Tumultuous political and economic developments have unfolded since this book was submitted for publication.

In Boris Johnson’s final speech as Prime Minister outside Downing Street in September 2022, he included social care in a list of manifesto commitments he professed to be ‘proud’ to have delivered, a claim at odds with accumulating evidence that social care remains far from fixed. As an issue it was barely raised at all during the leadership debates that preceded the appointment of Liz Truss as his successor, although she did pledge her intention to reverse the National Insurance rise introduced in April to provide more money for health and social care, with it to be raised through higher taxation instead. She argued, to the consternation of NHS leaders, that social care should get a bigger share of the proceeds because the NHS has already received “quite a lot”. An expected emergency Budget in the autumn will no doubt clarify whether robbing Peter to pay Paul is the new administration’s strategy to funding health and social care.

Although most elements of the government’s limited funding reforms show no sign of being abandoned, alarm bells have begun to ring. The Local Government Association has called for delay, arguing as it did in 2015 that the changes need more time and more money. It remains to be seen whether the reforms will unravel, with history again repeating itself. Even if they proceed, the new political mood music favouring a smaller state, lower taxes and de-regulation does not encourage optimism about the appetite of the Truss Government for further action to address the deeper problems in social care laid out in this book. Much may depend on the views of the new Secretary of State for Health and Social Care, the third postholder in as many months, the twelfth in twenty-five years. The absence of long-term continuity in national political leadership and policy direction has never been more apparent.

In the meantime, having barely recovered from the shock of COVID-19, the economic environment has deteriorated sharply since Russia’s invasion of Ukraine, with catastrophic rises in energy prices, record levels of inflation, rising interest rates and the economy on the edge of recession. This has profound consequences for private households and public finances.