Michael White: the well-intended Dilnot report may fall on deaf ears

In fact, health secretary Andrew Lansley was even a bit cheeky in his downbeat way as he made a Commons statement to MPs. They were a bit downbeat too, those who bothered to stay on and listen. Curious.

The report is calmly written, lucid and coherent, as good a piece of work of that kind as you could hope for, I’d say. Reporters who attended Dilnot’s briefing came away impressed by his enthusiasm, his graphics (he is a statistics junkie) and his self-deprecating style.

That’s hardly surprising. Dilnot is a Swansea comprehensive boy who scaled the technocratic heights as an economist and broadcaster, director of the respected Institute for Fiscal Studies from 1991-2002, presenter of Radio 4’s More or Less programme, and principal of St Hugh’s College, Oxford. He is poised to move down the road to Nuffield College.

His £3m inquiry team (Dilnot was paid £85,000 for a three day working week) was buttressed by local government veterans; Dame Jo Williams, ex-Mencap, now the CQC’s chair; and Lord “Stormin’ Norman” Warner, ex-health minister and Labour apparatchik, now in the Lords. Plus nine civil servants.

Yet the immediate word from Number 10 prompted political correspondents to reach for a favoured cliché, the one about the report being “kicked into the long grass.” Why? On account of the implied “significant cost” to the hard-pressed state which (on the favoured model which Dilnot’s commission offered) could be £1.7bn a year (rising to £3.6bn by 2026) if personal contributions are capped at £35,000.

Although that’s a piddling sum compared with what we spend on oldies via the NHS (£50bn on some estimates) and would, in any case, ease NHS delayed discharge problems, George Osborne’s Treasury officials won’t like it in the present climate.

Hence Number 10’s and Mr Lansley’s lukewarm response and the shift in timetable for the promised white paper from the end of 2011 – as stated in Dilnot – to next spring, with legislation “at the earliest opportunity”, a deadly phrase. In fairness to the health secretary he’s set a lot in train in this area – last week’s Hughes-Hallett report on palliative care, plus a new legal framework for adult social care – but, as we’ve seen on the Health Bill, good intentions are never enough.

Lansley rightly set out some familiar tests which reform must pass, including greater integration of health and social care, choice, quality, personalisation (ugly word!), better-trained staff, the growth of an insurance market which may help pool risk and thus lower costs.

But hang on, I hear you say, hasn’t the government’s own squeeze on local government spending added to the burdens of caring for the elderly, both in their own homes or in care homes at a time when 1.5 million of us are living beyond 85 – compared (says Dilnot) with just 60,000 in 1901?

Well, yes, the cash squeeze and postcode lottery make it a nightmare, one further complicated by devolved Scotland’s decision to embrace the 1999 Sutherland report’s majority recommendation: the state should pay. This “recognised disaster’’ has doubled the cost, say critics.

Did I say cheeky? Yes. When Labour’s Emma Reynolds urged Mr Lansley to apologise for the “death tax” advert which torpedoed Andy Burnham’s belated pre-election efforts to reach a consensus on elderly care he blamed Gordon Brown for the breakdown. I blame hooligans at Tory campaign HQ. And so do the Lib Dems.