Put fairness at the heart of care reform
I DO not think there is any doubt at all that funding is needed for social care. We cannot carry on trying to get this sorted out on an as-and-when basis every year.
We need a long-term solution that people, and particularly the local councils that have to deliver the services, can rely on. Politicians are often good at identifying what needs to be done, but not very good at saying how it should be done.
There are clearly demographic issues that are pushing costs upwards with regard to not merely the elderly, but people of working age with disabilities – there are demographics in both. We also have to accept that if we broaden the scope of people who get care, including people who have moderate needs, that will mean prevention and taking people out of the National Health Service. That is one way in which we can join up the two services very effectively.
We then have to look at quality. We all know of examples of quality failing at present. We know that the workforce are often on zero-hours contracts and the minimum wage – the same wage someone working on a supermarket checkout can get.
We need to look at the long-term stability of the workforce, as well as their pay and conditions. We need to consider the viability of care providers, which are often giving contracts back or going out of business. All those issues require money.
That is why, in the end, I have to say that although I very much support the long-term principle of care that is free at the point of delivery according to need, all the issues that I listed immediately need extra funding. It will therefore perhaps be some time before we can move to that free care system, but we can deal with clinical needs much earlier.
We can ensure that any money that is raised, whether through the National Insurance funding model or the German model, is earmarked so that people can see that if they have paid extra, it goes towards social care.
It is also about fairness and pooling risk, so that if everyone who can afford it pays a bit of inheritance tax, no one needs to find that the vast majority of their assets, including their home, has to go towards paying for their care.
That really upsets people – it is the lottery of life, is it not? If someone has dementia and ends up in care for a long period of time, their home simply goes to pay for that. Most people feel that is really unfair, so if everybody pays a bit when they can afford it, no one would risk losing everything in the way that they do under the current system.
Integration is a really important issue. Health and social care need bringing together, as do housing services – most people who receive social care do so in their home.
This week I was pleased to go on a 10mile walk, raising funds for the Sheffield Hospitals Charity – that perhaps says something in itself. I went with my own excellent consultants, Professor John Snowden and Dr Andy Chantry, together with their team from the haematology department at the Royal Hallamshire Hospital in Sheffield, who have given me such excellent care and treatment for multiple myeloma over the last year.
I thank them all very much for that. There is a little secret that I have to let out though: John Snowden and Andy Chantry did a 50-mile walk over two days, and I just came on the last 10 miles of it.
The commitment that they showed with members of their team demonstrates and is symptomatic of the approach that so many of our NHS staff have to the job they have to do – a job that we rely on them so much for.