Hasnain Khan makes the case for a National Care Service.
The Adult Social Care System should show dignity and respect to those who have worked tirelessly and contributed to our society. However, for 10 years governments have stripped away the liberties of our elderly population. Our current system is not fit for purpose for our growing elderly population.
The newly proposed social care system by the Department of Health and Social Care’s 'Integration and Innovation' White Paper, rightfully promotes communication between hospital and community care. However, it still fails to protect the day-to-day operational independence of the NHS. The history of the NHS is littered with reform plans, with successes only seen when we take steps away from a top-down command structure. With some pensioners forced to sell their homes, a new proposal needs to effectively address the disjointed system and give our elderly population the virtue they deserve.
Lack of Funding
Over £700 million from the social care budget has been cut since the final year of the Labour government in 2010. However, it has been clear that these measures introduced have had knock-on effects on NHS services. Cuts in social care have significantly increased the use of A&E services. Due to a reduction in the quality and quantity of social care, 2015/16 saw an additional 4 people aged over 65 visit A&E once a year from 23 in every 100 people aged 65 in 2009/10. This put further pressure on hospitals to meet waiting time targets, and these were patients who could have received care from alternative services.1
Quality of Care
Public concern stretches beyond funding to the quality of care. Neil Heslop, CEO Leonard Cheshire Disability Charity highlighted his frustration that ‘disabled and older people are still having to endure the indignity and disrespect of receiving flying personal care visits, … 15 minutes is nowhere near enough to do these essential tasks if you need support.’ Currently, the Care Quality Commission Quality (CQC) monitor the quality of social care homes. However, with private ownership of the majority of care home beds (83.6%), there has been no clear leadership to adapt and develop social care policy to meet the needs of our changing society.2
Adult social care services are too fragmented, leading to greater incidences of abuse and neglect. Efforts to join the two systems have been difficult with an NHS, free at the point of need, and yet a means-tested social care system. Lack of coordination has led to poorer outcomes and greater inefficiency.2
National Care Service - Quality driven, Run by the Devolved Authorities
The Labour Party should champion a system that looks to promote the values established by Clement Attlee in 1948, of a National Care System providing healthcare free at the point of need.
Integrated System
There must be a combined budget for the NHS and social care funding at both a national and local level. Whilst this policy change does not provide assurances for social care funding, systemic changes are required to provide better quality continuity of adult care.
Nationalisation would be a heavy taxation burden on the British public with 381,524 of the 456,546 care home beds owned by private companies. Similar to the NHS, commission of service use of social care homes should be run by the well-established 84 NHS Foundation Trusts. Based on reviews from the CQC, Foundation Trusts should provide services to care homes based on quality, not by price. This creates a market where care homes are driven to provide better quality care in order to compete, and for our over 65-year-old community to receive care based on needs, rather than where you live.3
An integrated approach with NHS Foundation Trusts, which have established one of the best healthcare systems in the world, would drive standards and address financial inefficiencies of a separated system. The Local Government Association predicted an integrated system could reduce social care funding by as much as 7-10% or £1 billion a year.3
Free Personal Care
People have the right to healthcare and that must be extended to adult social care. Evidence from our devolved nations of the UK shows that investment in aspects of social care, free at the point of need, has been achieved. Since 2002, Scotland has operated this needs-tested model for people aged over 65. Domiciliary care is provided for free. People who require care in a residential setting receive a flat rate from local government and an additional amount of money invested if nursing care is required. We have seen the recent boom of investment to protect workers from the Government 'furlough scheme'. It shows that the Government can choose to invest in the people if they want.
The lack of concern to address the social care crisis has been damaging to the British people. Whilst the proposed changes by the Department of Health are welcomed, they do not go far enough. In the future, there poses a risk for the exploitation by private companies to manage the integrated services and communication between hospital and community care. Under the current system, social care is not completely free to all. Integration of services raises concerns on what healthcare will still be covered under the National Health Service. People are looking for another answer and I look for local and national government to use these policy principles to deal with the social care crisis at its core.
References:
- https://www.bbc.co.uk/news/health-48690733
- https://www.kingsfund.org.uk/publications/whats-your-problem-social-care
- Bennett L, Bottery S, Murray R, et al. Approaches to social care funding. Kings Fund: Health Foundation. 2018. (cited 28th June 2020).
Hasnain is a medical student at the University of Sheffield. He was the president of the Sheffield MedSoc 2020-21, the largest society at the university, representing approximately 1,500 medical students. He led a South Yorkshire Covid-19 medical student volunteer scheme where over 200 students volunteered in hospitals, GPs, hospices and babysitting services for NHS staff across the region. He is the vice-chair of the Yorkshire Socialists Health Association, running ‘Rethink Healthcare’ policy workshops to shape regional and national health policy.
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