Senior Liberal Democrats are preparing to clash with the Treasury and their Conservative partners over increased funding for long term care.
Several government Liberal Democrat sources said they were worried the reforms would not be made, mainly due to a reluctance to commit the necessary funding, which would be likely to stretch to more than £1bn a year.
It is a particularly contentious issue for the coalition after health secretary Andrew Lansley was accused of betraying cross-party talks on long term care before last year’s general election, when he attacked plans for a so-called “death tax”.
One senior Liberal Democrat told HSJ that the reforms – likely to be based on proposals made by the Dilnot commission in July – “have to happen”.
But the source also said the Lib Dems were worried the changes would not be implemented because of the Treasury’s reluctance to fund them.
The Department of Health announced a further consultation on long term care last week and has been accused of kicking the issue into the long grass.
Another senior Liberal Democrat, involved in discussions on the issue, said: “It is a difficult decision for the government. Social care is not seen as a priority, unlike the NHS, even though the [growing social care] costs will be dumped on the NHS.”
The Liberal Democrat health minister, Paul Burstow, speaking at a fringe event at the party’s conference in Birmingham on Monday, said: “I’m committed to making it [long term care reform] happen.”
Also at the conference, Baroness Shirley Williams said clinical commissioning groups should be required to involve nurses and doctors with secondary care experience in executive decision making roles rather than just on a governing board.
She also called for changes to the Health Bill to ensure the health secretary retains responsibility for securing provision of services. She said government regulations should have to be reviewed by the Commons health committee, rather than being “rubber-stamped”.