The previous chapter on scale, style and scope highlighted the extent to which the institutional context of the four nations shapes their approach to policy and their relationship with other institutions such as local government. This relates to structure but also to discursive patterns in framing and identity. Scotland and Wales have had a less complex, more consensual and inclusive policy-making style compared to England and Northern Ireland. This has included a focus on trust and co-production over competition and adversarialism, which is relevant to the process of policy-making but also to the types of policies that have been favoured. In this chapter we look at the challenges of social care reform, and why the four nations have not been able to achieve more change over the period despite the clear commitment across a series of policy documents to do so. We consider the patterns of divergence and convergence in relation to social care policy. We compare an incremental versus transformative approach to care reform, and highlight how both of these approaches must still resolve the challenges of implementation. We also explore the ‘policy mix’, highlighting tensions between different policies that make it hard to achieve all of them at once, even if implementation challenges could be avoided. We set out two paradigms of care policy – the standardised, centralised and formal versus the differentiated, local and informal – and suggest that policy makers must engage with the tensions between these rather than offering ‘the best of both worlds’.

Divergence and convergence

Earlier chapters of this book highlighted the high degree of convergence between the four nations in relation to discursive framings of care (the key values underpinning it: wellbeing, fairness, rights, quality and sustainability) and aspirations about the decisions and practices that were required to reform it (redistribute costs of care; personalise support; support unpaid carers; invest in prevention; integrate with health; and professionalise the workforce). In achieving these policy reforms, the scale, style and scope of policy in Scotland has facilitated greater legislative activity than elsewhere. In Wales, devolution has been a more gradual process than in Scotland, and much time and policy capacity has been spent on institution building. Since 1998, the Welsh Government has been reviewing and renewing its constitutional settlement almost constantly, bringing it closer to the Scottish model over time.