It is now more than a year since the prime minister promised to “fix social care once and for all”.
To be fair he has faced one or two challenges since then but the need to fulfill that promise is now greater than ever. The pandemic has transformed attitudes, outlooks and ambitions in so many areas, but here it has made the unanswerable case for social care reform in England. The Commons’ Public Accounts Committee summed it up well, referring to a pandemic which had demonstrated the “tragic impact” on social care of “years of inattention, funding cuts and delayed reforms”.
The current emergency has exposed a fractured, understaffed and underfunded social care system in desperate need of reform. For some of us this call is not new, but there is now much greater public awareness of this major inadequacy in our welfare state.
Tackling it will require the government to deliver a long-term funding settlement to stabilise the current market, extend provision to many more people with serious care needs, and bring health and care services together to provide much more joined-up services.
Today Health for Care, a coalition of 15 national health organisations who have joined forces to make the case for a sustainable social care system, has called on Boris Johnson to honour his pledge. It is unusual for one part of the public sector to argue on behalf of another, but those responsible for the NHS now regard the success of social care as a precondition of success for healthcare itself.
In part, this is about widening access to appropriate care and a recognition of how it needs to be expanded to look after more people with a wider range of conditions.
It is also about making sure that the workforce crisis which afflicts social care is addressed now. There are currently more than 120,000 vacancies in England, a product of low pay, lack of opportunities for career progression, and little appreciation of what the sector does to support some of the most vulnerable in society.
There is also the failure to appreciate or support unpaid carers who, with even modest extra support from the state, would fare better and provide even more than they currently deliver. The Royal College of General Practitioners estimates that unpaid carers save the UK economy £119bn a year in care costs. But however it is calculated, more help for them is likely to pay a significant dividend.
Any future settlement must provide secure, long-term funding at a level that will enable social care services to operate effectively, which means enabling as many as possible to live as independently as possible in their own homes or at least in their communities. It will support a system that will minimise the pressure on hospitals which are great places to treat us when we are acutely ill, but are not the best places for managing long-term illnesses.
The pandemic has exposed the frailty of social care, and it has also shown how much the future of the NHS depends on well-funded, well organised health and social care services in the community. It will require radical reform, not just money, and it will need national leadership and commitment.
It is time for the prime minister to set out the steps and the timetable for this reform.
Niall Dickson is chief executive of the NHS Confederation and chair of the Health for Care coalition
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