Andy Burnham is right to try and grasp the political nettle of reforming social care, an achievement which has so far eluded Health and Prime Ministers including himself when he was Minister for Health. I don’t profess to have the answer, I think it needs a wider national discussion, and I deplore the mean-minded contribution of Kemi Badenoch that the first thing she thinks of is not to raise taxes or borrow. One of her colleagues then pompously stated “ We don’t want to penalise those who have done the right thing and saved up”. Much easier of course for those who have the means, and unfortunately not necessarily the right answer anyway. None of us of course can predict what will happen, whether we will die in reasonably good health without the need for much care, or whether we will have dementia for ten years or more.
I have had considerable experience of the NHS through membership of various boards and committees, and before I begin the discussion, I want to state unequivocally that in my experience most of the people who work for the NHS are very thoughtful, empathetic people who are always prepared to go the extra mile. I am not discussing individuals but the system they work in.
An experienced doctor once told me that three factors influence your health: where you live, how you live and how you are made. We cannot influence the last one, but we can influence the other two. Policies for social care, diet, healthy lifestyles and healthy environments are just as important as clinical medicine and health facilities. There are two ways of looking at health, the medical model and the social model. The medical model considers how to treat us when we are ill, and the social how to look after us to prevent us being ill, and if we are, how to look after us most effectively.
Clinical medicine and social health care
Clinical medicine is delivered through the NHS, while most social health care is provided, when it is provided at all, through local government. The big problem at the moment is that they do not cooperate very well, and that local government does not have adequate resources. Local government provides the resources for healthy living when we are younger, such as swimming baths and sports facilities. It also tries to ensure we have a healthy diet through its public health sector. Sports and leisure facilities become more important for people as they approach old age and have more time when they have retired. The majority of people I encounter at my local swimming baths are certainly not in the first flush of youth (including me). We should not ignore either the large number of voluntary and community activities, often provided by volunteers, such as walking and rambling groups, steps clubs, line dancing and recently the Parkrun, a fantastic example of voluntary effort which now takes a more inclusive approach and encourages participation by those who cannot run fast or even just want to walk. These activities also have a social element and combat isolation, often a cause of ill health, particularly poor mental health, in all age groups, not just the old.
Clinical health has for more prestige in our society. It is an unfortunate fact that however much we praise voluntary activity, people in real life take paid professionals more seriously than volunteers. In our society the NHS has considerable power and prestige, certainly compared to those in the social health care sector. One must only look at salaries, particularly for care workers.
It would seem sensible for the two to work together, and in some cases they do, but it is a very unequal cooperation. The NHS usually calls the shots. I can remember being greatly impressed by a Conservative Minister of Health, Stephen Dorrell, who first proposed the idea of Integrated Care Boards between Local Authorities and the NHS. He envisioned an equal partnership between the two. We now have Integrated Care Boards, but they are effectively a regional management structure for the NHS. They are happy for local government to have scrutiny committees for what they are doing, but anyone who has had anything to do with local government will tell you that most scrutiny in local government is not very effective, and largely a way of finding something for those councillors not involved in the major decisions to have something to do. There is certainly not an equal partnership between the NHS and local government.
An effective solution for social care
If we are to have an effective solution for social care this must be remedied. Many older people could stay in their own homes, and be happier there, if there was adequate and effective care in the community. Many are kept in hospital unnecessarily because social care in the community is not available. It is a harsh thing to say, but one of the main problems to establishing good social care is the NHS as presently set up. When it was established in 1948 its main emphasis was looking after people with industrial injuries or treating victims of epidemics. It was not established to provide social care. It has not adapted to a new world where people live longer. That is the problem Andy Burnham must sort out. It will not be easy, but it must be done, whatever Kemi thinks.
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