- Golden opportunity to address the social care crisis must not be missed.
- Integration of healthcare and social care can improve the quality of both.
- Meaningful reform must end artificial and unfair division between dementia and cancer.
As the population ages, the country’s care system simply isn’t fit for purpose: Social care available from local authorities is not providing good care for today’s elderly people (a cohort which is currently very small yet is causing such mayhem), and that lack of adequate provision then leads to problems in the NHS which damages health provision for the rest of the population too.
Social care system dates back to the Poor Laws: Leaving responsibility for care to cash-strapped councils, rather than ensuring good standards are provided alongside our NHS, originates from the 19th Century idea that those with serious ongoing illnesses would either be looked after by their families, or would not live long, while only the poor or destitute would fall back on the State if they could not look after themselves. The draconian means-test results in people having to impoverish themselves to pay for care, while those who are publicly funded are not given timely help. This system is not fit for the 21st Century.
The artificial distinction between healthcare and social care makes no sense: A millionaire with cancer will have all their care costs covered by the NHS, while a person with dementia who owns only their own home and no other assets will probably have to pay for their entire care costs themselves. Politicians have not explained this and it is something that families fail to understand. Successive Governments have tried to avoid grasping this nettle, as if the public did understand how the present system works, they would realise just how unfair it is.
Inadequate council provision pushes more cost onto the NHS – no incentives to save the NHS money: Councils have had to ration care much more stringently in recent years, as the numbers of elderly people has been rising while budgets have not increased commensurately. There has been no pre-planning for the rising care needs of local populations. This means many people who need care are not receiving it, either because they cannot afford it, or because the council only helps those with most severe needs. Meanwhile, if people with more moderate needs do not receive the care they require at a relatively early stage, they are more likely to end up in the NHS system. This costs far more, but that cost has always been the responsibility of the Department of Health, not DCLG, so the councils have had no incentive to prevent people ending up in hospital.
Bringing responsibility together under one Department could revolutionise the system: There is an opportunity to introduce incentives that encourage social care provision to save money to the NHS. At the moment, councils actually have the perverse incentive to maximise costs to the NHS because the longer an elderly person is in hospital (at a cost of maybe £3000 a week) the council is saving the cost of supporting that person in a care home (at a cost of maybe £600 a week). Clearly, from the national perspective this is a waste of resources (and has often resulted in other people being unable to receive hospital treatment if there are no beds available). But from an inter-Departmental budget perspective, the system made some sense.
Integration of health and care could allow radical reforms, e.g. encourage GPs to ‘prescribe’ care, or introduce lower cost convalescent facilities to free up NHS nursing beds: The Government needs to move forward urgently with reforms that will see more care provided for more people at an early stage as they get older, to keep them fitter, healthier and safer in their own homes, rather than continually cutting care provision from those with moderate needs who are then increasingly at risk of ending up with much more severe needs later. GPs could ‘prescribe’ or ‘advise’ frailer patients to get some help or some preventive aids like handrails or emergency alarms that will reduce risks to their health. The NHS could also perhaps earmark some facilities as ‘convalescent’ homes where elderly people who cannot yet manage to look after themselves at home do not have to stay in a fully staffed nursing ward just while they are recovering and awaiting home help or a care home place.
Demographic time-bomb is ticking, fuse shortening: Until now, successive Governments have abjectly failed to prepare for care of our aging population. The babyboomers are just starting to reach their 70s now. In a few years’ time this huge demographic group will need care in ever-increasing numbers and nothing has been done to plan for funding these manifestly predictable future needs. There is no silver bullet, a combination of measures is needed, alongside the integration of health and care. These could include incentives to help people earmark some of their ISAs, pensions or housing equity, a Care ISA allowance to help pre-fund care needs, future national insurance reform that includes care, a national equity release scheme to help fund later life care and life insurance that could pay out early if care is needed.
Jeremy Hunt to work with Simon Stevens on a new settlement for care: Simon Stevens has been pressing for the NHS to accommodate social care. He knows the NHS cannot thrive without addressing this issue. If Jeremy Hunt can work with him on meaningful reforms then maybe we can finally begin to address this ongoing crisis and our aging population – and their families – can look forward to a better future.