The future of social care

5 March 2015

Social care is on track for a £7 billion shortfall by 2020, proportionally even greater than the £30 billion funding gap projected for the NHS.

Integrated or co-ordinated care has been the holy grail of health and care for decades and is lauded as the answer. It is absolutely the only way forward, and the Better Care Fund’s spontaneous expansion from the £3.8 billion mandated by Whitehall to over £5 billion attests to genuine local enthusiasm. Indeed, this enthusiasm was one of the key drivers for the Liberal Democrats to set an ambition that by 2018 NHS and care budgets should be fully pooled, with commissioning reflecting local models of joined up care. Public health, social care, primary care, community care, mental health, acute care: all are better done as one co-ordinated, population based commissioning activity.

But integration alone cannot deliver the proverbial “rabbit-out-of-the-hat” and create sustainable systems when both badly need more funding. And it is foolish at best to assume that the watchword, powerful though it is, will of itself deliver an alignment of interests.

As I have been arguing since I chaired the Joint Scrutiny Committee of the draft Care Bill, the promotion of individual wellbeing must become the organising principle around which budgets are pooled, services commissioned and performance measured. Just as the Care Act has made well-being the organising principle of social care, it must also become the touchstone of healthcare in the next government.

And integration of health and care alone will not be enough. It should be possible to also pool housing-related budgets – a critical and often overlooked part of the health and care jigsaw. Last year I was privileged to chair a Commission on Residential Care with Demos and experts from across the sector, and as that work reinforced to me, with an ageing population we cannot afford to leave it too late to recognise the critical importance of housing for older people in local plans[1].

Getting integration right and delivering the ambition of the Better Care Fund will make better use of resources. But this leaves unanswered the question of how to meet future cost pressures.

In government we have achieved much in social care – we have reformed outdated and disparate legislation and established a long-sought-after, but little attended to, solution to the funding of long term care costs. But to isolate social care and its funding from that of the NHS is disingenuous. It will come as a surprise to very few that the social care system has been underfunded for decades and that lack of social care provision inevitably has a knock on impact on the NHS and demand for its services.

In this Parliament we have allocated additional funding to social care but with an ageing population and the dramatic rise in co-morbid long term conditions, demand is at risk of further outpacing provision and will increasingly create a threat to the viability of the NHS, even once the £8 billion funding the Liberal Democrats have guaranteed is delivered.

So before the next Spending Review, we will need an independently chaired, non-partisan Fundamental Review of NHS and social care finances to establish the scale of current and projected demand, and explore how they will be met. And to support this and ensure that due diligence is paid in regard to trends in health status, demographic change, demand for health, care and housing services, and the costs of new health and care technology – as well as new drugs – the Office for Budgetary Responsibility should conduct annual reviews, reporting to Parliament, to ensure Government is able to respond and take suitable steps to adapt resources and provision as required.

Whoever is in power in the next Parliament will not be able to muddle through. Getting to the election after next without a crisis is inconceivable without a new settlement. Business as usual in social care can only lead to crisis.

Rt Hon Paul Burstow MP, former Care Services Minister

[1] Demos, The Commission on Residential Care, 2014

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