Will the ever-rising cost of care spell the end of our cherished ?

AS an oldie I am naturally interested in health care and the future of the NHS. The good news is we’re all living 13 years longer than we did in 1948. But age-related illness is increasing.

Associated levels of ill-health for the average 65-year-old costs the NHS 2.5 times more than for an average 30-year-old, and someone of my age costs more than seven times as much. Inevitably, as the number of older people continues to rise so will the cost to the NHS.

Whether you are a service user or a service provider, the issue of adult social care provision has become a topic for concern. Independent reports show there are at least 10,000 assessed people in England waiting more than six months for care services. Much of the problem relates to recruitment and retention in an employment market benefitting from low-levels of unemployment, and increasing costs for service and practitioners.

Implementing its NHS Long Term Plan, the Government has settled £5.4 billion of revenue support to adult social care reform in England over the next three years. Of this, £1.7 billion will be used for a wider reform of adult social care.

As it stands, average home care costs between £17 and £30 per hour for each visit. The average cost of residential care ranges between £600 and £1,200 per week. If you have more than £23,250 in savings you will be expected to pay for care yourself. However, next year an £86,000 cap will be introduced on the amount anyone will need to spend on their personal care over their lifetime. Imagine the hole that would make in fallback reserves for you or your dependents.

There’s little doubt that the cost of social care is rising to such a degree that it is becoming so stretched as to be unmanageable. It’s worth a glance at history to make comparisons.

Before the foundation of the NHS in 1948, identified health needs and social care was paid through mutual and friendly societies. The reforming legislation included the establishment of residential accommodation for persons ‘who by reason of age, infirmity or any other circumstances are in need of care and attention’. This saw an upsurge of communal inmate institutional buildings.

Crusades against big institutions in the 1950s and 1960s aimed towards more community involvement, resulting in building publicfunded local authority care homes. But such advances were heavy on council budgets.

The big change came with the Community

Care Act 1990 making local authorities responsible for the assessment of need and good case management while promoting an independent sector for delivery to

‘secure better value for taxpayers’ money’.

This is as it stands.

Funding was complex as costs swelled.

Since 1948 the

NHS budget has increased steadily from £30 billion but rocketing from the 1990s to the current estimates of £160 billion. Today some 30p out of every £1 spent on public services goes on health. There is a suspicion that moves to privatise the NHS are already taking place.

GPS are in many ways independent small businesses contracted to provide NHS services. Many dental practitioners already operate for private patients only.

There is also a growing thought that specific services and routine treatments, like hip and knee replacements, is an area for privatisation. But the overwhelming majority of care provision remains delivered by the state and stateemployed staff.

In an age where core financial crises have become a regular phenomenon, many stakeholders believe the cost of overall reform won’t rectify the main unresolved problems. Struggling to address this is a problem for home care.

My thoughts are that investment here is so far behind that whatever is pledged is bound to be used in the process of catching up.

So, are we in danger of losing the much loved and proudly cherished NHS altogether? Evidence hovers realistically. Underpaid, overworked, staff. A&ES overwhelmed. Cancer care and serious illness targets are way off being met. It’s all very worrying.