Ideas for electability – A National Care Service

By James Valentine

The coalition’s comprehensive spending review is already unravelling and the Chief Executive of the NHS Confederation has warned of a potential “bed blocking” crisis in our hospitals caused by elderly people waiting for community care or assessment.

Under the CSR a notional extra £2 billion has been allocated for social care but this is meaningless when overall local authority budgets are being cut. A memo from the Director General for Social Care admits this – albeit in tortuous language of which Sir Humphrey himself would be proud.

Labour came late to the idea of a National Care Service. Its white paper on social care in March of this year set out some of the key principles and the NCS figured prominently in Labour’s manifesto, written by Ed Miliband. Our attempt at a bipartisan approach failed when the Tories walked out of talks amid hysteria about a so-called “death tax” to fund universal social care. Andy Burnham, while shadow health secretary and leadership candidate, kept the NCS argument going and has frequently indicated his preference for a levy as the only fair way to share the burden.

In setting out its proposals Labour needs to present social care in a positive manner. Many older citizens now live to their 80s and 90s in perfect physical and mental health; they can work longer and play harder than ever before. Labour shouldn’t allow itself to be boxed into favouring a purely “statist” solution. Relatives, friends and neighbours all do an invaluable job, and will continue to do so, for the elderly and frail – a genuine embodiment of the “Big Society” that David Cameron merely witters on about.

But however good the carer, she or he needs further assistance when the elderly person becomes ill or confused, or if the carer themself becomes frail. An alarming proportion of schoolchildren care for their elderly or disabled parents. When education or work become disrupted then as well as ruining life chances, productive power is taken out of the economy.

The principal behind the NHS is that of sharing risk and the same is true of a National Care Service. Healthy diet and lifestyle mitigate the risk of illness and frailty but nobody can say who will be hit by long-term decline or the curse of dementia. Burnham coined the expression “dementia tax” to describe the random and endless costs associated with this condition. Just as the NHS relieves citizens from the cost of falling ill, so an NCS will lessen the burden of old-age illness and decline. A properly organised National Care Service will keep elderly people in their homes for as long as possible, not only because this is what they want, but because it is more efficient to do so. A properly integrated NHS and care system will stop the economic insanity of bed blocking which ruins hospital finances and stops elective patients from getting their treatment.

A National Care Service will be expensive but as with the NHS generally, it will deliver good value for money in comparison to insurance-based alternatives. The Tories, extraordinarily, have gone back on their anti-death tax propaganda and now refuse to rule out a property levy, so we are back to the debate about funding that Labour originally started. The onus will be on Labour as a responsible opposition further to stimulate the debate, in contrast to this irresponsible, feckless, anarchic government.