Just before the summer recess the Government published a white paper and draft bill on social care. There was then a debate in the House of Commons for which I diligently drafted up a speech. Unfortunately due to a lack of time I didn’t get called by the Speaker, but as this is such an important issue I’ve reproduced what I would have said below.

The Civil Servants who wrote White Papers of 30 years ago would hardly recognise this document as a ‘White Paper’. I am sure that Ministers expect us to admire the ‘accessibility’ of this document with its graphics and colour photographs. Mind you am I the only one to be irritated by the faux-chumminess of the tone? It is full of statements like this:

I am supported to maintain my independence for as long as possible.

I am in control of my own care and support.

Is there not more than a touch of being patronised in this? This is the Government speaking for goodness sake, not some form of life coach.

All of this presentational veneer masks the vacuum at the heart of the White Paper – the vacuum where the real role of Government should lie. Much of it seems better suited to a manual of good practice . Do we really need a Government White Paper to tell us (in two columns with a chatty example) that it’s a good thing for young people to visit care homes to bridge the generation gap and create greater understanding – something that happens regularly in most areas already.

There then the endless ‘management speak’ (something to be fair all government & local government has become too enthralled with in recent years ). For example we are constantly to be ‘driving up standards’ as if the very use of such an active verb guarantees action. There are so many such words and phrases that it is hard to pick out any in particular, but I rather enjoyed this paragraph:

We will also create a Care and Support Implementation Board which will have ownership of the implementation plan, with members of the Board assuring on the delivery of specific milestones.

The few concrete proposals are either fairly limited in scope or set up inevitable tensions as duties are piled on local councils without the funding to fulfil them. For example setting minimum care standards is an important step forward – but what happens when a cash strapped council cannot meet the demand?

Or let’s take the proposal on housing – a promise of £200m over 5 years to support the development of specialised housing for older and disabled people. That’s £50m a year for the whole of England. That’s not going to stretch far.

Much emphasis is placed on giving better information. Nothing wrong with the giving of more information but we do see a lot of the ‘new magic’ – the development of web based information to aid choice – a bit like ‘trip adviser’ for care homes – but hopefully more reliable!

What though I also want to consider is what our two countries, Scotland and England, can learn from one another. I’ve quite often had people say to me ‘You’ve sorted it in Scotland with free personal care’ . But free personal care turns out to be a fairly narrow slice of most people’s care needs. There is a great deal which doesn’t get covered. So I was quite interested in Dilnot because it seemed to me that it was seeking to address a much wider range of provision and looking at how it all could be paid for. However it too failed , as the Scottish solution does as well, to go beyond the ‘who pays’ question – how the cost should be distributed between the individual and the State.

Free personal care in Scotland shifted the balance to all taxpayers from those who previously paid for the care – so was of no benefit to those already entitled to free care. There is an argument for doing this – after all it’s what we do with other services like health and education. But it put no additional money into the care system at a time when coverage was already inadequate and demand is continuing to rise. One result is the raising of eligibility thresholds – in my city to obtain an adaptation like a walk in shower one has to be incontinent or in a wheelchair. This means that quite often adaptations are too late – just last week I was told of one constituent who died while in respite provided while his shower was being installed. The preventative aspect is lost – so another 93 old constituent was refused because she wasn’t ill enough – but without either a relative or carer (which otherwise she didn’t need) she either couldn’t bathe or risked an accident – at what cost is that both personally and financially?

In Scotland the cost of all those services which can still be charged for has also been steadily rising, and the quality is diminishing. Councils can only meet rising demand by looking for efficiencies – so tendering has become widespread. Edinburgh Council has tendered out two thirds of home care, and boasted of the ‘savings’ to the council as a result – but at what cost? Lower wages – one constituent described the process – called to a meeting: Good news we have a four year contract, bad news we are reducing wages by 50p per hour. Clearly the company was underbidding to win contracts. Home visits are often 15 minutes or shorter. I know this White Paper says it wants to end this in England – but it’s another example of willing the ends but not the means. Carers are often required to use their own cars (if they have them) and have to pay such things as parking charges themselves. They don’t get paid for travel time. The White Paper mentions ‘concerns’ about carers not being paid the minimum wage , asking itself the question ‘why’? However not being paid for travel time is one of the important ‘whys’.

There are not magical ways of funding important social services. The spectrum runs from individuals meeting their own costs (the pre welfare state model) to the State meeting the costs and therefore all of us through taxation (the NHS model) . And there are plenty of stopping places in between. We need to have that debate publicly and honestly. Make a decision and move forward. But don’t pretend that either north or south of Hadrian’s Wall have we yet solved the problem.