Political crises come and go, but the crisis of social care has been growing for decades, and still needs a comprehensive solution. I have been trying to push it up the political agenda for years and will keep doing so, for a number of reasons.
The first is that it is simply not right for such an essential service for hundreds of thousands of vulnerable people to be constantly having to be patched up with emergency money to keep it vaguely afloat. The second is that demographic trends tell us that the pressures will only grow, as our population grows older. The third is that you cannot solve the NHS problems without a social care system that is bigger and better than the current one.
The amount of money we spend on social care clearly has to increase, and I welcome the extra money the Government has found in recent years to stave off the worst problems. But we need to go further and look at how we find this money. Simply taking more tax money from the working population will not work. I believe that a small sliver of the housing wealth that is largely in the hands of those of us who have benefitted from rising house prices would go a significant way to filling the funding gap. If we were all encouraged to take out an insurance policy to pay for care we may need in later life (perhaps paid for by a small percentage of the housing wealth) we would have peace of mind about potential care costs and know that the bulk of our inheritance would not be eaten up by those care costs.
As well as extra money we need action on four fronts. The first is the lack of capacity, meaning essentially that the workforce is too small by around 165,000 workers. To address this we need better pay, and I suggest using the same pay scales and grades as the NHS Agenda for Change scales. Too often the debate is framed as being about residential care home places, but in practice the biggest lack is of care workers who support people living in their own homes, where of course most people want to go after a hospital stay.
The second is to have a proper balance in the new Integrated Care Boards between the needs of the NHS and those of care providers. We do not need to expand the reach of the NHS or create a National Care Service. Either would be a route to even more opaque bureaucracy. But we do need better integration at a local level, not just between the NHS and Local Authorities who are the biggest customers for care providers, but for those providers as well. Everyone should have a voice at the table.
The third area for radical reform is the use of technology. It is frustrating enough that in a digital age it is still hugely difficult for patient information to pass from one part of the health and care system to another. Too often people must answer the same questions to different arms of the system which is meant to be helping them. It is even worse that we are missing opportunities to use digital technology to give people more control over their daily lives by providing them with reminders of what they need to do in terms of food and medicine. This applies not only to elderly care patients, but also the equally important group of working age people who need care.
The fourth area is in enabling people to live in their own homes for longer as they become frail. We should be building much more housing stock that enables people to receive support easily, including more retirement villages. We lag far behind other countries in this. Living at home for as long as possible is what people want and is far cheaper. I am grateful to Ministers for putting me on the new Older People’s Housing Taskforce so that I can make a difference on this key issue.
None of this is easy. But all of it is essential if we are to offer those who need social care, whether the elderly or those of working age, the proper level of dignity in their daily lives that they deserve.