Thirty years after the then Government established the “Royal Commission on Long Term Care”, five years after the 2021 Health and Social Care Act was to sort out social care once and for all, social care is still in crisis and, at long last. moving up the agenda of Government.
The NHS and social care need radical reform, restructuring and cultural change based upon a whole systems approach to liberate the hardworking professionals from the constraining contract culture into an enabling leadership one. Taking out functional divisions along patient / user pathways to create “whole task, right sized, multidisciplinary, inter-agency teams” aligned behind outcome, These teams need to be able to “plan do and evaluate* their own work which completes the learning cycle of constant improvement.
A survey by The Times found there were on average 13,600 people a day in hospital awaiting social care. To enter long term residential care is one of the few irreversible decisions in life and is not to be taken lightly or without an assessment of need and verification of wishes. And there are many more older people not receiving the help they need in the community.
Social care needs to move from a “minding” to a “mending” service. Social Work is under-valued and social workers misused.
Given the wealth of empirical evidence into the social determinants of health which has demonstrated the correlation between low income and health unless Government addresses the widening income inequality and increasing poverty in our society the NHS will not keep pace with demand and will always be playing catch up. Governments cannot go on throwing more money at the first aid camp at the bottom of the cliff without building a fence at the top. Treating the symptoms not the cause.
Britain has one of the lowest State Pensions in the developed world with 2.4m older people living in poverty. Many of whom, if they retired before the abolition of the “default retirement age” in 2012, were forced into retirement and condemned to spending the rest of their lives in poverty. Older people got no benefit from the two pre-2024 General Election cuts in National Insurance, previously lost their free television licence and some their winter fuel allowance and have to pay more income tax due to the freezing of the tax-free allowance
Older people account for approximately 70% of the expenditure of the NHS and on social care. To raise the State Pension to 60% of median household income to lift all older people out of poverty paid for in part by people continuing to pay National Insurance whilst ever they are working and not drawing their State Pension until they retire, with phased arrangements, would improve their quality of life, reduce demand upon the NHS (saving huge amounts of money) and mean that if they did need long term care applying the same financial assessment which has been in place since the 1948 National Assistance Act under CRAG (Charging for Residential Care Guide) they would be able to contribute more reducing the cost to local authorities and mean that their capital and house would no longer need to be taken into account.
Past deliberations have focussed on paying for social care. If the emphasis were to shift to where best to intervene in the system and put the money Government may find they do not need as much as they thought.
These ideas are developed further in my book “A Better World”.
* Chris Perry is a former Director of Social Services for South Glamorgan County Council, a former Director of Age Concern Hampshire, a former Non-Executive Director of the Winchester and Eastleigh Healthcare NHS Trust and a former presenter of an award-winning public affairs programme on Express FM.