Why Andy Burnham’s anger over social care scandal must lead to real change – Henry McLeish
It’s time for a new ‘Beveridge’ moment for social care in Scotland and the rest of the UK
Andy Burnham’s recent speech on adult social care was inspiring, personal, honest, informed and angry, suggesting that, after a long period of political indifference, things could be about to change.
Speaking in measured tones, he revealed his profound disappointment at what can only be described as a modern-day scandal in which millions of people are suffering from neurodegenerative diseases such as dementia, and yet pleas from their families, friends and carers for help go unheeded because ‘it’s not health’. Instead, they are left pleading for social care crumbs from politicians and the various elements of an often less-than-enthusiastic NHS.
Burnham must confront questions about the definitions of ‘health’ and ‘social care’, as well as financial constraints and powerful institutional interests which seek to frame the issues as being about cost and obscure the importance of adult social care. The Prime Minister must push on, outlining his ideas now and in greater detail in Labour’s next manifesto.
‘Cradle to grave’
As First Minister, in the early years of the new millennium, my push for the introduction of free personal care in Scotland was met with overwhelming public support. It was intended to be the first instalment of a bigger project, reflecting NHS pioneer William Beveridge’s inspirational ideas about care from the “cradle to the grave” and “free at the point of need”.
Twenty-five years on, and now an Ambassador for Alzheimer’s Scotland, my disappointment has only deepened, my anger intensified. Adult social care remains in crisis in Britain, including Scotland, and faces more serious challenges in the future: an ageing population with underlying health conditions, chronic underfunding of services, cuts in local council support, and bed blocking leading to corridor care for hospital patients.
Families have seen the destruction of their finances, with dementia sufferers too often forced to sell their homes amid the deepening inequality of market-driven care. Poverty can shape the final years of loved ones and their quality of life.
This is the world of neglect where people suffer and die of diseases which the state refuses to accept as ‘health’ issues. A postcode lottery determines what is on offer, not what is needed, with cash-starved local councils facing unimaginable dilemmas.
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Under-funded, fragmented and too complicated
While debates about cancer care rightly focus on outcomes and quality of life, when we discuss adult social care and the various diseases involved, especially in the media, it tends to be about financial cost, suggesting there are no benefits for those with a diagnosis and their families, friends and others who make up a small army of unpaid carers. Burnham is right to be angry.
Social care provision lacks political commitment. It remains underfunded, unbelievably complicated, totally fragmented in its coverage and consistency, with an over-reliance on shrinking private investment alongside rapidly diminishing financial support from government to local authorities.
The medical establishment has ensured that social care remains in the shadow of the NHS, and seems reluctant to use its cash or influence to get ‘Cinderella to the Ball’. A “lifetime cap on care costs” was a key recommendation of Andrew Dilnot’s commission in 2011, yet it has been ignored by successive governments.
READ MORE: Scotland’s social care system has reached 'breaking point' and is 'piling pressure' on NHS
In Scotland, there are 60,000 people who have been identified in official health and social care records with a dementia diagnosis and a further 30,000 people with other neurodegenerative diseases. However, new research by charity Alzheimer’s Scotland suggests that between 300,000 and 500,000 people, including spouses, partners, adult children, close friends and neighbours, are affected by the disease in different ways.
Prevalence statistics are complex but, across Britain, there may be a million people with dementia, who must pay for adult social care despite their condition being completely health related. This scandal defies logic and is bereft of humanity at a time when dementia is now the leading cause of death for women and second for men in both Scotland and Britain.
Five steps
The Prime Minister has asked Baroness Louise Casey to report a year earlier on her current review of social care. This should be lead to a radical package of reform which becomes a central plank of Burnham’s next election manifesto, in 2029 or earlier.
In extraordinarily difficult circumstances, excellent work is being done by local government, the private sector, the third sector and trade unions, but this is neither rewarded nor recognised. Burnham must change the narrative on the social care crisis.
First, there should be some form of cap on lifetime care costs with the government picking up the bill above a certain threshold. Second, we should provide more generous support to councils for adult care, both at home and in the community.
Third, free personal care, already in Scotland, should be available across the UK. Fourth, it’s time to build the foundations of a National Care Service in England and in each of the other nations. It should be highly decentralised, free at the point of need and led by local councils with serious funding.
Fifth, in order to build a more resilient and healthy population, we should adopt a preventative healthcare approach, with more community involvement by pharmacies and health providers and learning lessons in care from countries such as Japan and Germany, which could result in billions of pounds being freed up from the NHS to help expand social care.
This is how the Prime Minister can turn his empathy into action. The World Health Organisation defines health as a “state of complete physical, mental, and social wellbeing, and not merely the absence of disease or infirmity”. This was adopted into its constitution in 1946. Britain signed up for this, and it’s time to make it a reality.
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