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What the politics of health and social care looks like a week after ‘social care reforms’ were pushed through

Charlotte Augst

In this blog, Charlotte Augst, National Voices' Chief Executive, argues that the funding for social care via a rise in National Insurance only begs more questions.

  • Health inequalities
  • Communication and administration

National Voices works to make what matters to people matter across health and care. Our good friends the Care and Support Alliance bring together the sector as it focuses on a better deal for social care, while we focus more on the NHS.

Obviously people with significant and enduring ill health (which are the majority of people our members support) often also need care services, and vice versa. And from a user/ patient/ family perspective, the distinction between community nursing and continuous healthcare and social care is hard to see – if not utterly meaningless. So we have a natural interest in making social care better – more accessible, easier to navigate, more personalised and enabling, and yes, also more affordable for the many people currently frozen out of provision.

So against this backdrop, it seems useful to try to unpack what the politics of health and social care looks like now, a week after the ‘social care reforms’ were pushed through in Parliament.

  • Getting this owned as a problem that sits with the Prime Minister, getting the need for substantial investment recognised, and making this Government push through a tax rise is a success for both noisy campaigners and quiet influencers everywhere. Many of our members will have done their bit to make this happen, and they should be proud of having ensured this vital first step is taken.
  • There seems to be a consensus among people far more expert than I that the money raised, while significant, is too little, too late for social care – no money until 2023, and the idea the NHS will ever say ‘we have had enough investment now, time for our social care colleagues to have some’ does seem a bit fanciful.
  • Even thinking through the necessary catch-up and improvement on performance that needs to happen in the NHS alone (heading into another difficult winter) it seems that the investment will not be sufficient to expand and support the workforce, fix all the problems caused by the lack of capital investment, and enable the step change and transformation that’s required to reinstate timely access to care across all aspects of activity (emergency, primary, elective).
  • The announcement also doesn’t tackle the impenetrable maze that opens up to people and families who try to access social care, the lack of navigation, coordination and clear advice, and importantly, the lack of personalisation so many people experience who receive social care.

We now have an issue the Government have invested political capital into without there necessarily being enough money to actually lead to tangible improvements for all of us who will be paying more. This leads to a political backdrop that should be of interest to all us campaigners and practitioners who have been arguing for better health and care for a long time. Our arguments that current provision both across health and care is insufficient (insufficiently inclusive and personalised, but also just not enough of it) will have gained much more salience overnight.

It is when the issues of scarcity, waits and safety lapses spill from the health and care pages onto the radar of mainstream commentators that progress seems to be possible, particularly in the run-up to spending reviews.

One other interesting dynamic to watch is whether under these circumstances the Secretary of State for Health and Care is quite as keen as his predecessor to assert his control over the runnings of the health service via the ICS legislation currently at Committee stage. Maybe it is now politically more attractive to leave the thorny issue of improving access and quality to NHS leaders after all?

One way or another it seems likely that further investment will need to be found: to stop the social care system from falling over this year and next, and to lead to the keenly awaited improvements for access to health services people now expect. Against this backdrop, our members and wider coalition will continue to push for a recovery that is inclusive, equitable and personalised. The millions of people whose health and care have been severely disrupted, and who struggle to have their needs seen and responded to, deserve nothing less.