Radical reform of social care is key to saving Bevan's NHS dream

This issue has always brought out the worst of the Westminster system – a desire to put point-scoring above making a real difference. But it is the most vulnerable who end up as the biggest losers. 

Andy Burnham@andyburnhammp
Wednesday 04 July 2018 13:13
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NHS at 70: A timeline of the National Health Service and its crisis

As the NHS turns 70, this is a moment to celebrate what it represents to each of us. My favourite description of the service came from its founder, Aneurin Bevan: “It’s a piece of real socialism. It’s a piece of real Christianity too.”

Here in Greater Manchester it will be an extra special anniversary.

It was Trafford’s Park Hospital (now Trafford General) that Bevan chose to visit on 5 July 1948 to stage the symbolic event of “receiving the keys”. Today, I will be there to retrace his steps and recall the words of Sylvia Diggory, the first patient to benefit from free and comprehensive medical treatment who, before she died in 2006, said: “Mr Bevan asked me if I understood the significance of the occasion and told me that it was a milestone in history – the most civilised step any country had ever taken, and a day I would remember for the rest of my life – and of course, he was right.”

Nathan Wyburn soil portrait of NHS Founder has appeared on mountainside over night

However, there is another 70th birthday this week that won’t be getting the same attention.

Social care was also born in 1948 when the National Assistance Act put a duty on local authorities to provide residential accommodation for people who need it on grounds of age or disability.

The crucial difference between the legislation that set up the NHS was that social care services would be open to charges. This created an artificial divide that still persists today between a free at the point of use healthcare system and an inequitable social care system.

It’s a system that is both unfair and random, as people face charges depending on which illness they are unlucky enough to get, and then risk losing everything they have worked for to pay for their care. So the reality is this: if you have cancer you can rely on the care of the NHS; if you get dementia, you may as well be at the mercy of the US healthcare system.

Unlike the NHS, social care is provided by a workforce which lacks stability and career progression, and is built on a culture of low pay and zero-hours contracts. It means that a young person can often earn more walking a dog, or working behind a bar, than caring for someone’s mum or dad.

Ultimately, you get what you pay for – and right now we are only paying for a low cost, budget social care service that will never deliver the standards of care we want for our loved ones.

While the NHS undoubtedly has its challenges, it is entering its seventies loved by the nation and with the promise of a new five-year funding plan. Its neglected sister, social care, has been abandoned and left to fend for herself.

As our population ages, and as more people live longer with multiple, complex conditions, the neglect of social care is becoming increasingly unsustainable. If left to collapse, it will drag the NHS down with it.

A&E departments are seeing increasing numbers of older people arriving not because they have a medical emergency, but because they aren’t receiving the care and support they need to remain independent at home. And once they are in hospital, it becomes increasingly difficult to discharge them because the right care packages aren’t in place.

I have the scars of trying to reform social care in parliament, during the last Labour government. This issue has sadly always brought out the worst of the Westminster system – a desire to put point-scoring above making a real difference. But it is the most vulnerable who end up as the biggest losers.

Since the cross-party talks which I agreed to in 2009 went down in flames, I shudder to think of how many family homes have been sold and how many people have gone without the care they need.

Over the last 20 years, there have been numerous green papers, white papers, consultations and independent commissions. All of them reach a similar conclusion – that a bold funding reform is needed – and all of them get kicked into the long grass.

The present government’s latest green paper has now been delayed at least until the autumn, but it is likely that it will still work on the principle that people will have to pay upfront for care.

That will not provide an answer. As long as that is the approach, the health and care systems will never be able to integrate because of their conflicting funding systems.

The best 70th birthday present that the National Health Service could receive is a commitment from all political parties to a radical reform of social care that fully aligns it with the NHS funding principle. A system where everyone contributes and everyone is covered.

This, and only this, would allow us to build a National Health Service that is able to support people with dementia as well as it currently treats cancer. Only that will truly update Bevan’s dream for the 21st century.

Andy Burnham is mayor of Greater Manchester and was secretary of state for health from 2009-10

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