Professional Comment

A National Care Service – Time for Debate Is Over Says Industry Leader

Independent Care Group chair Mike Padgham writes exclusively for The Carer

The time for debate and discussion is done – we need a National Care Service and we need one now.
The simple fact is, the current system isn’t working and we need a bold, fresh approach to get care to the people who need it.

Politicians have been dancing around the creation of an NCS for many years but none have been brave enough to tackle it.

Let me straight away be clear that in talking about an NCS, I am not meaning a nationalised social care service, the idea of which terrifies many MPs on both sides of the political divide.

No, I am talking about a unified care service – bringing NHS care and social care under one roof to provide proper, cradle-to-the-grave healthcare for the country.

And my view is that such a National Care Service is both vital and inevitable.

Social Care Minister Helen Whately poured cold water on the idea of such radical change in a speech to ADASS recently and claimed that the Government was making progress in social care reform. She pointed to the introduction of the care workforce pathway, extra support for unpaid carers and investment in the Adult Social Care Technology Fund as recent examples.

In reality, these are tiny, tinkering measures that, though welcome, do little to shore up the crumbling fabric of the social care sector.

And promises of more change to come ring hollow as the Government has had 14 years to bring forward improvements to social care and, despite endless promises, has failed to deliver. Previous administrations – Conservative and Labour – have all failed the sector too. We have had endless reports, commissions and suggestions telling us what needs to change but we need to see some action.

Some 1.6m people can’t get the care they need and more and more care providers are struggling to survive, not least because the sector is short of 152,000 staff.

Why can’t politicians see that the current system is no longer fit for purpose, and no longer meets the demands of an ageing population with ever more complex care needs?

It doesn’t make sense to keep ploughing money into the NHS but not support social care. All you get is bottlenecks, with people stuck in hospital because there are fewer and fewer social care packages available to look after them. Reported figures suggest the number of people unable to be discharged from hospital is 15% higher than before COVID-19. Some estimates put the number at around 14,000 people – one in seven – well enough to be discharged.

We have to switch resources from the NHS into social care so that we can both look after people when they are discharged – freeing up the bottlenecks – and invest more in preventative care so that people don’t end up in hospital in the first place. Money switched into social care saves money for the NHS in the long run so it isn’t a case of finding billions in new investment.

To a certain extent, many of the current ills are self-inflicted. Local authorities didn’t pay a fair price for care when the economic climate was better and so they are now facing the repercussions because that lack of proper funding has left social care provision on its knees.

The NHS was set up in 1948 when life expectancy was shorter and nobody envisaged a need to care for people with such complex needs and without family support available.

We have to move forward and take the type of quantum leap that Aneurin Bevan and his contemporaries took in 1948. It was radical then and faced opposition but where would we be without the NHS today?

We need another politician or political party to take a similar leap today and bring social care – a service that has grown and developed piecemeal over the last 35 years – properly into the fold, with its workforce respected and paid the same as their NHS counterparts.

If the country isn’t quite ready to bring social care and NHS care together just yet, then we certainly need to reform the social care element soon so that it is ready for such a merger in the future.

That means giving social care a national framework but with local input into delivery, as the NHS works currently. Amongst our Five Pillars for Social Care Reform, the Independent Care Group suggests ring-fencing a percentage of GDP for care, setting a minimum carer wage and creating fair tariffs for services such as care beds and homecare visits. Those three actions would be an integral part of the creation of the social care portion of the new National Care Service.

Why not look at a model of social care delivery like that currently adopted by GPs in which social care providers provide services to their local communities under contract to the NHS and Independent Care Boards? That contract arrangement would provide the security they need to invest.

Nationalising social care does not strike me as the solution. Whatever your thoughts on nationalisation as a concept, it would be hugely expensive and massively time-consuming. As a country, we have neither the money nor the time for that kind of wholesale change.

The current mixed market approach, based on choice, can work perfectly well if it is properly managed and funded. A mix of small, medium and large care providers, working in the for-profit and not-for-profit sectors can meet current and future demand if changes are made.

But change is the key. The status quo is not an option. Politicians must be brave and accept that things cannot go on as they are, or the situation is just going to get worse with social care failing and dragging NHS care down with it. A complete overhaul of the way social care is managed and funded is the only way forward and whether you label that as part of the creation of a National Care Service or not, it has to happen now, or we soon will not have any social care at all.