Britain needs to have a serious conversation about the NHS

Published by the Financial Times (17th December, 2016)

It is rare that I agree with Jeremy Corbyn, especially in his outmoded approach to public services. Yet few could argue when he accused the government last week of ‘passing the buck, dodging the blame and handing the bill to those who can least afford it’ in its shoddy response to the social care crisis engulfing the country.

The situation is already depressing. For reasons of short-term political expediency, the coalition government heaped spending cuts on local authorities at more than twice the rate of cuts imposed on Whitehalll, ensuring councils took the bulk of the blame for crumbling services. Now more than half local authority spending goes on social care for adults and children. Yet as society rapidly ages and medicine advances, the number of old people getting help has fallen more than one quarter since 2010.

Acceptance of a problem is the first step towards treatment, so be grateful at least for the consensus that Britain faces a social care crisis. There is still, though, a silly worship of the health service as sacrosanct — which stymies serious discussion on how to salvage an often-shoddy service — while the linked social care system has been largely ignored. They are entwined on so many levels. Just look at the effect on hospitals of people unable to be moved into residential centres or cared for in their homes.

The artificial divide between health and social care must end. It makes no sense to ringfence health spending while slashing social care. The nation then needs to have a serious discussion over costs and provision of health and social care, rather than politicians professing undying devotion to the NHS while the public hisses at the slightest talk of privatisation. A system created to tackle infant mortality and industrial disease must adapt faster to a world in which most cash goes on old and disabled people with complex, sometimes intractable, conditions.

It is impossible to have low taxes, high spending and perfect public services, so such a pretence must end. One solution might be a dedicated tax covering all aspects of care, visible in pay packets and so provoking more realistic debate. This might result in more money being raised. It would certainly lead to more discussion over costs, funding and the nature of available services — and may even prompt a focus on how vulnerable people so often end up mistreated in both health and care services.

But it is not just about money. We should not forget that when the Blair government pumped extra cash into the NHS much of it ended up in the pockets of public servants rather than boosting services. Even now, serious inefficiencies remain across both health and social services, worsened by the passive nature of too many patients and a hostility to change that permeates state sectors.

Too much of the care debate focuses on the middle classes and their desire to protect inheritances. The more fundamental issue is how to help those unable to fend for themselves. Homes relying on people who pay their own way are doing fine, charging almost £1,000 more a month than those who depend on councils to pay bills. Some homes now refuse to take state-funded clients. Social care spending under the coalition rose in richer areas but declined in poorer regions — and this inequality will be intensified by relying on regressive council tax.

There should be more soul-searching over the nature of state provision. We should trust people more, rather than wrap every service in stifling red tape and place a relentless focus on ticking boxes. One Midlands care homeowner showed me more than 100 protocols his team must prepare, covering everything from bribery to turning on the television. Yes, we need strong regulation but ultimately care relies on human beings.

Perhaps a helpful way forward would be wider use of personalised packages to reduce bureaucracy, together with a greater acceptance that families tend to be best placed to determine needs. But at the heart of this crisis is a question of basic humanity. The UK has stumbled into a situation in which a wealthy nation has abandoned some of its people most in need of support. Old folks are left in lonely isolation, families failed by the state and people with disabilities trapped without essential help. There is cruel irony when we even talk of social care in such circumstances.

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