The cost of social care is bankrupting local councils and threatening the NHS. The latest study points out that any reform based, like the so-called dementia tax, on property values must take account of how different they are in the south of England compared with the north or with Wales. Last week, the normally ultra-cool NHS boss Simon Stevens told MPs on the health committee that its budget was “extremely challenging” and unless it was increased, the NHS might not be able to meet patient demand. With both health and social care budgets under such extreme pressure, it is no surprise that the two arms of care, instead of being locked in a protective embrace of those who should be able to rely on them, are engaged in the most bad-tempered wrestling that informed observers can remember.

Surveying the wreckage of seven years of austerity, the chancellor, Philip Hammond, is under instructions to find a headline-grabbing initiative in next month’s budget to redress the generation gap. The dementia tax may have been flawed, but some kind of windfall tax on the huge increase in house values enjoyed by many older voters is one answer, and seems still to be in the mix. At the Tory party conference, it has now emerged that the social care minister, Jackie Doyle-Price, repeated the argument that it was unfair if old people who lived in valuable houses had social care bills paid by the state.

There is no question that social care desperately needs more cash. In its budget submission, councillors argued that by 2020 councils in England will have lost £16bn of core funding. There will be a shortfall of nearly £6bn by the end of the decade, and despite the extra cash for social care that was released earlier this year partly to meet the cost of paying the higher living wage and partly to keep residential care homes afloat, £1bn of that will be in social care. Councillors say there is not a penny of slack in care home budgets, where fees are so squeezed that without cross subsidy from private residents – sometimes of as much as 50% – some care homes would cease to be viable. Nor is there an argument about the role that councils have to play in making sure care packages are available so that people can be discharged from hospital. But, as winter approaches, the pressure that government is putting on both the NHS and councils to enable patients to be discharged is driving to breaking point the tense relationship between the two different providers. While healthcare is free and social care is means-tested, it won’t heal.

This is not an insoluble problem. It is not all about money, although money is needed right now to keep the service afloat. As the economist Kate Barker said when she published her report for the thinktank the King’s Fund three years ago, there is a sustainable and affordable answer. But it would mean some structural reform and the gradual extension of free care, starting with critical care and extending to those with substantial needs as money became available. It would mean a bigger bill for the taxpayer, but a much more coherent experience for patients and their carers. It would end the disputes between NHS and local government over who pays for what, and it would reward cooperation. In Manchester, where integrated health and social care is already being pioneered across the region, the mayor Andy Burnham – a former Labour health secretary – is already pressing Mr Hammond to allow him to raise a levy that would enable him to introduce free social care and joint budgets. Mr Hammond should listen.

The crisis in social care has been predictable, and predicted, for a generation. The failure of successive governments to think clearly and build consensus around a solution is a bleak indictment of short-termist democracy. Like a patient too scared to see the doctor, their cowardly approach has allowed a complex but soluble problem to snowball into a threat to the welfare of thousands of Britons – and even to the sustainability of the NHS.

Source: Guardian