Comprehensive spending review: little for social care

The months of rumours, leaks and speculation are over; the Comprehensive Spending Review has finally been announced. As expected, for social care, it does not make for fun reading.

Here are some of my immediate thoughts, based on Chancellor George Osborne’s speech and a (very) swift look at the spending review document. While the review obviously affects everyone in some way, I’m going to try to focus on the impact it could have on people with mental health issues and/or learning disabilities.

Firstly, it should be noted that there is very little geared specifically to people with learning disabilities and/or mental health issues. For instance, specific mentions of ‘learning disability’ (or disabilities) does not get one mention and ‘mental health’ only 2. I didn’t expect there to be; today is the day for grand statements, with the detail to come at a later date.

In terms of what was said, while Osborne promised an extra £2 billion for social care in the next five years, including £1 billion to aid joint working between health and social care, he mentioned that this would help older people – no mention of adults with disabilities.

Also, BBC health reporter Nick Triggle worries this could be more or less cancelled out by the increasing demand of the aging population.

Meanwhile, benefit reform will ensure that it “always pay to work”, according to Osborne. Benefits are to be capped at no more than the average net wage from 2013 – which will work out to about £500 per week for couple/lone parent household and £350 per week for single adult households – although people receiving Disability Living Allowance are exempt from this.

However, this may well hit people on incapacity benefit/Employment and Support Allowance and other benefits, especially those who are moved onto Jobseeker’s Allowance from ESA. The focus of the welfare reform is evidently on people getting jobs, with benefits cut to make it more of an incentive to work.

There is also a new 12-month time limit proposed for the one million people on ESA in the Work Related Activity Group to find work or face having their benefits cut.

But surely this will be dependent on the jobs being out there for people to take? Many people on ESA would like to take up jobs – part or full-time – but with many businesses not looking to take on employees, and the public sector set to shed 490,000 jobs, there are precious few available and competition for them will be fierce.

The reforms to housing benefit will also hit many people with learning disabilities and/or mental health issues, especially those living in London and the southeast, where property prices are generally higher than in the rest of the UK.

Potentially, the adverse impact of money worries on people with mental health issues or learning disabilities could be immense, as could the upheaval of having to move, if they now cannot afford the rent on their homes. For someone to have to move away from an area they know – including a network of informal support – to somewhere new could have a disastrous effect on a person.

Not all bad news

But the CSR wasn’t all bad for social care; there were a couple of positive notes from the Chancellor.

Firstly, personal budgets are to be extended to people with long-term health conditions, children with disabilities and special educational needs and adult social care. The commitment to personalisation is welcome and, for some people, personal budgets have made a tangible positive difference to their lives. Giving more people the option to do this is a good thing. Whether their budget will be enough to do this is another matter.

Likewise, the commitment to increase talking therapies for people with mental health issues is also to be welcomed.

The government is also going to take forward proposals to invest nationally in mental health liaison services at police stations and courts to intervene at an early stage, diverting mentally ill offenders away from the justice system and into treatment. However, it does carry the caveat ‘subject to business case approval’.

Nevertheless, this is a good move. Far too many people with mental health problems get stuck in the justice system and opportunities for them to access treatment are often lost.

Conclusion

From an initial assessment, people with learning disabilities and/or mental health issues do not fare well out of the CSR, especially in terms of welfare and housing reform. However, I don’t think anyone – regardless of who they are – fares well out of this review.

But there are some crumbs of comfort, especially with expanding personal budgets and talking therapies, although they are probably outweighed by the cuts.

However, to paraphrase Winston Churchill, this is not the end, it is not the beginning of the end, it is the end of the beginning. Next month, government departments will set out business plans to outline how they will implement cuts. This is where the real detailed information about cuts will come at a local level, and we will all find out which departments, services, projects, charities etc will retain funding, be closed, or face hard times.

Paying for social care

There are an increasing number of local news reports coming through of cuts being made to social care provision and charges for it being put up. Unfortunately, this is going to be repeated across the UK in the coming months.

 In the past day or so, 2 stories have come across my radar, both of which detail aspects of social care cuts in local authority areas.

 These are just taken at random and happen to be the ones that appeared in my inbox. There have been others over the past few weeks and there will be more to come, these are just to illustrate my point.

 Firstly, www.getwokingham.co.uk reported that Wokingham Borough Council has confirmed that it will no longer offer free services to people with savings of more than £23,250 and will introduce a £16.30-a-day charge for day care services.

Meanwhile, Community Care carried a story about Derbyshire County Council’s plans to save about £4 million a year by ramping up its eligibility threshold for social care services.

I suspect that many more councils will follow suit as budget cuts really begin to bite. The oft-quoted figure of 25% savings having to be found still haunts managers and commissioners in local authorities who will have to make some very uncomfortable decisions in the coming months.

I don’t wish to be the harbinger of doom, but, well, I’m going to be; these cuts could get deeper too. The comprehensive spending review, which sets local authority spending budgets for the next 3 years, is in October, and with cutting the UK’s deficit at the top of the government’s priority list, there are likely to be more cuts to come.

While many politicians claim that cuts won’t affect frontline services, it seems to me to be political flannel. Cuts of that magnitude will inevitably affect frontline services, as the 2 reports above show.

Currently 72% of council have their eligibility criteria set at ‘substantial’. Meanwhile, 24% will cater for people with ‘moderate’ needs and only 1% provide services for people with ‘critical’ needs, according to the Local Government Association and the Association of Directors of Adults Social Services.

I reckon that the percentage of councils catering only for ‘substantial’ or ‘critical’ needs will rise in the next year, which will mean that increasing numbers of people with moderate needs will be left out of the care system, unless they can pay for it themselves.

The government has talked about a focus on early intervention and prevention – which is to be applauded – and will help to keep people independent for longer. There is also a focus on those with the highest needs, as there should be.

But this leaves an enormous hole in the middle of people with moderate to quite complex needs who, unless they are lucky enough to live in an area that isn’t scrabbling around for every penny it can find, won’t be getting any services.

To me, there are inevitable knock-ons from this. For instance, without any care services, more people will end up with higher – and more expensive – needs faster than if they had got support earlier. It also puts more of a strain on carers, many of whom undertake the role without any financial support, or just for the Carers Allowance, which is still only £53.90 a week.

Not only this but services such as day care and meals on wheels, which are often vital lifelines, will also be cut back on.

I apologise if this makes for grim reading – I take no pleasure in writing it – but I can only see hard times ahead for everyone associated with social care. I doubt I’m saying anything revelatory, either.

But, to end on a positive note, if there is one thing the sector is good at, it is being resourceful. Social services, charities, third sector organisations and carers will always find ways to provide services that make a difference. This won’t stop because of local authority cuts.

DLA changes worry majority of claimants

When the coalition released its emergency Budget in June, the introduction of medical assessments for all Disability Living Allowance (DLA) claimants from 2013-14, with the aim of only paying the benefit for as long as the person needs it, caused much consternation among claimants, their families and disability groups.

Now, the extent of that dismay is becoming clearer. It seems that nearly all people who claim DLA are very or quite concerned about the changes to the benefit being introduced by the coalition government’s Budget, according to a survey by the Essex Coalition for Disabled People (ECDP).

More than half (57%) of respondents fear that their DLA may be taken away under the new assessment rules and 1 in 3 respondents thought it unlikely they would be able to work as a result of the changes.

Nearly 6 in 10 (58%) respondents said the changes were likely to have “a big impact” on their everyday lives, including not getting the support they need (67%) and a negative impact on their family (55%).

For many people receiving it, DLA makes up a significant proportion of their income and is not spent on luxuries, but everyday things that enable them to live their life as they choose, including having a job and, in some cases, paying the bills.

Without it, life would become tough very quickly – they will still need the equipment/services DLA enabled them to buy but have less money to do it with.

Even more so if they were to give up a job because of it, as one respondent quoted in the ECDP report said; “Without my DLA I would lose my adapted car, my independence and my job. DLA supports me to contribute because it enables me to work full time.”

In addition, many service users are also concerned about the closing of the Independent Living Fund to new service users until at least April 2011– something that was not widely flagged when it was announced in May – more than 6 in 10 are very concerned by the changes, particularly around not getting the level of care and support they need (64%) or not being able to live independently (62%).

While this survey was only of 141 people, 93% of which were of working age – and 12% of which had a learning disability and 11% a mental health condition – it nonetheless provides an interesting snapshot of the overwhelmingly negative feelings about the changes.

To bundle DLA and the ILF into the drive to get people off benefits and into work misses the point of them. There is a suspicion among some that the government views DLA as an unemployment benefit, which it isn’t. Also, DLA is not a “scroungers” benefit – the assessment people have to go through in order to receive it is already rigorous.

Some people, such as the example above, rely on DLA to be able to work; to take it from such people and force them back onto benefits seems wrong.

This is something the government should investigate with urgency. Any changes to DLA should not be about cost-cutting, but ensuring disabled people have the means to be able to live their life as they choose and have the same life chances as their able-bodied counterparts. Many people believe the current changes do the opposite and could be disastrous for many people.

Social care funding commission has 2 options

This blog was originally going to be about how unhelpful the newspapers’ focus on the Commission on the Funding of Care and Support’s decision to not automatically discount bringing in a “Death Tax” was, but since I started writing, the government has ruled it out completely, according to Community Care.

This isn’t a surprise, to be honest. Firstly, the government would want to defuse criticism from the newspapers that saw this as the Conservatives back-tracking on their stance from the election campaign.

But in any case, since it was christened the “Death Tax”, that idea – a compulsory levy on estates after death – would have been impossible to implement because of the backlash from the press it would get and the image it has in the public’s eye. Whether or not it was the best option is a moot point.

But on the upside this should help bring about a more reasoned debate in the media on what the funding options are – no more tub-thumping headlines screaming about the injustice of the “Death Tax”, for instance.

Many people do not understand the social care or benefits systems currently, so a clear setting out of the current regimes, along with an explanation of all the options being considered and their relative merits/downsides would be good.

Not that there is that much to cover now. Currently, there would seem to be 2 options realistically on the table; a voluntary insurance scheme and a partnership of state finance and service user finance. A system completely funded by users or by the state was ruled out by the last government and has hardly been mentioned by this one, so I think we can assume those ideas aren’t really being considered.

So, it seems as if the commission’s job is to decide which of the 2 options – or slight variations on – is better.

Considering when this last went out to consultation there was no consensus on which option was best, they have a tough job ahead.

So how does the commission decide? Perhaps they should get Harry Hill in – “There’s only one way to find out…”

Care funding commission must consider all adults

Here we go again. Today sees the launch of the latest Commission on the Funding of Care and Support (catchy title) for adults.

We’ve been here before, most recently with last year’s Big Care Debate. That got as far as a White Paper before the election, but as soon as the government changed the proposals were swiftly dropped. So we’re back to square one. Again.

Nevertheless, the new commission has been detailed to report back within a year. Health secretary Andrew Lansley expects legislation in front of Parliament next year, and it will eventually form part of a larger White Paper that also takes in the Law Commission’s work on creating a single modern statute for social care, and the Government’s vision for social care.

The commission will focus on:

• The best way to meet care and support costs as a partnership between individuals and the state
• How an individual’s assets are protected against the cost of care
• How public funding for the care and support system can be best used to meet needs
• How its preferred option can be delivered, including an indication of the timescale for implementation, and its impact on local government (and the local government finance system), the NHS, and – if appropriate – financial regulation.

The politicians have, as usual, made all the right noises about this; for instance, Lansley said; “we must develop a funding system for adult care and support that offers choice, is fair, provides value for money and is sustainable for the public finances in the long term.”

All regulation political guff and nothing that anybody disagrees with; it’s just that successive ministers have said this for some years, so its hard not to feel cynical.

But reading between the lines, service users should not get their hopes up that reform will improve things too much. As care services minister Paul Burstow said: “Trade offs will have to be made but we are determined to build a funding system that is fair, affordable and sustainable.”

Trade offs? Is that a euphemism? To me, that is a subtle way of saying that to get to a solution, some existing ways of being funded may have to be axed/cut back. However, this is just speculation on my part – I may be reading too much into it.

But the commission does take place against the backdrop of swingeing budget cuts and this will form a major spoke in their thinking, hence why a leading economist, Andrew Dilnot, has been chosen to chair it.

He will be assisted by the CQC’s Dame Jo Williams and Lord Norman Warner, a Labour peer and former director of Kent social services – and also an outspoken critic of Gordon Brown’s free personal care at home policy earlier in the year – who will help to ensure that the commission does not just focus on the numbers.

As with the last commission, a range of funding options will be assessed, including a voluntary insurance scheme, as favoured by the Conservatives, and a partnership of state and individual contributions, the Liberal Democrats’ preferred option. No mentions of a compulsory levy – aka Labour’s “Death Tax” – being considered in the press release however, so we can assume that that won’t be an option.

But if this is to be successful the commission has to look at funding care for all adults. One of the criticisms of Labour’s last attempt was that it focused too much on older people – especially the voter-winning solution to people having to sell their houses to pay for care – with people with disabilities sidelined.

While older people do make up a significant proportion of those receiving care services, those with disabilities are just as important and any solution has to appreciate their needs and circumstances as well.

The solution also must been seen to improve – or at the very least not cut – services, if it is to get widespread acceptance from the public. Again, this will require doing more with less – a neat trick if you can pull it off.

But what the commission must do above all is to come up with a conclusion. The Big Care Debate had 3 options, but no one option was significantly ahead of the others. This commission should look at all the options and consult widely with frontline workers and service users before making a decision – and then sticking to it.

Coming up with a solution to funding adult social care is not going to be easy – otherwise it would have been done years ago – but this time it needs to happen. However, while some tough choices will have to be made – the financial situation is inescapable – the option of doing nothing is even worse for service users.

Social care providers worry about maintaining service quality

These are worrying times for service users, carers and families involved in social care; with the uncertainty over service provision, eligibility criteria, benefit cuts and future policy all causing stress. Now, care providers are adding to that by saying that services may get worse.

A survey published last week by accountants PricewaterhouseCoopers (PwC), Fair care crisis? An independent survey of social care providers for the elderly,  found that many care home and domiciliary care providers are worried about the effects of cutbacks on service users, and have warned that some have ‘unrealistic expectations’ of the services they receive and ought to revise their expectations downwards.

Providers said a key challenge is maintaining the quality of services against a background of rising costs and downward pressure on fees. Indeed, 80% worry that quality of care services will suffer due to cost reduction measures.

While it has to be remembered that these are the views of care providers, who are always going to say they need more money – the majority want a fair fees policy for local authority commissioners, for instance – this survey nonetheless highlights some of the current concerns among the sector.

Respondents also fear that smaller providers may go out of business because of cost pressures, which could lead to reduced choice for service users – so much for the increased choice and control promised by the personalisation, it seems.

OK, that’s the scary part over with. The survey also had some positive messages; 97% feel they are equipped to meet current or future challenges and 94% are already taking action to address market challenges.

Of those taking action, 83% are increasing skills and capacity – meaning better-trained staff – but 78% are controlling costs, which can be a double-edged sword, depending on where the cuts come.

This survey provides an interesting snapshot of the mood of social care providers. While there is optimism about meeting the future challenges, it is worrying that some say that service users should not expect so much of them.

While this may be realistic talk from providers – if you know how to do more with less please tell me – it does not augur well for service users; it seems they will face increased eligibility criteria, fewer services, less choice and less care.

The uncertainty in the sector is also not helping. The survey notes that 79% of providers want the government to outline its vision for the future of elderly social care, but they are likely to be disappointed. While there may be some measures outlined in the plans for the NHS today, for the definitive standpoint I imagine we will have to wait until the independent commission on the future of adult social care reports back sometime in the next year.

Only when policy is confirmed, along with budgets – we’ll find out what local authorities have to spend in October when the comprehensive spending review is announced – will providers be able to plan with certainty, and therefore give service users a better picture of what services will be provided – or not, as the case may be.

While PwC’s report closes on an optimistic note from a business point of view – many expect to cope with the future challenges and see opportunities in an expanding marketplace – I can’t help feeling that the outlook for service users, their families and carers is much more pessimistic.

Incapacity benefits claimants worried by threat of cuts

These are nervous times for incapacity benefits claimants; with more rigorous testing coming for Incapacity Benefit and Disability Living Allowance, there is also the threat of more cuts to come later in the year.

Earlier this week, Chancellor George Osborne hinted that benefits which the government had not given specific commitments to protect would be part of a summer spending review aimed at cutting the deficit – although exactly what form this may take has not been elaborated on and work and pensions secretary Iain Duncan Smith has since tried to play down reports of cuts.

Nevertheless, it all amounts to a worrying time for disabled people. There have been several blogs in the past week by people who fear for their future or are angry at the nature of the changes, such as Emmanuel Smith in The Guardian and Dawn Willis.

Already Incapacity Benefit – and its successor Employment Support Allowance – has been in the firing line for some time, with new claimants having to go through more stringent checks with the work capability assessment since before the election. This is set to be extended to all claimants next year.

The government reckons that about one in 5 people on Incapacity Benefit – about 500,000 – are fit for work.

Some people – the much talked about “benefit scroungers” – who do play the system that will be found out by this, which is good.

But the vast majority of claimants are legitimate – 500,000 erroneous claimants seems high to me – and the Citizens Advice Bureau reported in March that the work capability assessment has found seriously ill and disabled people fit for work, including people with Multiple Sclerosis and severe mental illness.

There are several potential negative effects of taking people off Incapacity Benefit and onto Jobseeker’s Allowance. For instance, not only will income be reduced – and many disabled people are not well off to begin with – but, for people with mental health problems especially, the stress could harm their recovery.

The targeting of DLA is also serious; the new assessment seems designed to get people off it.

Indeed, there is a feeling among some commentators that the government has misinterpreted what DLA is. The Guardian’s Anne Wollenberg pointed to the government’s state of the nation report, which noted that “…around 2.2 million people, including 1.1 million people of working age, have been claiming disability living allowance for over 5 years”.

As Anne says, DLA is not and never has been an unemployment benefit; it is there to support people with the extra costs associated with disability – usually a long-term condition – such as wheelchairs and care services.

For many claimants, DLA is essential to their quality of life and if they were moved off it, life would become very tough very quickly – they will still need the equipment/services DLA enabled them to buy but have less money to do it with.

All these measures are wrapped up in a drive to get people off benefits and into work. While this is a laudable aim, there are problems. For instance, the UK is just coming out of one of the longest recessions of recent times and jobs are scarce, with 2.9 million unemployed and another 1.3 million set to lose theirs due to the measures in the recent Budget, according to news reports today.

The struggle to get work is often magnified for people with disabilities. Even though there is anti-discrimination legislation, I would be willing to bet that many employers would still choose an able-bodied person over someone with disabilities – although few would admit as much and may do it unconsciously.

I could go on. But it is clear is that life could get very tough for some people with disabilities or mental illness in the coming months and years if the government goes ahead with its plans.

Postscript: The government has now announced an independent review of the methods used to assess incapacity benefits claimants’  fitness to work and will report back by the end of the year.

Would increasing NHS spending cut social care services?

Interesting stuff from shadow health secretary Andy Burnham today, as reported in the Guardian, who claims that increasing NHS spending could adversely affect social care provision.

Burnham objects to the government’s commitment to increase NHS spending in real terms year on year; “If they persist with this councils will tighten their eligibility criteria even further for social care. There will be barely nothing left in some parts of the country, and individuals will be digging ever deeper into their own pockets for social care support,” the Guardian reports him as saying.

As a cynical journo, my instant reaction is this is just a way of scoring a few cheap political points before the emergency Budget next Tuesday. And it probably is – but he does make a couple of salient points nevertheless.

It has struck me as odd that the only department with a guarantee of an increase in spending – amid swingeing cuts for everyone else – is health, especially at a time when the NHS is performing relatively well – if you take meeting the majority of targets as ‘well’. It smacked of a sop to the electorate – increasing health spending is always a vote winner.

Also, while there is nothing to say that the increase in NHS spending will come from the social care budget, there is nevertheless an element of robbing Peter to pay Paul with the Conservative commitment too – its reasonable to assume that increases in one department will mean that others gets cut. There are no spending commitments for social care (that I know of), so cuts in this area would seem inevitable.

Burnham also notes that putting the NHS in a stronger financial position to social care would make joint working – the current prevailing trend – harder to achieve.

Also, cutting social care could increase the burden on the NHS if more people end up in hospital due to falls etc due to struggling without care services they need because they cannot afford them. They could stay there longer if there is not the social care provision – meals on wheels, housing, care services etc – to support them in the community on release.

But whatever happens in next week’s Budget, it would seem the future for social care is an austere one; at a local level, there are already news stories of cutbacks in services, or charges for them increasing. To pick one example at random, here is a story from the online version of the Northampton Chronicle & Echo about county council proposals – currently out to public consultation – to raise £600,000 by increasing the cost of social care services.

Northampton County Council justifies this plan by saying that without the increase in charges, services would have to be cut.

This is a situation repeated across the country. It would seem that social care providers and service users are going to have to do more with less. How the government – and local authorities – will deal with this will be interesting to see. All should become clear in the coming weeks.

Hospital car parking charges need reform

Today’s blog returns to an old hobby-horse of mine: hospital car parking charges.

This issue is back on my radar again as I will be making regular hospital visits for the next few months (my wife is pregnant) and was stung for more than £2 for an hour’s parking earlier this week.

Some of you may remember a recent blog where I highlighted/ranted at what I saw to be the scandal of hospital car parking charges for visitors and patients (Hospital car parking charge scandal) and how this should be ended. Pleasingly, it seems that I’m not the only one that thinks this way: consumer watchdog Which? has now called for charges to be revamped.

As reported by the BBC today, Which? has published a list of the best and worst performing hospitals in terms of clamping and fining car park users (or abusers, depending on your viewpoint). The worst were Epsom and St Helier University Hospitals NHS Trust (most clampings) and Leeds General Infirmary (biggest finer). Barnet and Chase Farm Hospitals NHS Trust charged the most at £4 – £4!! – for 2 hours.

The fines and clamping system highlights another issue I have with car park charging; having to be aware of how long you’ve got left on your ticket.

Again, I’ve experienced this one; having recently bought a ticket for 3 hours parking (which I assumed when I purchased it was more than enough) I had to dash out of a waiting room to extend my parking stay. I shouldn’t be thinking about a parking meter when being given important information about my unborn child.

Hospitals visits can be stressful enough without having to worry about the threat of extra charges, fines or even clamping, especially when it is usually through no fault of your own; we all know how hospital appointments can – and often do – run behind schedule.

Perhaps the worst bit is that there is little sign of this ending. While Labour announced plans last year to scrap charges for in-patients, their families and friends within 3 years, the new coalition government has made no such commitment. And with budgets cuts imminent, they are a useful moneyspinner for cash-strapped PCTs that they will not give up voluntarily.

Which? has called for a ban on clamping and towing, as well as “fairer” charging systems such as allowing patients to pay on departure rather than arrival – although some already do this, to be fair – or reimbursing patients for additional parking fees when appointments are delayed.

All good points, and hopefully, given the clout that Which? has, someone in power will listen.

But for me, it doesn’t go far enough; as I’ve said before, I’m not against charging per se, but it does seem ridiculous to pay more than £2 for an hour, given the costs of upkeep of a car park (not that much) and the number of people who pass through one on any given day (lots).

Surely a flat rate of, say, 50p to park would be fairer? After all, unless my memory is deceiving me, it’s not all that long since that was roughly the cost of parking at many hospitals. That would cut out the stress of the charging, but also still cover the costs of running it – car parks should not be there to make money out of people who have no option but to go there.

Back to the future for social care

I had a peculiar sense of déjà vu reading new care services minister Paul Burstow’s interview in the Daily Telegraph the other day. While spoke about his hopes – and the need – for reform of adult social care, I had the funniest sense I’d heard it somewhere before.

Maybe because I have; about the time the green paper on adult social care was first mooted by the old Labour government a few years back. And a various points since then, up to and including the run-up to last month’s election (Doesn’t it seem a long time ago now?).

In the Telegraph interview, Burstow – who has a decent reputation within the sector – spoke of the need to find “a sustainable funding settlement for social care” and to reform a system that will soon become “not fit for purpose”.

Nothing new there. Many commentators – as well as service users and workers in the sector – have been saying this for years, to no avail.

There is also nothing new in his outline for the funding options that will be discussed by the upcoming independent commission; a voluntary scheme, a partnership scheme where state and individuals contribute, and a compulsory levy after death – yep, Labour’s much-derided ‘Death Tax’.

This is something of a turnaround for the government, which only referred to the partnership and voluntary models in its coalition document, released just a couple of weeks ago.

But what is new is a little detail on the timescale for reform. Those of us who thought that the coalition’s plans kicked the issue into the long grass now know how far; Burstow wants the soon-to-be-formed independent commission report back on funding options within a year, with a White Paper ready by autumn 2011.

He admits this is ambitious, but necessary as the Baby Boomers hit old age.

Nevertheless, it is good to see a timescale being laid out, even if it isn’t the one most people involved in the sector would have liked – in an ideal world reform would already have been carried out.

Also, carrying on with the positives, Burstow does seem to have a good handle on what needs to be done – saying it would be wrong to fixate on the problem of older people having to sell their homes to pay for residential care, something that the last consultation seemed to, almost with an eye on the upcoming election – and is willing to consider a range of options.

But what the independent commission comes up with remains to be seen – as does how different it will be to what came out of last year’s Big Care Debate – although the rumoured presence of economists on it suggests that it may be geared towards saving money.

Again, it feels like we’ve been here before. So while this could easily be a false dawn – and there have been enough of those over the years – at the moment, it is probably best to give the benefit of the doubt to the government, while all the time reminding them of what is needed and why, and to call them to account if they let the sector down.