There are no easy solutions. But there is one major bottleneck that urgently needs to be resolved: the UK’s long-term care system, known as social care, is so underfunded and fragmented that it has increased pressure on the NHS and exacerbated the crisis.
A patient with brain cancer is entitled to treatment on the NHS, which is paid for by the taxpayer; however, someone with Alzheimer’s disease or long-term complications from a stroke will in most cases be left to the social care sector, where funding is means-tested. While local authorities are largely responsible for funding such care, their budgets have been eroded by a decade of conservative austerity. As a result, the system has been overwhelmed and the workforce has reached crisis levels, with more than 160,000 vacancies and attrition rates often exceeding 30%.
The failure of this system has had huge knock-on effects. Because beds in social care were scarce, only 4 in 10 eligible patients could be discharged from hospitals in July. Blocked beds prevent emergency departments from taking patients to hospital wards for surgery or treatment. Overcrowded ERs leave ambulances parked outside hospitals for hours, unable to unload their loads and respond to emerging emergencies.
In addition to the human toll, this collapse comes at a colossal budgetary cost. Simple elements of long-term care – such as balance and strength training for the elderly, which have been shown to reduce the incidence of falls and fractures – have been neglected, leading to additional costs to the NHS of around £1 billion a year.
Prime Minister Rishi Sunak has pledged to allocate more money to health care and pledged to address the workforce issues. The government plans to block beds in care homes, freeing up thousands of hospital beds. Such solutions may get Britain through this winter, but they will not create a system that the country can rely on over time.
As one royal commission after another has pointed out in recent years, the UK needs to think bigger. Firstly, coordination between the health, social care and social housing sectors needs to be improved. It needs to collect better data to identify capacity and track needs. In particular, it needs good training and better career opportunities for social care professionals.
It could also learn from models elsewhere. Successful long-term care systems – in the Netherlands, Germany, Japan – usually focus on keeping patients independent for longer and reducing demand. They provide a continuum of care, from prevention to rehabilitation, as well as community-based services. They also have financing models that are considered transparent, sustainable and fair. A combination of general taxes, usage fees and social insurance (for example from the age of 40) can help stabilize such systems and to some extent shield them from politics.
Of course, such reforms will only be the start of a wider – and more contentious – discussion about the future of the NHS. For now, Britain must deal with one crisis at a time.
More from other writers at Bloomberg Opinion:
• Strikes are bad for the British economy? Go figure: Marcus Ashworth
• All I want for Christmas are no emergencies: Therese Raphael
• What does Sunak stand for? His party must know: Martin Ivens
The editors are members of the Editorial Board of Bloomberg Opinion.
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