Debrief: The care crunch – who will pay for the baby boomers?

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Yesterday evening I attended a Progress event, The care crunch: who will pay for the baby boomers? chaired by Hopi Sen, a Progress strategy board member. The evening provided the opportunity to discuss the recently released Purple Paper written by Patrick Diamond, part of the Real Change for Britain, Real Choices for Labour series.

Patrick Diamond, a senior research fellow at Policy Network, and visiting fellow at Nuffield College, Oxford as well as a councillor in the London borough of Southwark and a former special adviser to Tony Blair and Gordon Brown, spoke on several methods to approach the growing health care costs the UK will face due to ageing baby boomers.

Patrick described care as not just a transactional relationship between the person and the state. Government has to think about how services work and we have to think much more creatively. He explained that one option to pay for the rising cost of health care is the inheritance tax based solution. Patrick described this as a quid pro quo – cutting something to get something, and inevitably not popular.

He explained that a major issue is that child care does not register much with voters, even though investing in child care is one of the best investment a government can make. Stating, “when we talk about social care, we often talk about old people. Yet children and people with disabilities are often left out of the dialogue.” He explained the IPPR has released a report stating upfront costs for child care would be pay for themselves in 5 years because of moving more women into work and reducing other public costs as children develop.

Patrick added the role of local government in health and social care reform has not been touched on very much, but is huge. For example housing, and how there are individuals living in unliveable conditions.

Shadow Health Secretary, Andy Burnham MP stated the Office of Statistics reported that government has not increased real spending on health care in the NHS this year.

Andy stated that good health was once defined as good social, physical and mental wellbeing,  but this is increasingly harder to maintain and afford in a health care system where people live increasingly long lives.

Andy stressed that social care and the NHS remain divided and we are going to have to work much harder to get money to fund the system properly. He explained, “a major problem with the system is the NHS gets money based on how many people come through the door, and they are not paid to keep people out of the system. There is no incentive to go and install equipment to assist people at home, or provide care workers. Hospitals are increasingly full of frail people who do not necessarily need to be in a hospital.”

Andy thus argued that in effect, we should have one budget and one system. The NHS should lead on the provision of all care, not necessarily but at least coordinate it all. If one system existed, it would create incentives to get people out of the acute system. There would be a need to cross subsidize care in homes by cutting care in hospitals and you could ask people to pay differently depending on the services they accessed, yet still have everyone covered.

Andy added if we don’t make health and social care reform at the beginning of the 21st century a priority, there are real questions about the sustainability of the NHS. He added that the Dilnot report does not cover that the real questions around local government budgets and the fact that local government is better equipped at understanding prevention compared to the NHS. Local government has links to areas such as leisure, highways and parks which all affect quality of life and health. Andy added that right now we have a narrow model, not a whole person approach.

Andy stated we have a dementia tax, since we let the most vulnerable people lose the most.  He added Labour has not done enough to bring this issue forward, and that Dilnot is a product of an everyone solution to social care, but he does not personally hold out a great deal of hope for it though.

In closing Andy cited the example of Torbay, which has joint medical teams and very fast reaction times. There are high death rates at home, as people wanted to die at home and the system is designed to work together. The model joins different sectors of the health and social care community together. Andy explained the significance of this as his own sister had requested to die at home, which was impossible as the system was not designed to handle it.  In this one budget, one system model people will have to work very differently, and there will be changes to hospitals, but you can improve social care by bringing it into the NHS. The way to frame it, is people are paying now and will be paying more for poor quality care unless the system is integrated.

Michelle, Mitchell, Charity Director, Age UK asked the audience, “What is social care?” The answer, which many people did not know, was that is provides for all basic needs.

Michelle stated Blair, Brown, and Cameron have all said social care is the great failing of social policy.

Michelle explained social care in the UK suffers from huge variation in the system, a post code lottery and there is a high chance you will face huge costs. There is growing demand, increasing numbers of over eighty-five year olds, and a big debate about how you pay for it and a lack of political will about how to deal with it.  She added the quality of hospital and continuing care varies greatly, people can see 25 carers, who are paid minimum wage, and not paid between assignments to people’s homes or if they have to stay longer than estimated.

Overall, Michelle stated we are seeing a major shortfall in the quality care for those who have no other choice. She explained there needs to be a transformation in terms of how we look at health and well being.  Health care should start with the individual and build personalized care particularly for the elderly. Michelle explained there are some people she has met who have 35 contacts, so they have resources, but it is things like loneliness and a lack of goals that drive them back into the hospital. There are many simple problems that could be avoided.

Michelle added that the Labour Party needs to have a strong programme of how they want to change the NHS, it is one thing to say something in Whitehall but there are very intelligent people within the NHS who are adept at gaming the system.

Bobby Duffy, Managing Director, Ipsos Mori Social Research, explained health and social care is depressing to people, hugely confusing over what is included and overall, people do not want to think about it.

Ipsos Mori research shows 55 percent think it will be free, but many are not sure, and 72 percent are not prepared for it financially.

Research also shows there has been a big shift in more people thinking they are responsible for their own health and social care. Initially, people think health and social care are the responsibility of government, but then realise it is more of a partnership between the person and the government. He added, when compared to other cohorts it has always been the pre-war generation which has always been the most satisfied with the NHS.

The above report was written by Xanthe Couture

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