The best present you could give the NHS? End the social care crisis

Both the Conservatives and Labour have talked a good game on care reform for 25 years, but their hearts have not been in it, writes Andrew Grice. Now it the time to change that

Thursday 06 July 2023 13:08 BST
The ailing social care sector is a victim of our playground politics
The ailing social care sector is a victim of our playground politics (PA)

The best birthday present the NHS could get on its 75th anniversary today is not an injection of billions of pounds, or even the magical reforms everyone is demanding. The best thing our politicians could do for it would be to finally end the crisis in social care.

They know that if the NHS was being created today, social care would be part of it. Yet the ailing sector is a victim of our playground politics: Labour justified branding Theresa May’s reform a “dementia tax” on the grounds the Tories dubbed Andy Burnham’s national care service a “death tax” seven years earlier.

Although both the Conservatives and Labour have talked a good game on care reform for 25 years, their heart has not been in it. Jeremy Hunt admits his biggest regret as health secretary was not having a 10-year plan for social care as well as the NHS. But, as chancellor, he postponed Boris Johnson’s promised £86,000 cap on the amount an individual contributes to their care costs. That now looks dead as Labour is unlikely to resuscitate it if it wins power.

Care is always the poor relation, as ministers prefer to spend their billions on shiny new hospitals – like the 40 promised by Johnson at the 2019 election (some of which turned out to be not quite so new).

Building hospitals is more glamorous and voter-friendly than the hidden crisis behind closed doors, as social care makes do with sticking plasters. The Treasury reluctantly stumps up just enough to prevent the sector’s collapse, but there is no improvement, even though it costs NHS England £1.7bn a year to keep people in hospital who don’t need to be there.

Last year, 5,300 people who were declared fit for discharge died in hospital. A much-trumpeted £500m plan to reduce the list of 13,000 patients awaiting discharge has so far resulted in just 470 no longer being stuck.

A start has been made with the setting up of integrated care systems, but everyone working in the NHS knows reform needs to go much further.

Last week’s 15-year NHS workforce plan was welcome but predictably had little to offer care workers – to the alarm of health leaders, as The Independent revealed.

Will this deadlock ever end? I think it will if Labour wins next year’s election. The party has a blueprint up its sleeve – a national care service putting social care on an equal footing with the NHS and, crucially, boosting the pay of care workers (often on the national minimum wage) to give them parity with NHS staff over time.

This would reduce the number of carers who leave for more money in the NHS or supermarkets. (Labour’s ideas are much more serious than the potty one from the New Conservatives group of Tory MPs, who called for the scrapping of the 60,000 social care visas for foreign staff at a time when the sector has 165,000 vacancies).

Labour’s “shared brand” would see central government, local authorities and the private providers, who run most care homes, operating as a public service with new standards on care quality, the workforce and financial conduct.

The unpaid army of 2.5 million carers, who include one in five women aged 55-65, would be asked how much caring they wished to do and have a right to short breaks. The eventual goal is a guarantee of care instead of the current rationing and postcode lotteries.

The plan was drawn up by the Fabian Society think tank at the request of Wes Streeting, the shadow health secretary. This arm’s length operation gives Labour deniability – in the hope of preventing the Tories putting a multi-billion pound price tag on the plan, and saying how much taxes would have to rise to fund it.

I’m told Streeting and Liz Kendall, Labour’s spokeswoman on care, are privately backing the blueprint, which has been widely welcomed in the sector. (Kendall does not like the “national care service” label, thinking it smacks too much of “Whitehall knows best”).

In practice, would Labour really be different from previous governments? Streeting would need to win the backing of Keir Starmer and Rachel Reeves, his chancellor, if and when they inherit a fiscal straitjacket and face many competing demands by other new ministers.

However, I think Labour is serious about replacing our politicians’ obsession with hospitals with a “home first” policy in which most people would be looked after in the community or in their own home.

Tight spending constraints would mean a Starmer government could not transform care overnight. Labour’s internal target is to have a national care service by the time of the NHS’ next big birthday in five years. I suspect it might take 10 years, but at least the direction of travel would be clear.

This would not be the only example of Labour proving much more ambitious after the election than suggested by Starmer’s cautious approach before it. That’s not a secret agenda, even though the Tories will doubtless claim it is.

The public caution is deeply frustrating for shadow cabinet members, Labour backbenchers and the party’s activists. But Starmer must play within the rules of the game. As one close ally told me: “We still have to win first.”

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