So the predictable annual orgy decrying the imminent death knell of the NHS is in full, sweaty hue and cry. Repeatedly broken targets around A&E waiting times, patients dying on trolleys in corridors, over worked doctors and nurses and creaking infrastructure are the usual suspects. But this time it feels different. This time people are dipping their toes into the used bed pan of causation beyond the usual dogma of underfunding. Now the hitherto overlooked human misery manifested by chronically underfunded social care has reared its ugly head as a direct cause of the NHS’s sickly symptoms.
The budget for NHS England in 2016/17 was a sphincter splitting £107 billion. This budget has, wrongly, been ring-fenced from cuts as some kind of sacred cow, rendering it immune to the kind of grown-up debate that politicians should be having about its future. In a way that only the Brits know how to do with such effortlessly glib aplomb, we like to laud “our NHS” as the envy of the world. As long as the Health Secretary Jeremy Hunt (who my consultant friends assure me has a consonant misplaced from his surname) keeps regurgitating the assurance whilst wearing his NHS badge of honour on his lapel, he may yet believe it. He is fooling nobody. In layman terms, “our NHS” is knackered: a highly complex story of a simple case of under supply in the face of over demand; and a desperate need for original thinking to drive wholesale reform of an institution that is an unsustainable anachronism in its current form. Unfortunately, the NHS has been weaponised politically. Successive governments have equated tipping ever larger sums of money down an ever larger and darker black hole with a de facto better end product. Record spending has poured in, yet the NHS has moved on to life support. The shot in the arm that the NHS needs is a package of reform that extracts maximum value from a sustainable funding model, not the obsessional pre-occupation with absolute monetary values.
The social care budget, however, is a separate and tightly rationed beast. Divvied up on a strictly needs and means tested basis, it is funded by local councils through central government grants. In the seven years of austerity, council funding has been raped and pillaged with social care funding decimated. According to The King’s Fund, the number of people aged 65 or over accessing publicly funded social care has fallen by 26%. Self-evidently this leaves an ever increasing number of people more vulnerable and without the support to carry out basic every day activities. In a remarkably enduring display of austerity addled short sightedness in the face of the rising demand of an ageing population and greater life expectancy, UK public spending on social care is set to fall to less than 1% of GDP by the end of this parliament. Get old; but don’t decay. Good luck defying that physiological inevitability.
It was announced before Christmas that councils would have the power to raise council tax by 3% this year and next to help fund social care, bringing forward already planned increases of 2% per annum for the three years left in this Parliament. Whoopee-do. 6% tax rises over two years, versus 6% over three. Given the parlous state of the problem, such a pathetic gesture is akin to using butterfly stitches to patch up open heart surgery.
So how does the crisis in social care tie back to the travails in the NHS? You don’t have to be an NHS scientist to comprehend that if the oldest and most vulnerable people in society do not get the care they need either at home or in a nursing home, and they cannot access their GP when their ill health demands (not when GPs’ 9 to 5, “make an appointment” attitude to local healthcare dictates), then they are going to use the only other realistic option available to them when they need help: A&E. And what happens? They receive hospital treatment and are declared fit to be discharged. Except they are not discharged because there isn’t the social care available to ensure that the patient can return home safely. In NHS parlance, such a patient becomes a “delayed transfer of care”, or, more succinctly, a bed-blocker. Bed-blocking can go on for weeks whilst social care is arranged, such that patients effectively take up full board and lodging at the NHS’s considerable expense.
According to The King’s Fund, nearly 570,000 bed days were lost in the three months between July and September last year as a result of such “delayed transfers of care”. Problems in arranging the appropriate social care are cited as the main reason given for these delays. 570,000 bed days.
I am loathed to be one of those who lazily shout for the elixir of more cash, but in the case of social care, the correlation and causation between lack of funding and the crises in both social care and the NHS seem compelling: rationing of social care is clogging up the NHS’s arteries.
The health system is a screwed up hybrid whereby the politically weaponised provision of unaffordable free universal healthcare sits on a lofty and idealistic pedestal, some way above the deprioritised problem child of social care provision. Quite why and how the disciplines of “health” care and “social” care have been discriminated, demarcated and separately funded when the link between the two seems inextricable is baffling: invest in social care and relieve the pressure on the NHS. The cost-benefit analysis is that simples.
Agitated statements this week by Theresa May and Jeremy Hunt may indicate that they are going to take their medicine, albeit whilst kicking and screaming. And a carefully timed and choreographed Party Political broadcast by the Conservative Party on 11 January espousing Mrs May’s core values and her vision of a country that “works for everyone” was no coincidence.
It is estimated that there is funding gap in social care provision of at least £1.9 billion in 2017/18 and £2.3 billion by the end of this parliament. In the context of the NHS budget, such sums are loose change. It’s hardly radical thinking- and may, shock horror, be both populist in flavour and popular by design- but the Department for International Development controls a budget of £11.8 billion, channeling tax payer money to Jonny Foreigner. Whilst our trending national narrative is inward looking and nativist, why doesn’t the government take the pulse of the protectionist mood and divert cash to this most pressing of domestic issues? Given how much money the DfID advances to the Fat Catisation of aid contractors and charity bosses that receive millions of pounds in foreign aid for their charitable causes, I can’t see anything other than the move being universally applauded (as well as being politically adroit). It may also have the handy side effect of serving as a timely reminder that the government’s head is not entirely engulfed up the fat, rancid arse of the Brexit behemoth and that it is still doing what it was elected to do: to run the country and to run it for the benefit of all of its citizens, not just the 52%. Nobody will die from Brexit, chronic as the indigestion may be at times.
The UK is a rich and civilised country by any conceivable measure. This has gone beyond the question of money and strikes at the fabric of the kind of society to which Mrs May aspires to foster. Conservatism with a human face, compassionate conservatism, conservatism that works for everyone; call it whatever philosophy you like. But if protecting Mrs May’s “most vulnerable in society” isn’t going to become another vacuous platitude that has come to characterise this administration over the past six months, it’s time for the PM to take her medicine and cough up.