NHS Needs Sustainable Social Care System
If we are to secure the future of the NHS in this its seventieth anniversary year, then one thing we must challenge is the divide between it and social care. This was left unresolved by the post-war creators of the welfare state and has been a festering and worsening problem ever since. The baton has now passed to us.
The NHS’s ideological and political enemies continue to hollow out our health system before our eyes. Private sector parasites increasingly steal its resources and undermine its efficiency through their efforts to profit from it.
PFI continues to burden its finances and ‘new managerialism’ wastes resources and undermines worker and patient relations, generating bullying and fear. But the NHS continues bloodied but unbowed.
We can watch its wonderful daily reality on TV progammes like GPs Behind Closed Doors and 24 Hours in A & E, as well as experiencing it routinely first hand. We marvel at what it and its workers daily do for us; their love and dedication, the care and technical mastery. And we bear witness to the meaning of medicine without profit and for all. We worry for the NHS’s future but glory in its past and present.
But when we turn to social care, it’s a very different story. This is the policy the post-war Labour government forgot and we have lived with its consequences ever since. It is still needs and means tested, just like its Poor Law predecessor.
It’s a residual service that reaches fewer and fewer people. Mrs Thatcher made it her vanguard policy to privatise and run-down the welfare state. Social care is a wasteful, poor quality, over-institutionalising and insecure system, ironically based on some of the most cutting edge profit-driven financial arrangements which magnify risk, insecurity and unaccountability.
Post 1945, the assumption was that poor law problems of neglected and instititutionalised older people would disappear with a proper system of pensions and social security; that numbers of disabled people would diminish as general health and social conditions improved.
Social conditions and medical expertise with the NHS did improve but, contrary to expectations, the numbers of older and disabled people increased and have continued to increase ever since as it became possible to increase people’s longevity and life chances.
There have been numerous modern inquiries into the inadequacy of social care – the Sutherland and Dilnot reviews – whose recommendations were ignored. There were Labour’s 2010 election proposals, vilified by Conservatives as a ‘death tax’ and then Mrs May’s comparable proposals for the 2016 election which were similarly condemned and which played their part in her electoral failure.
There have been numerous investigations, whose evidence and proposals have been ignored. Almost invariably they have focused on finding ways of making people needing social care more financially responsible while limiting the extremes of cost.
The latest idea comes from a House of Commons Joint Select Committees’ report on social care funding. It calls for a further regressive shifting of the financial burden, with a new tax for the over-forties to help pay for elder care, although people in care homes would probably still have to contribute to their accommodation costs.
There have also been all kinds of bright ideas for how to make bricks without straw in a chronically impoverished system. These include successive governments’ so-called personal budgets policy, which has been shown to have failed dismally, to the so-called ‘three conversations’ model by which social workers are supposed to sort things out by asking the right questions!
Social care is the blot on the landscape of the NHS’s anniversary celebrations. The bottom line is that there can be no adequate or effective NHS without a sustainable social care system.
As we, as a population, have changed over the years our health needs have changed too. But the NHS hasn’t kept pace with this, as it has increasingly been focused on acute issues. This has left the long term and social ones to a failing, yet more and more essential social care system.
The service user movements, which emerged from the late twentieth century, have highlighted how such a care system can redefine and realise independence for disabled and older people, mental health service users, people with learning difficulties and long term conditions.
By securing their human rights, and personal and social needs, it offers the prospect for this growing population to have a real chance to live their lives to the full, with equality, in the mainstream.
The health and social care systems will never work properly together so long as they are differently organised and funded. Social care will only be sorted when it is put on the same financial basis as is beloved of the NHS – a service essentially free at the point of delivery paid for out of general taxation.
But lurking behind all this has to be the fear that an underlying political destination in the minds of many of our leaders is an NHS put on the same disastrous financial basis as present social care; paid for through additional taxation and at the point of delivery – in other words no NHS at all.
Our watchword on this critical anniversary must be: We fight for a universal free NHS and universal free social care. Nothing else will work or is sustainable.