Managing and Funding Care Services Properly

The coronavirus pandemic has thrown a harsh light on some of our most vital services. Despite setbacks, our NHS has emerged with great credit from this testing time. People recognise and applaud the quality of the work and the selfless resilience of doctors, nurses, and the thousands of hospital support staff.

The same cannot be said of our provision for caring for the aged and those suffering serious illness in care homes or in their own homes. During Covid-19, the UK suffered one of the highest death rates across Europe for care home residents. This is in no way a criticism of the exceptional work of thousands of care workers, showing great dedication, risking their lives often without adequate protection, usually on woefully low pay.

The problem is that social care is not integrated into the national health system. Local authorities are nominally responsible for care homes, but the majority are now run by private companies. Many of the larger operators, some managing dozens of homes, are based offshore, draw substantial fees and pay desperately low rates of pay to their workers. Whilst NHS services are ‘free at the point of delivery’ social care is ‘means-tested’ – provided according to ability to pay. Cancer patients in hospital pay nothing; many with dementia, in care homes or cared for at home, pay impossibly large sums for an under-resourced service. Local authorities have had their financial support cut to the bone; they are in no position to improve the funding they provide. Staffing is a long-standing problem. Care homes are closing at a time of increasing need.

We are faced with a major crisis, which must be addressed as we emerge from this pandemic. Radical reform is urgently needed. The answer is to end the distinction between the NHS and social care and create a coherent single entity, a National Health and Care Commission, which integrates these two inter-dependent services. Care workers at all levels should be properly rewarded for skilled work, now recognised as essential. Market forces and privatisation are entirely inappropriate in what should be a major public service commitment.

Liberal Democrats have long called for a new Health and Care Tax on the basis of wide consultation and engagement with the public. We would establish a cross-party health and social care convention to agree on the long-term sustainable funding of a joined-up system of health and social care, involving if necessary an increase in tax. Our ultimate objective is to bring together NHS, Social Care and public health. Should any future pandemic strike, we must be much better prepared.

Roger Putnam

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