For a politician in his situation, care services minister Phil Hope was in a remarkably cheerful mood when I caught up with him to find out how well - or badly - his department’s latest green paper had been received.
This was the “national care service” paper unveiled by Hope and the boss, Andy Burnham, in the middle of a week in which Lord Darzi quit the Department of Health. It also saw Mr Hope involved in a joint “no secrets” initiative (designed to protect adults from all forms of abuse) with the Home Office.
Exhausting stuff (I quite forgot Mr Hope’s “more help for carers” speech at the Carers UK conference), especially with financial storm clouds darkening over the NHS - as Monday’s King’s Fund/Institute for Fiscal Studies report underlined. But remember: we don’t have to slash spending right away to pay off the credit crunch debts, we do have to have credible plans to get borrowing under control again.
All of which is a far cry from Mr Hope’s bubbling optimism (this is a man recently battered by the expenses scandal) about being “fired up by the most radical transformation of care services for over 100 years: it doesn’t get better than that”.
Yes, he did say that - and clearly means it. He had done an explanatory session, organised by Age Concern, with constituents in Corby and they had been “absolutely thrilled” once he had explained how the three new funding options might work.
Me, I assumed that option three, the one which requires us all to commit £20,000 from our estate (ie, paying posthumously) rather than the voluntary option, is the government’s preferred choice because it pools risk better (ie most of us won’t need it). Mr Hope wouldn’t be drawn: there is a public consultation first.
In Parliament the Lib Dems were supportive (despite that by-election in Norwich), as were some Tory MPs, but Candid Andy Lansley was rather more suspicious, grumpy even. You have taken long enough to get this far and, even now, you haven’t costed the government’s contribution, Mr Burnham’s shadow complained. That is what is blocking consensus, added ex-health secretary Stephen Dorrell.
The best Andy Burnham could come up with was that it is a question of spending existing funds better through a system which rests on principles which voters - not just in Corby - want to see: it is universal; simple to understand; it unifies health and social care; quality is much improved; and it is fairer - ending that “postcode lottery”.
That sounds a bit airy fairy to me, albeit more realistic than the Scottish government’s policy - free social care funded out of taxation - which both the 1999 Sutherland commission and the 2006 Wanless II report supported in varying degrees. Why? Because it is so expensive at a time when the ratio of employed people to retirees is heading from a healthy 4:1 to a scary 2:1 by 2045.
There are ever more old, healthier people, but they can’t stay healthy for ever.
Our demographic situation is better than most in Europe, but we look after our oldsters worse. Trends we have known for decades we are only now addressing - older retirement for instance (68 by 2048). What is more, the post-war baby boomer generation have had it cushier than most: we can’t burden our grandchildren.
None of which detracts from Phil Hope’s determination, backed by extra funds (though adult social care cash is not ringfenced), to improve the quality of care, not least prevention - where new technologies can help the elderly stay in their own homes without breaking their hips.
“Doing nothing is not an option,” says Mr Hope. He is well named.