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We need to ask why we fund social care differently to the NHS.For all the emphasis on integrated care, we have a system which assumes it’s possible (and maybe even meaningful) to distinguish between people who are ‘sick’ (who we see as having ‘health’ needs met free by the NHS) and people who are merely ‘frail’ or ‘disabled’ (who we see as having ‘social care’ needs which are met by local authorities and subject to means-testing).Whatever funding options we pick, there are a number of key issues and principles that we would do well to reflect upon: While the Green Paper could be an opportunity to finally put this right, it could also be a question of history repeating itself. Typically, we end up concluding that all of the options seem too politically unpopular and we place social care in the ‘too difficult’ box, kicking the issue into the long grass for someone else to sort out in future. Since the late 1990s, we’ve had major reviews and reforms of adult social care on at least 12 occasions, and we’ve tended to fail utterly to implement the key recommendations around funding. Many people still assume that social care is funded in the same way as the NHS and will be available to them free of charge, and it often comes as a severe shock when people find out that this isn’t the case – usually when they are already in crisis and urgently need support. With adult social care, in contrast, we have a system that few people understand, that is heavily rationed and targeted on those with only the most severe needs and the lowest incomes, and that is means-tested and subject to very significant user charges. With the NHS, the answer to many of these questions is usually very clear – none of us know when we may need to access health care, and we really value the fact that we have a health service based on clinical need rather than ability to pay, available to us all largely free at the point of delivery.
All too often, the funding of adult social care is seen as an economic and a technical issue: what’s the best mechanism for raising the funding we need? While this is important, the more fundamental questions are personal, political and philosophical: what kind of life do we want to have together as a society? How much do we value disabled and older people with care needs? What sort of support would we want available to any of us if we needed care? How much do we really value this and how much might we therefore be prepared to pay for whatever quality of life we decide we want?
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