Jeremy Corbyn, we need to talk about social care
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Version 0 of 1. Dear Jeremy Corbyn, Since your election to the Labour leadership, political commentators have been asking you hard questions about the key issues of our time. Now I want to ask you a question about social care. It could certainly benefit from the new perspective and radicalism you have brought to political discussion. Admittedly, social care has long been seen as far less than a major issue by successive governments, if you look at the priority and funding they give it. So far, it has never been seen to merit the oversight of a senior minister, let alone a member of the cabinet. Yet we know that social care’s current failure is creating chaos for the NHS and causing untold financial waste and human suffering for hundreds of thousands of older and disabled people and their families. It has a workforce at least as large as the NHS and, with changes in demographics and medical innovation, the long term community-based support it is intended to provide is becoming more important than the acute care associated with the NHS. At the same time, there is widespread agreement that its funding is chronically inadequate. Related: Life outside the public sector: what it's like to be a social care spin-out New Labour failed to address social care properly. It set up the Sutherland Commission as a manifesto commitment in 1997, which recommended free nursing and personal care – such as help with washing and dressing. But Tony Blair’s government rejected its recommendations. More recently, it was hoped the Dilnot Commission on the future funding of social care would offer a solution without making new demands on the public purse. But it became clear that the private insurance industry wasn’t stepping up to the plate. Instead, there would still be big bills for many in need. Under this government, Dilnot’s implementation looks increasingly unlikely. The Independent Living Fund was a great idea, but it did not enable equality for all, and now has been destroyed by short-term cost cutting. The integration of health and social care has been the mantra of successive governments. To achieve this, redistribution of funding, reorganisations and new local partnerships have been recommended. But none of these has addressed the fundamental problem getting in the way of the seamless collaboration of the NHS and social care. This is that they are based on fundamentally opposed principles and funding systems. Social care is the last legacy of the Victorian poor law, left almost untouched by the creation of the welfare state. It remains a means-and-needs tested service, with ever-shrinking budgets as austerity cuts are imposed on local councils. The NHS is still essentially a universalist service, free at the point of delivery, funded out of general taxation . Why would we expect such conflicting systems to work in harmony? There are increasing right-wing ideological pressures to bring the NHS more into line with social care, through more charging, more privatisation and more means and needs testing. No major political party, except the Greens, has made the case for putting social care services on the same footing as the NHS; paid for out of general taxation, free at the point of delivery. Related: The fragile care market will collapse unless councils act quickly | Paul Burstow Instead of seeing social care as a financial burden it is time it was seen, like health, as a wealth creator. Isn’t this the policy most in line with your broader values? Isn’t it actually the most cost-effective policy, despite the derision of its opponents? How else are we likely to get a truly effective, preventative social care service, with a workforce that has decent conditions of work and career opportunities, that no longer transfers inefficiencies and waste onto the NHS, creating human and economic costs? In recent years, lots of “more for less” ideas have been touted to get social care out of the mess it is in. But the evidence shows that the latest personal budgets, which put service users in charge of their own social care spending, fail to give greater control, and actually create more costs and bureaucracy. Extending such a voucher system to the NHS in the form of personal health budgets, as is now happening, undermines its universalist, needs-based principles and is unsupported by the evidence. Meanwhile, because of the inadequacy of social care support in the community, far too many people are still being institutionalised, denied the real choice of living with suitable support in their own homes. Service users and their families have long argued for social care that is properly funded and listens to what they say. The system we have now fails on both counts. Demographic change also means that the unpaid family carers that policymakers have relied on are unlikely to offer a viable alternative for ever-increasing demand. It is time to return to first principles. There is no alternative to a truly integrated health and social care system, available to all, paid for by all our taxes. This is closely consistent with the principles you highlight as underpinning your policy proposals. Disabled people, service users and our user-led organisations would be happy to help you in every way we can. Yours sincerely, Peter Beresford |