The ongoing procrastination of social care reform must be testing the calm resolve of the interest groups who have demonstrated impressive political restraint and communications discipline to date.

A financial crisis in the care home sector, staff morale reportedly plummeting to an all time low, and no resolution in site, you could understand if social care campaigners took to the streets to show their anger at the pace of reforms.

In contrast however, campaigners have devoted their efforts towards developing a unified voice, and articulating their case clearly and effectively in public, and no doubt privately to Ministers and their advisors.  One thing that is clear, politically, is that social care campaigners seemed to have learnt key lessons from their healthcare cousins during the Health and Social Care Bill.

A combination of the ‘motherhood and apple pie’ nature of the Government’s Health White Paper, and the sheer size and complexity of the Bill that was then presented, meant that healthcare interest groups were on the back foot during the debates.  In fact, it wasn’t until the latter stages of the Bill’s progression through Parliament, fuelled by Liberal Democrat revolt and Baroness William’s entrance in to the debate, that the opposition began to find momentum. By this stage campaigners were forced into attritional dialogue, compounded by the evocative language of Lib Dem and Labour opposition to the Bill, and an uncompromising Richmond House. The result was an increasingly polarised debate, often populated with vitriol, hyperbole and multiple narratives which never really got traction.

Social care interest groups seem determined not to go down the same route. They have clearly worked out the areas they all agree on, the first rule of coalition, and therefore their messages are well developed and they are applying sustained and sensible pressure. 

The seeming de-prioritisation of social care to a ‘draft’ bill in Wednesday’s Queen’s Speech, was clearly a blow – kicking full legislation off the agenda for at least a year. However, campaigners appeared well prepared for the news with a well timed letter to David Cameron urging him to make reform his “personal mission”. Here they demonstrated another lesson learnt from the Health and Social Care scrap, that the Government looked at its most vulnerable when David Cameron had to intervene. Putting the focus on the PM from the beginning is a subtle and shrewd move.

The real tests will come when the details emerge, and there will surely be an unavoidable impasse as the question of funding comes into focus. There is simply not enough money to pay for the increasing social care burden this country faces, no matter how well you integrate care. This is surely the reason behind the procrastination, and a Treasury strategy that rests on simply hoping UK plc finances improves before they have to find a settlement looks increasingly optimistic.

Opponents of the Health and Social Care Bill are currently drinking in the last-chance saloon, as the Bill staggers to its 3^rd Reading in the House of Lords.

It appears that a consensus may be developing amongst the noble Lords that it is probably time to call it a night, having pushed the Bill to the edge of their revisionist powers. As the swashbuckling Peers dust themselves down and filter out of the bar of rebellion, they creep pass ex-Foreign Secretary Lord Owen. Eyes glazed, head lolling, he looks somewhat bewildered standing by himself desperately trying to convince Peers to stay with him and fight to save the NHS for one last hurrah.

This week Lord Owen has tabled a motion which, if accepted, would delay Third Reading until the risk register is finally published. The government are still fighting its release. The theory is that the risk register is so explosive the Bill will surely fail if it is released before Royal Assent.

Here are three reasons why Lord Owen’s motion is unlikely to succeed:

1) Whilst the Lords have becoming bolshier of late, they still don’t take unconventional acts lightly

Since the formation of the Coalition Government the Lords has become a much more tribal place and many of the agreed Conventions have begun to be overlooked. However, in the main, the Lords still take their role as the revising chamber very seriously. Whilst there is precedent for voting to approve motions like these, it will require significant support and strong feeling for their Lordships to take an unconventional stand like this. This could be present a problem for Lord Owen.

2) The Crossbench opposition may be softening

Crossbench Peers have played an important and fiery role in scrutinising and opposing this legislation, but there are signs amongst Peers that they feel that maybe their job is done. Respected former president of the BMA, neurologist, and Crossbench Peer, Lord Walton of Detchant, wrote this week to the Times(£) saying: ‘while I would have preferred it had never been tabled, I believe  that when the Bill completes its stages in the Lords…it will be much more acceptable and manageable.’ The question is whether his view that the ‘end of this marathon is in sight’ is shared amongst colleagues.

3) Relations are strained between Lord Owen and Liberal Democrat Peers

To be successful on unusual motions like these, a Peer will need to need to win friends and influence colleagues, often through demonstrating experience and expertise in the issue. Dr Owen, certainly has credentials for the latter, but can he win the support of Peers?

The House of Lords is a place steeped in political history and houses many rivalries that go back through decades and Governments. Some of the press coverage this week has focused on old battles of the Gang of Four. Many of the Lib Dem Peers in particular feel the scars of the break-up of the SDP and the troubled merger of the Liberal Democrats. Former SDP leader, Lord Owen, refused to recognise the merger and the battle scars run deep.

It is worth noting that on his Second Reading motion which also attempted to delay the Bill’s progression, he received just two Lib Dem rebels. There were some Lib Dem Peers who even voted against the Bill at 2^nd Reading, but still weren’t able to vote for his motion. Whilst Lib Dem activists and MPs have shown their rebellious side recently, it is unlikely that his call for Lib Dems Peers to ‘stand by their principles’ will have helped already strained relations…

There was no need to read between the lines last week to see that the Prime Minister got tough on ‘alcohol abuse’.

Recently, a doctor I was talking to corrected me when I used the term ‘alcohol abuse’, saying that it was not the terminology that they now use – with ‘alcohol misuse’ tending to be preferred. A quick scan of the responses to Cameron’s speech from medical bodies, charities and the drinks industry showed various different terms used from ’alcohol related health harm’ by the Royal College of Physicians, to ‘problem drinking’ by Alcohol Concern and ‘alcohol misuse’ from Drinkaware. Interestingly, in the main, stakeholders have not adopted Cameron’s chosen term: ‘alcohol abuse’.

What is in a name? In truth, with so many possibilities, the terms are often, particularly in the press, used interchangeably.

Perhaps it comes down to context. There are often legitimate reasons, not least stigma, in ensuring that the terminology fits the actual issue. For doctors, terminology and stigma are acutely important as they look to work with individuals to tackle alcohol problems.

In this case, it was clear that Cameron was looking to move the focus on to ‘binge drinkers’ who he believes are ‘abusing’ their responsibility to drink sensibly.

The ‘responsibility’ message in his speech in the North East was clear: “it’s about responsibility and a sense of respect for others… Over the last decade we’ve seen a frightening growth in the number of people – many underage – who think it’s acceptable for people to get drunk in public in ways that wreck lives, spread fear and increase crime.”

What was striking about the speech was the extent to which it followed a Home Office agenda, focusing on policies around police, pubs and regulation. Given the tough message put out by Cameron, his ‘alcohol abuse’ terminology was possibly entirely deliberate.

There is one small problem though. The various statistics mentioned by Cameron and others (cost to the NHS of alcohol misuse of 2.7 billion per year etc.) and the problems described are caused not just by binge drinkers but by a wide range of different types of drinkers, many of whom may be alcohol dependent.

Some people may say that it doesn’t matter what you call it, the important thing is to tackle it. Yes, there is definitely some truth in this and indeed behind the terminology, Cameron outlined some radical measures yesterday, not least hinting at introducing a minimum price for alcohol.

However, alcohol stakeholders pointed out last week that tackling alcohol misuse is going to need an approach which looks at not only the criminal justice and regulatory issues but also focuses on healthcare. As the Public Health Minister, Anne Milton said, there is “no magic bullet” and what the Department of Health will need is a range of approaches, bringing on board the general public, the drinks industry, charities, and importantly the medical professionals, some of whom may take issue with the terminology used last week.

The healthcare sector has been slower to get to grips with the new communication channels (targeting both patients and healthcare professionals) offered by digital and social media. However, it is clear that consumers are becoming more engaged in the management of their condition than ever before – connecting online with fellow consumers both locally and nationally and researching their own treatments (as patients expect to be partners in their own care). The patient opinion leader is rapidly becoming as important as the key opinion leader. Blogs, twitter feeds, patient group fora and Facebook pages all exist to share the experience of living with certain conditions.

This presents an opportunity for communicators. More informed consumers can be offered targeted information such as lifestyle advice on a particular condition. Additionally, the use of apps, for example, means brands can help their customers get the most out of their product, for example by creating medication reminders or usage instructions.

Healthcare professionals are also waking up to the possibilities of digital media. Research presented in early March at the EyeForPharma conference suggests that, of the third of HCPs online during patient consultations, half are actively recommending patient sites. Research from the US suggests that two thirds of doctors believe wireless devices to be essential to their job taking connectivity further. While an iPhone app that takes an ECG reading (a simple and useful test which records the rhythm and electrical activity of your heart) is still in ‘gimmick’ phase, as technology improves we’ll continue to see more diagnostic and information tools being made available to doctors, and their patients, via tablets and smart-phones.

There will, no doubt, always be a place for traditional media – we know patients love taking pages from the Daily Mail into the GP surgery! But when developing our communications strategy, it is now essential to consider what these new channels can deliver.