The Big Care Debate

Published on Wednesday, 03 March 2010 00:00
Written by Phil Hope

When the National Health Service was created in 1948, the concept of social care as we know it today did not exist. The world has changed a great deal in the last 60 years, and so have people's needs and expectations.

Improvements in health care mean that more of us are living longer and more of us are living with long-term conditions and disabilities. In fact, we are living on average 11 years longer than 60 years ago and the number of people over 85 will double over the next 20 years.


There are currently four people working to every one aged 65 years or over. But because people are living longer, by 2059 there will be around two people working to every one aged 65 or over. This means there are not enough people of working age paying taxes to support people of retirement age and there are more people in retirement age who need care and support.


Most of us - seven out of 10 men, nine out of 10 women - will need help in our daily lives as we get older. But, contrary to what many expect, help with personal care is means tested and only partly covered by the State.


The values we celebrate in a health system, free at the point of need are reversed in our care system as at times of great emotional stress the vulnerable struggle to pay for themselves. It is a cruel lottery. Older and disabled people can end up paying anything from a few thousand to hundreds of thousands of pound in care costs.


Together with stakeholders, we have worked incredibly hard to ensure that we got as many views to guide the radical overhaul of the system that's needed.


Many of you played your part in the Big Care Debate last year - the largest ever consultation on care and support.  As part of this, I met many families across the country and heard their remarkable stories of how care services have helped people live more independent lives. And also, some saddening stories of people who have really had to fight the get the care they need.

Of course, a key issue in the debate is about money. How are we going to fund care services in the future? Under the current system, many people have to pay themselves, an expense that few plan for.


I know some people are disappointed that we ruled out funding care services in the same way as the NHS, through general taxation. But the fact is an aging population means there will be fewer working age people paying tax and more people who need care. This would simply not be sustainable or affordable in the long term for young families today struggling to buy a home and bring up children.


So in our green paper, we outlined three options that included the state and individual paying in partnership, either through a voluntary or compulsory payment.


Last month we brought together the leading voices from care and support to canvas their views and the growing consensus from the sector is a comprehensive system that offers flexibility in how people pay.


Many suggested that there should be a compulsory element to this and that it should be based on peoples' ability to pay, not a flat rate. Two other aspects that were identified as key were a recognition of  the important contribution of carers and that change should be phased in over a period of time.


There was also a growing consensus on how a National Care Service should work. There was clear understanding that individuals would have to make a contribution to care in partnership with the state. It should also ensure a personalised system, which gave individuals and families maximum control of the care and support they get.


This is one of the most important debates facing the country. These are just some of the views I've heard over the past year and all of them have been considered carefully. We now need to build on the points of agreement, and the recognition that leaving things as they are is not an option. We will shortly publish our blueprint for a National Care Service that is simpler, fairer and more affordable system. 


Phil Hope MP, Minister of State for Care Services


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