Sajid Javid works on radical plan to merge social care with health in England | Social Protection
Radical plans for a new national care service in which health and social care would be provided by the same organization are being actively considered by the government for inclusion in a white paper next month, according to senior Tory officials and Whitehall.
The idea that local authorities and the NHS take joint responsibility for social care, perhaps working for the first time from a single combined budget, would be one of the most ambitious reforms since the NHS was created in 1948.
At present, local authorities are responsible for managing social assistance services in their own region. Critics say there is therefore not enough incentive for cash-strapped councils to develop better care for people at home or in the community, as it becomes cheaper for them if people in the need go to hospital where the cost is covered by the separate NHS budget.
The result is that many people who could be cared for at home or in the community end up occupying much needed hospital beds.
Similar systems operate in Wales and Northern Ireland, although there are variations in the amount of care paid for by the state. The Scottish government is holding a consultation, which is due to end next month, on proposals for a national care service.
Health Secretary Sajid Javid is believed to be examining how a new integrated service that would provide better care and free up NHS beds across England could be delivered. It is understood that there would be national standards for care and conditions for caregivers.
The Observer was informed that Prime Minister Boris Johnson was keen to announce his intention to integrate health and social care services last month when he revealed that national insurance contributions would increase by 1.25 percentage points to from next April, to raise Â£ 12 billion a year for the NHS and social services to worry about. But at that time, Downing Street was unsure of how an integrated system could best work, so an announcement was postponed.
In the most radical option of all, local authorities would be stripped of any involvement in social care, which would fall entirely under the NHS. Sources say this would cause too much upheaval, however, and prove hugely unpopular with the councils, many of which are controlled by the Tories. The councils have already lost much of their responsibility for education.
Last night Tory MP and former Under Secretary for Health Dr Dan Poulter, who works part-time as an NHS psychiatrist, said: a national care service.
âFor integration to be successful, it is essential that the reform not only provides a parallel order of health and care services, but also services ordered through a single common budget. Unified health and social protection budgets are the only way to provide both a more efficient health and social protection system, as well as to properly integrate for the benefit of patients what is currently a very fragmented system. “
Former Tory Cabinet Minister Damian Green, who has written extensively on social services, added: ‘Running social services jointly between local authorities and the NHS would be an interesting idea but would of course leave big questions on how to ” attract a larger and better paid workforce. , how you ensure adequate housing so that people are not prematurely placed in institutions.
In his party conference speech last week, Johnson alluded to integration. He said: âIn 1948 this country created the National Health Service but kept social care at the local level. And while that makes sense, in many ways, generations of older people have found themselves lost in the ditch. He added that it was not just about providing more money, but about reforming the system. “This government which made Brexit, which is rolling out the vaccine, is going to provide social care.”
The Covid-19 pandemic has further highlighted the crisis in social services. Currently, a shortage of around 120,000 caregivers means 300,000 people are waiting for local authorities to assess their needs or provide care. In addition, many elderly people who end up in hospital due to a poor local supply of care cannot free beds once they are better because there is no room in nursing homes. retirement.
There are around 17,000 homes in England, most run as small independent businesses funded by local authorities or paying residents, making coordination with large hospital trusts difficult.
Shadow Health Secretary Jonathan Ashworth said: âSocial care is in desperate need of wholesale reform, but the cap Boris Johnson announced does not deliver the solution he has promised. It is essential that health care and services are brought together to provide personalized care so that people can stay at home and not be forced into it.
âThis is why I have long advocated for national health care services, delivered locally according to national standards, to provide the quality care people deserve. “
Sally Warren, director of policy at the King’s Fund, said: âPeople actually mean different things when they talk about providing social care in the NHS. For some this means having social care services provided by the NHS. For others, it means a shared responsibility for how health and care services work together. Rather than spending energy shifting responsibilities from local government to the NHS or vice versa, the important thing is to focus on improving the coordination of services so that they work together to improve health and well-being.