Editorial Comment:

One of the great challenges posed by an ageing population is to ensure that both medical treatment and social care are available when needed. Too often, older people who could be looked after in their own homes languish in hospital because there is nowhere for them to go or no one to look after them. Not only does this take up beds that others will need, it is dangerous.

As Stephen Powis writes on the opposite page, a person over 80 who spends 10 days in hospital ages 10 years in terms of lost muscle mass. So getting them out as quickly as possible is essential, but that requires much more co-ordination between the relevant services. Much of the pressure on the NHS could be relieved if the system for getting patients back into their homes could be improved. Integrating health and social care is the key.

This was acknowledged in the Cabinet reshuffle in January when Jeremy Hunt had the title Social Care Minister added to his health portfolio. He recently set out seven principles that will underpin a policy paper on social care reform to be published this year. These include commitments to high-quality care delivered by highly trained staff, backed by access to all-round health treatment.

In the past 20 years, there have been five green or white papers, umpteen policy proposals and four independent reviews into social care. Yet hardly anything has changed, and many families still find it hard to access the care they want, while staff struggle with fragmented services coming under unprecedented pressure.

Prof Powis rightly says that, as the 70th anniversary of the NHS approaches, it is time to stop papering over the cracks and fix them. But this also requires a serious look at the way the whole system is funded. Arguments remain over whether the contributions people make to their own care should be capped, which could open up an insurance market, since companies would take on the risk.

It is likely that older people who carry on working past the state pension age will have to continue paying national insurance contributions. But thought also needs to be given to how additional money can be raised for the NHS beyond the call on the taxpayer.

A truly integrated health and social care system is essential. But we need to work out how to pay for it.