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Radical social care reform is vital if we are to solve the crisis in the NHS


3 min read

One side-effect of the current enormous pressure on the NHS has been a recognition that if you do not fix social care you cannot fix the health service.

For those of us who have been arguing this case for years this is a significant step forward, even though it has been brought about in the most difficult circumstances.

The government has already made big financial commitments to the care sector over the next couple of years, and I believe that more announcements will be coming which will specifically ease the pressure of the 13,500 people stuck in hospital beds who would be better off elsewhere if only there was the capacity to care for them. Again, this is a move towards a better future, although we should remember that providing care in the right setting is a goal in itself, and not just a way of easing NHS problems.

The workforce is too small by around 165,000 workers. To address this we need better pay

The real prize would be to take the winter events and use them as a springboard for a proper systemic improvement in all aspects of social care. Although funding is at the core of this, even if you provide the right amount of money, extracted in the best way from those who can afford it, you will not have “fixed” social care.

To do that you need action on four fronts. The first is the lack of capacity, meaning essentially that the workforce is too small by around 165,000 workers. To address this we need better pay, and I suggest using the same pay scales and grades as the NHS Agenda for Change scales. Too often the debate is framed as being about residential care home places, but in practice the biggest lack is of care workers who support people living in their own homes, where of course most people want to go after a hospital stay.

The second is to have a proper balance in the new Integrated Care Boards between the needs of the NHS and those of care providers. We do not need to expand the reach of the NHS or create a National Care Service. Either would be a route to even more opaque bureaucracy. But we do need better integration at a local level, not just between the NHS and local authorities who are the biggest customers for care providers, but for those providers as well. Everyone should have a voice at the table.

The third area for radical reform is the use of technology. It is frustrating enough that in a digital age it is still hugely difficult for patient information to pass from one part of the health and care system to another. Too often people must answer the same questions to different arms of the system which is meant to be helping them. It is even worse that we are missing opportunities to use digital technology to give people more control over their daily lives, by providing them with reminders of what they need to do in terms of food and medicine. This applies not only to elderly care patients, but also the equally important group of working age people who need care.

The fourth area is in enabling people to live in their own homes for longer as they become frail. We should be building much more housing stock that enables people to receive support easily, including more retirement villages. We lag far behind other countries in this. Living at home for as long as possible is what people want and is far cheaper.

None of these changes are easy. But they are all essential if we want an effective and compassionate care system.


Damian Green is the Conservative MP for Ashford.

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