Health Policy InsightEditor's blog Monday 4 July 2011: Lansley's six social care tests; any more use than his four reconfiguration tests?
The excellent Guardian Politics LiveBlog main man Andrew Sparrow cleverly picked out the bones of Andrew Lansley's Commons statement in response to the Dilnot report on social care and its funding.
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Sparrow identified six tests Lansley set for funding reform: "whether they would promote closer integration of health and social care; whether they would promote increased personalisation, choice and quality; whether they would support greater prevention and early intervention; whether a viable insurance market and a more diverse and responsive care market would be established; whether there was a consensus on the amount of extra money that should be put into the system; and whether a fair method of financing the costs could be found".
Well spotted, Mr Sparrow.
And as regular HPI readers know, Lansley has form with setting tests.
Of those much-cited four reconfiguration tests Mr Lansley (Saviour, Liberator) set last year shortly after taking office, only one is empiricially measurable: the rest are subjective.
Any more objective?
So how do these six tests look? Are they any more objectively measurable?
The first - promoting integration of health and social care - is one of those things that look like a given good idea. The question required here is always two-fold. Firstly, who defines integration? Secondly, who pays?
It's also worth remembering Leutz's six laws of integration, about which I wrote last autumn.
In the absence of any form of answer to the key questions above, I think this is clearly not empirically measurable.
The second is promoting increased personalisation, choice and quality. Again, they sound uncontroversial. Of the three, you can certainly measure choice. Personalisation is far more ambiguous, however, and I can do no better than to quote the management thinker Russell Ackoff: "quality is a term so vague as to be practically meaningless. Use it as often as you can!" So the second is one-third measurable.
Third on the Lansley list is supporting greater prevention and early intervention. These are Good Things, in all areas of health and care. There is a risk that they will be more asserted than achieved, and I am very far from sure the baseline data for measurement exists. But in a spirit of charity, let's say it does and will be splendidly measured, and give Our Saviour And Liberator this one.
The fourth raises a wry smile around the corners of my well-chiselled features: whether a viable insurance market and a more diverse and responsive care market would be established. The first half will be measurable, as will the diverse bit of the second. Responsive - not sure that is a goer. So this one is three-quarters measurable.
Fifth, we have whether there was a consensus on the amount of extra money that should be put into the system. No idea among whom this consensus should exist. Politicians? providers? Taxpaying voters? No definition means not measurable.
Finally, the question of whether a fair method of financing the costs could be found is unambiguously wholly subjective.
So on this occasion, Our Saviour And Liberator has presented us with 2.08 out of six tests which are actually empirically measurable. That is one-third, near as damnit.
His previous best was one-quarter.
The Secretary Of State For Health is improving. Which is nice.
If this annual improvement of policy-reality metrics of 8% (2010: 0.25; 2011, 0.33) is maintained, then at some point early in 2014 we can expect a set of tests that will be half-way useful.