Merging social care services with the NHS makes sense

And anyone who is really in the business of serving the public will agree

Share

Maybe it’s the sort of conversation that you have when you reach a certain age. But I’ve lost count of those who tell me, often after losing an elderly relative, that there has to be something better than the desperate and humiliating mess that passes for our care system.

To those who have seen it at its worst, even Jeremy Paxman’s much-criticised euthanasia clinics on street corners don’t seem so bad. The number of those making living wills in the hope of ending their days with dignity has risen exponentially. Assisted dying may have been rejected by the courts and by the House of Lords, but popular pressure only grows. For some, a one-way trip to Zurich looks an ever more attractive option.

By and large, though, it is not the last days, even weeks, of utter dependency that concern us. With any luck, we’ll be high enough on morphine not to notice. It is the months and years before, when, with the right sort of accommodation and some help, we would have a good chance of coping, even enjoying life. But that housing and that help is just not there. Or if it is, it is so difficult to find and obtaining it so hedged about with restrictions that it is simpler just to soldier on. Those who do receive help from the state – real help, of the sort they need, when they need it – seem to the rest of us to have won life’s lottery.

This sense of trepidation about future care needs and the glaring contradiction, so it seems, between health care (free at the point of need) and social care (anything but) is addressed in two reports out this week. The timing is not coincidental. One aim is to catch the attention of politicians as they go into the last conference season before the election. But will they have any effect?

Dame Kate Barker’s commission, which reported yesterday at the King’s Fund, recommends – among other things – fusing the health (NHS) and social care (local authority) systems, so that people are not passed eternally between the two as each tries to avoid paying. It suggests an extra penny on national insurance for the over-40s to help pay for this joined-up service, plus means-testing of such benefits as free TV licences and fuel allowances. It was the “cuts”, alas, not the benefits, that captured the headlines.

Read more:
Unhealthy service: Merging the NHS with social care will be expensive  
Raise taxes to give free social care to elderly and chronically ill, think-tank says

The previous day, the left-leaning think-tank Demos had published the findings of its Residential Care Commission. Chaired by the former care services minister,  Paul Burstow, it suggested, among other things, that hospitals use spare land (yes, they do have some) to build sheltered housing and care homes. It also wants private companies to build more retirement developments so as to tempt people out of the houses that are so badly needed by families. What is on offer at present, the report said, is simply not good enough to persuade people to move. Indeed.

My own view is that pretty much all of this makes sense, and pretty much all of it should be feasible – except, perhaps, for the one change on which most of the rest depends: the fusion of health and social care.

As Health Secretary, Jeremy Hunt has made a start, by diverting a small sum from the NHS to a social care fund, but this is tinkering. The two services really have to be brought together, not primarily for the savings that might result, but for the sake of the confused and abysmally served public. It’s not easy, though: the two sectors have resisted such calls before, and they will fight tooth and nail to defend their separate hierarchies and separate budgets.

In the last Budget, George Osborne shocked the insurance world by summarily abolishing their nice little earner, the compulsory annuity people had to buy with their private pension pot. I was amazed he had the authority, let alone the guts, to do something that would so obviously affect their bottom line.

Something similarly bold will be needed here. Of course, NHS staff will say the service can bear no more reorganisation; the social care establishment will warn of destitute 90-year-olds wandering the streets. But if these people are really in the business of serving the public, rather than themselves, they will knuckle down and get on with it.

Trierweiler should tell a little less

Granted that Paris Match, like any magazine buying book rights, will have chosen the most salacious morsels, and granted that Valérie Trierweiler had a difficult time of it as the first unmarried partner of a French president to reside at the Elysée – still, I feel that she has not done either herself or womankind many favours with her angry and self-pitying account of their break-up.

Thank You for the Moment, as her book is called, may be a novelty for the French, whose privacy laws protect public figures from prying eyes. But I doubt it will damage her ex any more than he has already been. After all, he left the mother of his four children to join Trierweiler, and the tales of his nocturnal motorcycling antics made him a national (and international) joke. “Discretion” used to be considered a virtue in France. I rather hope that, after Trierweiler’s outpourings, it might stage a speedy comeback.

Not fit for a king... or anyone else

Even if he never does anything else, Prince Charles has already left an honourable legacy in his description of a projected new wing for the National Gallery as a “monstrous carbuncle on the face of a much-loved friend”. The Carbuncle Cup, awarded in an online competition run by Building Design magazine, identified a true horror this year in Woolwich Central – a massive outcrop that combines the worst of 1960s council estates with clumsy, faux-modernist adornment. The judges described it as “oppressive, defensive, arrogant and inept”.

I was also gratified that Broadway Malyan’s Vauxhall Tower – which dominates the view from our kitchen window and resembles an out-of-proportion glass candle with a clichéd wedding-cake top – was the runner-up. It has only two saving graces: it’s so tall that it’s periodically lost in fog and it makes the still uglier (and already ageing) riverside ensemble beside it look a bit smaller than it is.

 It turns out, though, that one of this year’s most-nominated  buildings was eliminated as it’s not quite finished. The so-called “Walkie Talkie”, in the City of London, is an absolute shocker that eclipses both Woolwich Central and the Vauxhall Tower in its leering awfulness. “Carbuncle” would be letting it off lightly.

React Now

  • Get to the point
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
iJobs Job Widget
iJobs General

Recruitment Genius: Junior Web Designer - Client Liaison

£6 per hour: Recruitment Genius: This is an exciting opportunity to join a gro...

Recruitment Genius: Service Delivery Manager

Negotiable: Recruitment Genius: A Service Delivery Manager is required to join...

Recruitment Genius: Massage Therapist / Sports Therapist

£12000 - £24000 per annum: Recruitment Genius: A opportunity has arisen for a ...

Ashdown Group: Practice Accountant - Bournemouth - £38,000

£32000 - £38000 per annum: Ashdown Group: A successful accountancy practice in...

Day In a Page

Read Next
 

Etch, a Sketch

Jane Merrick
 

Something wrong with the Conservative Party’s game plan

John Rentoul
Election 2015: How many of the Government's coalition agreement promises have been kept?

Promises, promises

But how many coalition agreement pledges have been kept?
The Gaza fisherman who built his own reef - and was shot dead there by an Israeli gunboat

The death of a Gaza fisherman

He built his own reef, and was fatally shot there by an Israeli gunboat
Saudi Arabia's airstrikes in Yemen are fuelling the Gulf's fire

Saudi airstrikes are fuelling the Gulf's fire

Arab intervention in Yemen risks entrenching Sunni-Shia divide and handing a victory to Isis, says Patrick Cockburn
Zayn Malik's departure from One Direction shows the perils of fame in the age of social media

The only direction Zayn could go

We wince at the anguish of One Direction's fans, but Malik's departure shows the perils of fame in the age of social media
Young Magician of the Year 2015: Meet the schoolgirl from Newcastle who has her heart set on being the competition's first female winner

Spells like teen spirit

A 16-year-old from Newcastle has set her heart on being the first female to win Young Magician of the Year. Jonathan Owen meets her
Jonathan Anderson: If fashion is a cycle, this young man knows just how to ride it

If fashion is a cycle, this young man knows just how to ride it

British designer Jonathan Anderson is putting his stamp on venerable house Loewe
Number plates scheme could provide a licence to offend in the land of the free

Licence to offend in the land of the free

Cash-strapped states have hit on a way of making money out of drivers that may be in collision with the First Amendment, says Rupert Cornwell
From farm to fork: Meet the Cornish fishermen, vegetable-growers and butchers causing a stir in London's top restaurants

From farm to fork in Cornwall

One man is bringing together Cornwall's most accomplished growers, fishermen and butchers with London's best chefs to put the finest, freshest produce on the plates of some of the country’s best restaurants
Robert Parker interview: The world's top wine critic on tasting 10,000 bottles a year, absurd drinking notes and New World wannabes

Robert Parker interview

The world's top wine critic on tasting 10,000 bottles a year, absurd drinking notes and New World wannabes
Don't believe the stereotype - or should you?

Don't believe the stereotype - or should you?

We exaggerate regional traits and turn them into jokes - and those on the receiving end are in on it too, says DJ Taylor
How to make your own Easter egg: Willie Harcourt-Cooze shares his chocolate recipes

How to make your own Easter egg

Willie Harcourt-Cooze talks about his love affair with 'cacao' - and creates an Easter egg especially for The Independent on Sunday
Bill Granger recipes: Our chef declares barbecue season open with his twist on a tradtional Easter Sunday lamb lunch

Bill Granger's twist on Easter Sunday lunch

Next weekend, our chef plans to return to his Aussie roots by firing up the barbecue
Joe Marler: 'It's the way I think the game should be played'

Joe Marler: 'It's the way I think the game should be played'

The England prop relives the highs and lows of last Saturday's remarkable afternoon of Six Nations rugby
Cricket World Cup 2015: Has the success of the tournament spelt the end for Test matches?

Cricket World Cup 2015

Has the success of the tournament spelt the end for Test matches?
The Last Word: Justin Gatlin knows the price of everything, the value of nothing

Michael Calvin's Last Word

Justin Gatlin knows the price of everything, the value of nothing