An area that was hotly debated before the election but so far has not been seriously addressed through the campaign is the issue of social care.
The lack of consensus as to whether there will be a National Care Service perhaps does not address the reasons why social care is the poor relation of the National Health Service and whether it might be perceived in a better light if it were commissioned as part of the NHS.
What has contributed to social care being a very poor relation of health?
Many would argue that is it because the state has been able to continue to rely on an army of unpaid carers to shoulder this burden – you can’t do this in the same way with education or medicine.
Others might argue there is a weaker producer lobby and that health is a much more exciting area to work in as professionals are solving problems clinically. This is easier to measure in terms of the quality of life for care service users and also more satisfying politically. The infrastructure of ambulances and big hospitals also makes health much more visible and most of us may have cause to visit A&E’s on a few occasions.
Other reasons that people advance include:
- It is run by local government and thus competes with a range of local priorities.It is usually the second largest amount of expenditure for upper tier or unitaries after education
- There has been a shift from institutional care (local authority old people’s homes) too a more domiciliary based service operated through mainly private contracts or spot purchasing. This is almost like a continuation of CCT though quality control has improved as result of the Best Value regime. High intensity in-house home care services still exist in some places but this is very much rationed.
- Resistance from some elements of the traditional voluntary sector to radical change
- Health providers do still provide some recuperation services, Though fines have reduced bed-blocking, consultants may still keep older people in longer than might be required.
- The social care profession is generally under-valued and thus is often filled with a significant proportion of short-term agency staff. Interestingly where social care has been taken over by health providers, staff have said they get greater professional recognition
- The vast amount of capital owned by non-poor elderly incentivises family members to retain this and to deliver more care at home. Carer’s allowances and benefits may also encourage this. Arguably this is good and a form or co-production, but means that the role of relatives is different when compared to their role in health, where they may have a more passive role.
- The health regimes for some older people (eg. take 8 tablets a day and self-medicate) and the improved management of administrating this through phone lines mean that chronic disease management is a lot better
- Alarm systems worn round the neck mean much of the work of social can be run through call centres and then the use of emergency services
- The substantial tightening in eligibility criteria over the last decade. Belatedly the National Care Service may in 5 years tackle this if it is agreed. In the end this will set a cap on personal expenditure in whichever form it emerges.
Hopefully the general move from a focus on acute care to one on primary care automatically shifts the debate in a way that opens up the possibility of a better balance in the relationship between health and social care.
Charlie Mansell is Research and Development Officer for the Campaign Company