This post has been written by Moira Fraser, Director of Policy at The Princess Royal Trust for Carers

The Prime Minister’s  been saying a lot on domestic policy recently. I wonder if he was saving it all up over the Christmas break, making notes in between his turkey and plum duff. He’s been wading in on a few issues which he normally leaves to others, which have  hit a bit close to home on the caring front.

Over the weekend he made what was apparently an off the cuff quip about Tourette’s syndrome. Maybe some people found it funny, but I bet people with Tourette’s and their families didn’t. Most people with a disability will tell you about the names they’ve been called  or the humiliation they’ve had to put up with, just because they look different, need different things, talk differently, behave differently. Making fun of someone’s disability  to score a couple of laughs just isn’t on, and if you’re the Prime Minister, frankly, you should know better. Zero points, Mr Cameron, for disability awareness.

And  last weekend he was on about health and social care and how they need to be more joined up. He wants to make it a priority, as care in England  is too fragmented .

I’m delighted he’s taking an interest. We desperately need our political leadership to social care right at the top of the list as a major priority to be addressed. He’s absolutely right that the artificial boundaries between health and social care make no sense and act as a barrier. I can’t tell you the number of times I speak to carers who are stuck in the middle, making never ending phone calls to different departments trying to put together all the pieces of the jigsaw puzzle. It’s no wonder carers don’t access support for themselves- by the time they’ve got the essentials in place for the person they care for, they’re exhausted, just can’t face it, or think there’s no blooming point.

But it is a bit odd, all the same. We’ve been talking about joined up care for as long as I can remember. We have pooled budgets which are supposed to mean health and social services plan  together. We have jointly agreed care plans and in some places care trusts which bring all the services together. And whilst there are successes,  they’re there because the local leadership pushes it and people on the ground are fully, root and branch, committed to making it work. In many places it’s still very much  a case of the right hand having no clue what the left hand is doing.

At the same time, the Health and Social Care Bill drives policy in the opposite direction – removing more and more central direction, and removing the need to have the same boundaries for health and care authorities. We lobbied hard on this, including talking to the PM about it directly,  because  where families need to work with multiple services – for example,  adults and children services, health trusts, education services, all at the same time –  creating extra confusion doesn’t  help and people who are the most disadvantaged get missed.  The reorganisation which health services will have to go through following the Health and Social Care Bill is going to make things a lot worse at least in the short term. I’m worried about how we will make sure everyone gets what they need whilst the NHS is trying to figure out who’s in charge and who works for who.

It’s fantastic that the PM  has spoken about the importance of social care, and of integration. If we can find ways of achieving better joined up working, let’s do it. But I’m worried that his comments suggest that if we all try a bit harder to work together then the social care system might turn out not to be quite so broke and therefore not need fixing, meaning we can shelve the difficult decisions for another day. No matter how much integration there is, social care in England needs reform and needs more funding. Let’s keep our focus there.