Radical plans for a new national care service under which health and social care would be delivered by the same organisation are being actively considered by the government for inclusion in a white paper next month, according to senior Conservatives and Whitehall sources.
The idea of local authorities and the NHS taking joint responsibility for social care, perhaps working from a single combined budget for the first time, would amount to one of the most far-reaching reforms since the NHS was founded in 1948.
At present, local authorities have responsibility for running social care services in their own areas. Critics say there is, as a result, insufficient incentive for cash-strapped councils to develop better care for people in their homes or in the community, as it is cheaper for them if those in need go into hospital where the cost is met from the separate NHS budget.
The result is that many people who could be cared for at home or in the community end up occupying much-needed hospital beds.
Similar systems operate in Wales and Northern Ireland, although there are variations in how much care is paid for by the state. The Scottish government is holding a consultation, due to end next month, on proposals for a National Care Service.
It is believed that health secretary Sajid Javid is examining how a new integrated service that would deliver better care and free up NHS beds across England could be delivered. It is understood there would be national standards for care, and conditions for carers.
The Observer has been told that prime minister Boris Johnson was keen to announce plans to integrate health and social care services last month when he revealed that National Insurance contributions would rise by 1.25 percentage points from next April, to raise £12bn a year for the NHS and social care. But at that time Downing Street remained unclear about how an integrated system could best work, so an announcement was put back.
Under the most radical option of all, local authorities would be stripped of any involvement for social care, which would come entirely under the NHS. Sources say, however, that this would involve too great an upheaval and prove hugely unpopular with councils, many of which are Tory controlled. Councils have already lost much of their responsibility over education.
Last night Tory MP and former health under-secretary Dr Dan Poulter, who works part time as an NHS psychiatrist, said: “There is a growing expectation that a substantive health and social care white paper will emerge in the next few weeks aiming to establish a national care service.
“If integration is to be a success, it is essential that reform does not just deliver parallel commissioning of health and care services but also services commissioned through a single pooled budget. Unified health and social care budgets are the only way to deliver both a more efficient health and social care system as well as properly joining up for the benefit of patients what is currently a badly fragmented system.”
Former Tory Cabinet Minister Damian Green, who has written extensively about social care added: “Running social care jointly between local authorities and the NHS would be an interesting idea but would of course still leave big questions about how you attract a bigger and better paid workforce, how you ensure appropriate housing so that people do not go prematurely into residential care.”
In his party conference speech last week, Johnson hinted at integration. He said: “In 1948, this country created the National Health Service but kept social care local. And though that made sense, in many ways generations of older people have found themselves lost in the gap.” He added it was not just about providing more money but reforming the system. “This government that got Brexit done, that is getting the vaccine rollout done is going to get social care done.”
The Covid-19 pandemic brought the social care crisis even more sharply into focus. Currently a shortage of about 120,000 care workers means 300,000 people are waiting for local authorities to assess their needs or provide care. In addition, many elderly people who end up in hospital because of poor local provision of care cannot free up beds once they are better because there are no places in residential care homes.
There are about 17,000 homes in England, most run as independent small businesses funded by local authorities or paying residents, making coordination with the large hospital trusts difficult.
Shadow health secretary Jonathan Ashworth said: “Social care is in desperate need of wholesale reform but the cap Boris Johnson announced fails to provide the fix he promised. It’s vital care and health services are brought closer together to provide personalised care so people can stay at home and not be forced into a home.
“That’s why I’ve long advocated national care services, locally delivered within national standards, to provide the quality care people deserve.”
Sally Warren, director of policy at the King’s Fund, said: “In reality, people mean different things when they talk about bringing social care into the NHS. For some it means having social care services delivered by the NHS. For others, it means some shared accountability for how health and care services work together. Rather than spending energy shuffling responsibilities from local government to the NHS or vice versa, the important thing is to focus on improving the coordination of services so they work together to improve health and wellbeing.”
