14 July 2006
Social care is often described as the Cinderella service. So will Ivan Lewis, the fourth to wear the ministerial shoes in just five years, turn out to be its Prince Charming? Sally Gainsbury went to find out
They say a picture can tell a thousand words. The Department of Health's waiting room is decorated with glossy photographs of the NHS's pride and joys: architectural glamour shots of new hospitals, mental health facilities and a large GP surgery, all dolled up with shiny glass and sharp angles.
But the absence of any representation from social care seems to confirm the sector's frequent complaint that it is the Cinderella service of the DoH. Acute and primary services are all dressed up for the glitzy ball of patient choice and personalisation, but what fate awaits social care?
In steps Ivan Lewis, the fourth social care minister in five years. Tall, dark and Mancunian, could he be the sector's Prince Charming?
It is a role Lewis seems ready to adopt. 'It's absolutely right for social care to say we've not been given the profile, the respect, the status and the value that we deserve, and my job is to change that,' he tells Public Finance, six weeks into his new post.
'It's been for too long at the margins of this department, it now must be brought to the centre, in society more generally too. We're going to bang the table, in terms of our health service colleagues. We're missing lots of opportunities by social care feeling, and to some extent being, treated at the margin.'
Those in the social care sector will welcome that intention. But they might not be quite so enamoured of what he has to say about funding. Liam Byrne made himself popular as Lewis's predecessor by admitting, on the record, that social care is significantly underfunded. However, as perhaps befits a new minister fresh from the Treasury, Lewis is more cautious. 'The chancellor said to me: “You'll probably enjoy spending money, rather than keeping a tight arm on it”,' he comments.
On the forthcoming Comprehensive Spending Review, into which the social care sector is investing much hope and lobbying, Lewis says: 'The challenge is not just about asking for more money, it's about saying “here's what we bring to the table; here's the value we add; here's the preventative contribution we can make to people's health and wellbeing; and here's how we can demonstrate our capacity to be innovative and reforming”, rather than just going along and saying “we do a really good job, we're really good people, we're really virtuous: we want some more money.” That won't work.'
Lewis also dismisses concerns that NHS deficits might hinder integration of health, social care and community services. 'Actually, one of the ways we get better value for resources is by genuinely integrating the way we define and approach the needs of our local populations. We have to change the mind-set which says that when things get difficult, we become inward-looking and insular, when actually, it should be the opposite,' he says.
What reassures the sector, however, is that Lewis feels the contribution and value social care provides in his body and soul. His career in social care began at the age of 14, as a volunteer working with people with learning disabilities. That led him to set up his own voluntary organisation, working with people with learning disabilities and mental health problems. Eventually he became chief executive of Manchester Jewish Federation, which provides adult and family services to more than 1,200 people.
Amid all that, he found time to serve seven years on his local council – including four as chair of its social services committee – before being elected MP for Bury South in 1997, becoming a junior minister in the Department for Education and Skills in 2001 and in the Treasury in 2005.
The 39-year-old father of two describes his new appointment as 'like coming home… going back to my roots'.
'The person I am today and much of my life has been shaped by social care. I've got tremendous job satisfaction out of it. It can change your values, influence what you do with your life. I almost certainly wouldn't have got into politics without having had that social care involvement,' he says.
Those 25 years in social care show – not just in Lewis's knowledge of the big themes and 'perennial problems' of social care – but also in his understanding of the nitty-gritty of the state-provider relationship over which he now presides.
At one point, only half-jokingly, he defines 'partnership' – that New Labour watchword in public service delivery – as 'the mutual suppression of mutual loathing in the mutual pursuit of government money'.
However, it is not that element of social care that he is most fired up about changing. Asked the Desert Island Discs question about the one thing he would change if given only one year in the job, he disarmingly falls back on his office sofa and stares meditatively at the ceiling.
After a few stalled starts, he says: 'Maybe it's that I get us to a situation where everybody understands that the starting point is that frontline dynamic of an individual or group of individuals providing a service to a vulnerable member of society. If I can get the system to remember that as the starting point, rather than focus on all the architecture and wiring, then I think we may end up with better policy and better delivery as a result.'
Getting away from the 'architecture and wiring' is a running theme for Lewis. This might be seen as a subtle reference to the famous 'blue skies' thinking of his predecessor, who could frequently be heard discussing examples of 'co-production' from cyber communities, a year before the term became fashionable parlance in the rest of Westminster.
Lewis's sights will be set more on the ground. He says he is 'very excited' about the current experiments around direct payments and individual budgets – which aim to give people more personalised services by making them the effective commissioners.
'But there are major challenges there,' he admits. 'One is that while we're giving people more and more purchasing power and therefore changing the provider network – you would hope – how do we maintain some sort of stability at the same time? It's also very important that we're not just giving people power to purchase from the same menu of services. The whole idea is that we also offer people new services and different ways of doing things that genuinely are responsive to them.'
So far, so good. But the important thing, as Lewis says, is 'to close the gap between rhetoric and reality'.
Has he got what it will take to dust down social care's neglected rags and put it – and its users – on the pedestal it deserves?
Julie Jones, president of the Association of Social Service Directors, is hopeful. She told PF: 'He's seen as someone very committed and with a strong background in both social care and the voluntary sector, which is very welcome.'
Lewis is also confident. He refers back to his five years as minister for skills in the DfES. 'That too was at the margins of the department,' he says. 'You had schools and universities at the centre, and skills was to the side. I think that if you spoke to the stakeholders in the world of skills about what we were able to do in those four years… they'll say we did an awful lot to shift it. That's exactly the same challenge in terms of social care in the DoH.'
Perhaps then, social care's will be a modern fairy tale. Her Prince Charming has a penchant for the underdog and hopefully her fortune won't be at the misfortune of her 'ugly sisters' in acute and primary care. Perhaps in this modern fairy tale, they can all live in the castle.
PFjul2006
