by Roger Abbott on 12 February, 2017
I have long believed that social care and health care are two sides of the same coin. Both should be universal, such that the care service is the same whoever you may be and wherever you may live. As such they should be treated by government as a single entity within the same government department under the same cabinet minister. Thus it will become much easier to bring together the necessary people and systems to (eventually) provide a single seamless service. It follows that funding for BOTH must come from central government, NOT out of council tax.
The question then is how we raise the funds from central taxation. I have always wondered why we have a National Insurance Payment on payslips as well as Income Tax. The Treasury has always treated NI as an additional income tax and they are extremely reluctant to ring-fence anything anywhere within the tax system for any particular purpose. So, last September, I was delighted to hear Norman Lamb (Lib-Dem health spokesman) say that we should consider moulding national insurance into a ring-fenced NHS and social care tax. Obviously income tax would have to be reduced by a corresponding amount. This would make it absolutely clear to everyone how much we are spending on health & social care and it gives the chancellor a uniquely identified tax account that he is varying during budget statements.
My big fear with all this is that the NHS is on its on its deathbed and yet another reorganisation will prove terminal.
Over the past 60 years just about every minister of health has tried to make his/her legacy mark by reorganising the NHS. The result, today, is that everybody is under constant pressure, each NHS unit has its own objectives, the direct workforce is demoralised and the external providers are only in it for what they can get. The consequence over the past 15 years or so has been that whenever the government of the day has found that their latest reorganisation has not solved the NHS problems, it has simply thrown money at it. Inevitably, the improvement in service received, if any, has been considerably less than commensurate with the investment. This is not a criticism of the NHS or the people who work within it: the problem has been, and continues to be, with the successive governments and the politicians who have abused it.
The social care network has also suffered abuse from the government and ministers. Funding has been seen by various governments, particularly but not exclusively the Tories, as an easy target for cuts. The result is that a significant proportion of the workforce are now on minimum wage or zero-hours contracts. In addition, the front-line staff are frequently short of time to deal properly with their client’s problems. Far too many people fall through the system and end up in hospital because the lack of social care creates a medical problem.
Even though the NHS is more disjointed than ever before It simply cannot take any more structural changes. Social Care needs a fundamental rethink to enable the eventual integration of the two services. We need a minister in charge who is sympathetic to the plight of both the NHS and Social Care Network. That minister must have the skills to smooth-in integrated practices, common objectives and, above all, teamwork.
It may well be necessary to provide a large transition budget to this proposal so the minister can plug the gaps in service and keep things running. Certainly time is required to let the NHS recover from the most recent set of changes and just to allow everyone to develop ways of working together. Change will require cross-party support in Parliament together with co-operation of the unions, NHS trusts, county councils and others. A tall order, I agree. But late last year Norman Lamb (Lib-Dem) did get together with Liz Kendall (labour), Dan Poulter (conservative) and about 20 other MPs in an attempt to get a commission formed that would study NHS funding.
Although the cost of funding social care from council tax was not the only financial problem being faced by Surrey County Council, it did bring the whole issue to the fore. The big question is: does the government really understand the problem and will it do anything about it? Or will the government make a few small changes to the funding of county councils and hope the problem goes away?
Just maybe, we might be getting somewhere…Leave a comment