Unhealthy service: Merging the NHS with social care will be expensive

Yet, as the population ages, it may be the best option available


Years ago, the rock group The Who had a hit with a song containing the line: “I hope I die before I get old.” That was in the 1960s, when the state pension and a welfare state that promised free care, from womb to tomb, meant that there was no need to fear the onset of old age. Taking care of the elderly was less of a problem when there were fewer of them and the relative absence of social mobility kept families together, so that the elderly had their children and grandchildren to help them out.

Now we can all expect to live longer. The Office of National Statistics has estimated that a third of the babies born in 2013 will live to be 100. A man of 65 can now reasonably expect to have 15 years left in him even if he lives in the worst social conditions to be found in Britain – longer if he comes from a prosperous suburb. Women can expect to do even better. Families have been scattered in our modern, highly mobile society, leaving hundreds of thousands of elderly people to cope on their own. Who will take care of us, if we don’t die before we are old?

A report by the Commission on the Future of Health and Social Care in England, set up by the King’s Fund and chaired by Dame Kate Barker, a former member of the Bank of England’s Monetary Policy Committee, offers an answer – but a very expensive answer. The commission proposes an end to the separation of the NHS and social care, which is currently the responsibility of local councils, paid for by a single ring-fenced budget.

The artificial divide between these two services causes many more problems than it solves, and The Independent, which has called for the pair to be merged in the past, supports a restructuring. Any transition is sure to be painful. Yet, for the many elderly people who have to pay for their social care, so is the status quo. At a time when the Government is struggling to find ways to cut public spending, the Barker Commission wants that combined budget to rise to at least 11 per cent of GDP by 2025. The implication is that this one integrated service would by then consume more than a quarter of total government spending.

As if to add to the Chancellor’s woes, the commission has also rejected charging for any NHS services that are now free. Instead, they propose an increase in National Insurance of 1p in the pound for everyone on an income above £42,000, and another for the over-40s, who make up half the population, so that the costs of social care would fall most heavily on those who stand to benefit the most.

This is radical stuff. It is a general rule of politics that the middle-aged and highly paid buy more newspapers, are more likely to vote and generally have more clout than the young and the low-paid. So while the tax rises proposed by the Barker commission would be relatively simple to implement, they could be politically lethal for any government that dared introduce them.

Another way to meet part of the cost would be to attack universal benefits. The Government has already cut child benefit for high-earners, but has not dared go for the benefits enjoyed by pensioners, such as free transport and winter-fuel allowance. There is no compelling reason why these should not also be means-tested.

One way or another, the problem of an ageing population has to be faced. We cannot pretend that it is possible to guarantee universal healthcare free at the point of use for all and security and dignity without imposing a heavy tax burden on the healthy and not-yet-old. The reluctance of politicians to face this fearsome problem is understandable, but face it they must.

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