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Saturday, 13 January 2018

Social care crisis

Source: ASCC

 Funding social care was the subject of Key Issues for the New Parliament 2010. It read:

In 1997 Tony Blair told the Labour Party conference “I don’t want [our children] brought up in a country where the only way pensioners can get long-term care is by selling their home.” Local authorities have been able to require people to sell their homes to pay for residential care since 1948. Thirteen years after Tony Blair’s speech, local authorities continue to do so. 

The system was seen as inherently unfair, penalising those who have saved for their old age, whilst those who have been less prudent are eligible for state-funded care.

The Money Advice Service web page includes a  table: Local authority funding for care costs – do you qualify?

Source: money Advice Service

 Age UK has a useful explanation of the means test when paying for care. The NHS also has a guide to care and support. Health and social services in Wales are explained here and here.

No comfort there for the frugal. Anyone who has saved for their old-age hoping to pass on their property to their children, especially now that it is so difficult to get onto the property ladder, is likely to regret the fact when the profligate are rewarded.

The Commission on the Future of Health and Social Care in England (also known as the Barker Commission) was asked whether the post-war settlement, which established separate systems for health and social care, remains fit for purpose. Three problems were identified:

Problem 1: the system is unfair  Most health care (major and minor) is free at the point of use. Social care is heavily rationed and means tested. This leads to situations where people with dementia have to pay for their own care while people with cancer don’t. Both cases involve significant care needs but they get very different levels of assistance from the state. There is not equal treatment of equal needs.

Problem 2: the funding is separate  The NHS budget is ring-fenced, comes mostly from national taxation and must be spent on health. Publicly funded social care is paid for by local authorities through a mixture of central government grant, council tax and user charges. Levels of spending vary across the country. Deciding who pays for what is a constant source of friction which can impact on people who are caught between the two systems.

Problem 3: the system is not co-ordinated  The organisations that commission health and social care - 211 clinical commissioning groups for hospital care, emergency care, community care and mental health; 152 local authorities for social care; and NHS England for primary and specialist care - are not aligned. This creates inefficiencies with financial and human costs. For example, 3,000 beds a day are occupied by people who are fit to leave but are stuck in hospital while funding or assessment is resolved.

The current system is unfair, unjust and unsustainable. Bed-blocking up by 52 per cent in three years, NHS figures show. For example, Patients in England experienced some 177,000 days-worth of delays paffecting more than 5,900 beds a day in April 2027. "The problem was projected to cost the NHS £169m directly for the 2016-17 financial year, but the National Audit Office believes the overall related cost may reach some £820m annually, according to David Hare, the chief executive of NHS Partners Network."

Last January, YouGov research showed 53 per cent of people supported the idea of a 1p-in-the-pound rise in National Insurance, from 12 to 13 per cent, if it was used to fund healthcare, while 26 per cent opposed it—down from 37 per cent in 2014.

The Illustrated summary of the Barker Commission's final report posed the question 'How can we afford it?' giving examples of how almost £6 billion could be saved and suggesting a review of taxes on wealth and consider reforms to inheritance tax, wealth transfer tax, capital gains, property tax, etc.

They conclude, "Overall, the government should assume that public spending on health and social care will increase from 9.6% to 11–12% by 2025. The commission believes that in the long run this is affordable and sustainable" pointing out that it "sounds like a lot of extra money but it’s still less than other similar countries spend on health care alone."

Source: King's Fund

A report in the Telegraph shows that "the growing NHS crisis has been fuelled by the closure of almost 1,000 care homes housing more than 30,000 pensioners."

It comes as NHS figures show the worst Accident & Emergency crisis on record, amid a 37 per cent rise in the numbers stuck in hospital for want of social care, since 2010. Experts said hospitals were being overwhelmed by the spread of flu because they had almost no spare capacity to cope with surges in demand.

The report by industry analysts shows that in the last decade, 929 care homes housing 31,201 pensioners have closed, at a time when the population is ageing rapidly. The research from LaingBuisson show care homes going out of business at an ever increasing rate, with 224 care homes closed between March 2016 and March 2017, amounting to more than 2,000 beds."

For far too long Local Authorities have regarded care providers as charities resulting in business closures or demeaning 15 Min home care visits.

It is over twenty years since Tony Blair told the Labour Party conference in 1997 “I don’t want [our children] brought up in a country where the only way pensioners can get long-term care is by selling their home".

We can't wait another twenty years. Action to integrate health and social care is needed urgently, free at the point of delivery, raising revenue as necessary to assure equity. It could even be a vote winner.

Postscript [16.01.2018]

Revolution in health and social care urged in Wales

Nine leading international experts, chaired by the former chief medical officer for Wales Dr Ruth Hussey, have been looking at ways to try to put the health and social care system on a stronger footing. Ministers say a new plan will take into account the review's recommendations.

Without "significantly accelerated" change, services which are already not fit for the future, will further decline, the expert panel warns.

The NHS and social care will be expected to work "seamlessly" together to respond to a person's needs and to deliver care closer to home.


  1. Profligacy unlimited13 January 2018 at 23:01

    Tony Blair was full of bullshit 20 years ago and is still full of bullshit today.
    Theresa May has allegedly agreed to pay the EU £50 million to buy Brexit.
    The UK is spending almost £14 billion on foreign aid.
    Meanwhile we continue to pay billions on PFI schemes hatched by Blair/Brown and £40+ billions more on interest on government borrowing.
    Spotted the problem yet?

    1. Regret to say that sometimes Foreign Aid funds are misappropriated on arrival with some corrpupt governments. It would be much more sensible to fund and assist only at the time of emergencies and disasters . Then I bet we were have a bit more available for our own in distress.

  2. Pondering Pastor: Social Care is just as bad in Wales. As a devolved area, the WAG are making just as much a hash of it!
    If it was not for third sector organisations, including the Churches, social care would have sunk.
    NHS most of the newish local hospitals are nothing more than hotels. Take Ebbw Vale, five hospitals closed, to merge to one; no theatre suite, no AnE, 3 wards one closed due to cuts.
    The Church sadly does not speak loudly enough on social justice. Bias to the Poor, the CofE report decades ago heralded this future, what are we doing?
    Churches have as much a duty of care,to speak out,why the silence? The former AB, much as he is negatively discussed, did at least make statements, some not so hot, but at least he did.
    If each diocese directed a programme of not tolerating poor care,acting, speaking etc etc then we might find the crachan of Wales actually listening.

  3. In fairness to our Christian"leaders" they ARE very busy promoting matters of sex and sexuality AND wiping out Anglo-Catholics. We can't expect care for the poor, healing the sick and preaching the gospel at the same time.