A matter of priorities

Pithkeathley4x3.jpgJill Pitkeathley on the continuing disappointment of the government’s response to Dilnot

A year ago I led a debate in the Lords on the Dilnot Report at which the Minister, in replying, said: “We have an opportunity to get this right and we must not miss it”. 

It is an intense disappointment therefore, that a year on we are no further ahead with implementing a long term solution to the problems of social care. A sentiment which I am sure will be echoed by many of the peers taking part in the debate today – many more by the way than those who participated last year.

In the meantime, things have got worse for the local authorities trying to cope with rising demand and scarce resources. While the government allocated an extra £2bn, half of that came direct from the NHS budget. Either way, not all of this money has been spent on the innovative schemes it was meant to finance or on re-ablement services. Much has had to go on ‘papering over the cracks ‘ in local budgets and schemes to promote integration have not benefitted at all from the upheavals following the implementation of the Health and Social Care Act.

In summary, the system is not fit for purpose and we spend inadequate amounts on care and support both publicly and privately. Social care funding has totally failed to keep pace with demographic changes. Since 2004 while spending on the NHS has risen by £25bn, spending on social care rose by just £43m. If attitudes to this funding gap do not change, local authorities have predicted that within a very few years waste collection and social care will take such a huge percentage of their budget that all other services will have to take at least an 80% cut. This despite the fact that most councils already only providing services for those whose needs are classed as severe or critical.

When people can’t get social care services, what do they do? They turn of course to the NHS: resulting in pressure on services, delayed discharges and shortages. A recent report from the CQC paints a sad picture of how cost cutting is being put ahead of patient welfare, with 16% of the hospitals surveyed not meeting the required standard of having enough staff on duty to care properly for patients.

The government’s response usually is to say there is no more money available. But as Andrew Dilnot often says: it is not a case of can’t afford, it is a case of won’t afford. Our GDP shows we are five times better off than we were in 1948 when the NHS was established. Time and again we find that social care, properly delivered, of good reliable quality and with an emphasis on prevention, is a better way of caring for frail, elderly or disabled people than health care. 

If we pool the risk – only one in five of us ever needs the more expensive types of care – and give it the priority it deserves, we can afford it. It is a matter of priorities. Surely it is not asking too much to call for some commitment and vision about this most pressing of problems?

Baroness Jill Pitkeathley is a backbench Labour Peer in the House of Lords

Published 29th November 2012

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