The chickens have well and truly come home to roost. It is hardly surprising with an ageing population that demand for health and care would grow. Coupled with increasing expectations and rising costs, the growing demand has led to a crisis in both the NHS and social care.
The problems are now well known. But the government response has been pitiful.
The consequence of massive spending cuts by local authorities was bound to be huge cuts in care. There are more older people but significantly fewer older people are getting any care and support as councils tighten eligibility criteria. Help is now focused on crisis intervention and the government has shifted responsibility onto older people and their families.
At the same time the NHS is facing a crisis in emergency care, triggered by the lack of support in the community, from GPs and in older people’s homes.
So what has the government been doing over the last five years, apart from cutting funding? Fiddling while Rome burns, it seems.
On the NHS, the government’s big solution was clinical commissioning groups. On care, it has been the cap on care costs alongside a raft of measures in the Care Act, most of which have yet to come into effect. Even the Better Care fund has been slow in taking off.
The government has not addressed the real issues which in short are: under-resourcing (funding and human); lack of integration between health and care; and failure to bring services much closer to where people live.
The solutions are also inter-linked. The whole system has to be addressed to make real progress.
More funding is crucial. But we also need to ensure that health and care are funded in the same way, through taxation with services delivered free at the point of need. If this doesn’t happen integration will always be hampered.
Integration has to cover physical, mental and social needs, as Andy Burnham has argued. One body locally has to lead on planning and commissioning care and health services for the local population.
The focus has to shift to how we help and support people, particularly older people, to stay in their own home, rather than hospital or residential care. We have to help people much earlier and we have to help them take control of their own health and care.
Just one example. In North Norfolk we have seen a consistently under-performing ambulance service which with tightening resources can’t deliver the response times that our ageing, rural communities need let alone meet national targets. The answer is not just more ambulances to take more people to the region’s major hospitals. We need better access to GPs, better support in the community to prevent greater needs and support people socially, and better local urgent minor treatment centres.
There is a wide-ranging consensus for integration, but it needs to be local and it needs to be under-pinned by integrated funding. This of course is still quite a technocratic debate.
The challenge for Labour in the run up to the election is about communicating a clear narrative along these lines: the NHS is under huge pressure because of growing demand, higher expectations and rising costs; it needs to be better funded, we can afford it and it is a Labour priority to do so, but the NHS and care systems also need to change to support more, particularly older, people at or closer to their home and not in expensive hospital/residential care.
Finally, of course Labour needs to say how it can be afforded. We are still one of the richest countries in the world. With effective and fairer taxation and different priorities, we can find the resources to create an enduring national health and care service fit for the 21st century.
Stephen Burke is director of United for All Ages and www.goodcareguide.co.uk and vice-chair, North Norfolk Labour Party