We must end the social care vs NHS funding tug of war
4 min read
No government in the last 30 years has managed to achieve the scale of change that is needed to reform social care.
It is frustrating, but hardly surprising perhaps, that in the October Budget the Chancellor announced £26bn for the NHS and just £600m for social care; without serious reform, social care will remain the poorer relation to healthcare.
It is also frustrating that Baroness Casey’s social care review will not report until 2028 – Sir Andrew Dilnot managed to publish his report in just one year. Dilnot himself has said there is no justification for taking this long, and Baroness Casey is well capable of reporting sooner.
He said: “It is really a matter of political courage and political decision-making.” I wholeheartedly agree.
The Health Secretary Wes Streeting is at least making the right noises. I believe the government will have cross-party support if it comes forward with genuine proposals to tackle social care, one of the biggest challenges of our times, in the first half of this Parliament.
The care too many people receive is simply not good enough. With an ageing population and a decline in the proportion of working-age people, the situation will only get worse if this government continues to delay and prevaricate, which it looks like it is tempted to do.
The situation will only get worse if this government continues to delay and prevaricate, which it looks like it is tempted to do
The Health and Social Care Committee, of which I am a member, has wasted no time in initiating an enquiry into the cost of inaction in social care. As part of the enquiry, the committee visited my constituency on the Isle of Wight where we have an older population that reflects where the rest of the UK will be in about 20 years’ time. We have the highest per capita spend on adult social care for any local authority in the country, but a smaller tax base to pay for it. The country will have a smaller working age tax base to pay for social care in 20 years’ time too.
It is of course right that our cherished NHS grabs the limelight, but it need not be at the expense of social care.
NHS reform must reduce unnecessary hospital admissions and the length of unavoidable stays by better supporting people in their own homes. Community services can make all the difference, supporting people in their own homes and unpaid family carers. But the NHS and local authorities have to come together to ensure that these services are actually commissioned and properly funded long term. So long as the NHS sees it as a social care problem, and local authorities (often the lesser funded of the two) see it as a hospital problem, nothing will change and vulnerable, often older, people will lose out.
Improving social care support and early intervention will help “compress” ill health. As professor Chris Whitty, the chief medical officer, explained in his annual report on health in an ageing society 2023, it is not inevitable that as the population grows older, the time spent in ill-health will inevitably rise. If we can shorten the time someone spends in ill health towards the end of their life, it is possible to live longer but also more independently and healthily.
All of this can help reduce the amount of money we spend on acute hospital care which can then be redirected to the community, including to social care. But all the government’s tax and policy decisions must be in line with this aim. That is why the decision to increase NICs on employers but exempt the NHS was so retrograde. By taxing social care providers (be they charities or businesses), hospices, GPs and the third sector, while exempting the providers of acute hospital care (the NHS), the government disincentivised the very thing it says it is trying to achieve – better care and support outside hospitals.
I took it up directly with the Health Secretary at committee just before Christmas. Let’s hope he listens. He can start by telling the Chancellor.
Joe Robertson, Conservative MP for Isle of Wight East
