Author: Paul Goulden

Now that all the froth and noise has passed and we have some more of the detail, it’s clear that the implications of the Government’s announcement on health and social care are far reaching, and there are some areas where we can’t say exactly how the reforms will play out.

On the plus side, we have at last got a plan. Successive governments have put health and social care reform into the “too difficult” pile, and at least now there will be a measure of security for people in terms of how they will fund care in later life. But the debate seems to have pitched old against young and “haves” versus “have nots” when it should be addressing the actual ageing experience itself.

So, my overarching problem with the Government’s approach is that it starts from the question “how can we fund social care?” rather than “what do people need to age well?” – two fundamentally different problems. The first question presumes that the current system is fine but needs more money, whereas the second posits a far deeper debate about society’s view on ageing in its widest meaning.

And clearly the current system is not working – and this isn’t the fault of the many dedicated professionals in both health and social care systems, statutory and private (who have been particularly stretched and brilliant during the COVID-19 pandemic) that mean we have poor ageing outcomes. But it cannot be denied that some of the experiences of people as they age are not what we as a society would want. Lack of dignity and choice, the quality of care and its affordability – all of these are constant experiences of those interacting with our health and social services.

There are several reasons for poor experiences from health and social care:

• Differing cultures between social care and health care
• Convoluted pathways between the two systems
• Differing systems and pressures within the respective areas – e.g. primary care and hospitals
• A focus on budgets, KPIs, systems and procedures rather than on outcomes

All of these mean people disengage with health and social care, leading to crisis or worsening conditions, or have additional stress when it is needed least.

Which is why the Government’s approach is flawed – if the “check engine” light on your car is flashing, putting more petrol into the tank is not going to solve the problem.

Social prescribing has taken huge steps in improving health and social care outcomes, with genuine, needs-led options being offered that cross the artificial health and social care divide. But this remains a movement within the existing set-up, and the funding of the services people are referred to remains an issue.

The boat has clearly sailed in terms of changing the question that the government has asked and answered, and there is clearly little appetite for root and branch reform of the structures involved – so the debate needs to now shift to making sure that the extra money the Government is raising is not just spent in the same way as before.

I would argue that to age well we actually need to be funding services that keep people away from health and social care services as much as possible. Prevention has been a key theme of our work here at ILC, and in previous roles I have seen the value of services and activities such as nail-clipping, befriending and groups such as Men In Sheds for tackling loneliness and isolation, and in giving people a feeling of being valued. To age well, we need services and support that acknowledge the changes that happen throughout the life course, as well as being:

• Timely: At the point where the support can make a difference
• Needs-led: Giving the support that is required, not what the system has available and
• Person-centred: Taking all aspects of a person’s life into account and tailoring support to that

The case for prevention funding is that small and relatively cheap support early on mean that crises and more expensive interventions are avoided later on – meaning that people are healthier and more active for longer – which is surely the basis of ageing well. Beyond the benefits to health and wellbeing, our research has found that in countries that spend more on prevention, older people contribute more economically through working, volunteering and spending more.

With the vast sums of money currently available for health and social care – and the extra that is on the way – the Government should be committing to spend a percentage on prevention at least equal to the 6% that Canada commit. Beyond this starting point, more ambitious targets, such as the 15% goal called for by the UK’s All Party Parliamentary Group (APPG) on Longevity, will be crucial to making the most of longevity.

If the argument on how much is passed, then the “what” we spend it on will make all the difference to how we age in the UK.

This is the next challenge for health and social care.