Opinion

Equitable access to great care

Sir Norma Lamb

Music for Dementia is a national campaign leading the call to make music freely available as an integral part of care for people living with dementia.  Some of the UK’s most respected experts in the field of dementia, music, health, social care and politics are supporting the campaign.

Over the next three months we will be publishing a series of articles to provide expert comment on dementia and music as well as the broader health landscape we now find ourselves in.  This first blog by Sir Norman Lamb, presents a look at lessons learnt during the COVID crisis. 

The COVID crisis has really exposed the cracks and frailties in both the NHS and the social care system. For years, we have run the NHS on close to breaking point with little spare capacity. By international comparison, for example, we have a very low number of intensive care beds. In social care, the position going into this crisis was even more precarious. Many providers faced challenging finances. The numbers of older people, including many with dementia, who receive help with their care needs has been in decline for years as local authorities tried to cope with significant cuts to their funding from central government. Care staff are under-valued and under-paid.

Then COVID hit. Thankfully, the NHS was not, ultimately, overwhelmed but it has been a torrid time for so many staff working on the front line. Many doctors and nurses have experienced real trauma, and total exhaustion, as the death toll rose. They have felt let down by inadequate stocks of PPE.

As for social care, yet again, the sense is that it is the poor relation. With all the focus on what was happening in acute hospitals, it felt like care homes had been forgotten. Patients discharged from hospital into care homes without being tested for COVID, wholly inadequate supplies of PPE and yet here we had the greatest concentration of people who were most vulnerable to fatal consequences of contracting COVID.

So, as we look ahead, the first conclusion is that lessons must be learnt, not just for the next time we are hit by a pandemic, but to repair and rebuild a fragile and inadequately resourced health and care system.

I had spent the last four years of my Parliamentary career leading efforts to persuade the Government to establish what I called a ‘Health and Care Convention’ in order to build a consensus for a new settlement for the NHS and for social care. The case for this is now overwhelming. Getting people to pay more for public services is always challenging politically. Parties become wedded to the idea that the public would never stomach an increase in taxation. And so election manifestos always fall short. Surely, therefore, we have a duty to the people of this country to bury our differences and to work together to come up with solutions. William Beveridge, back in 1948, proposed the founding of the NHS. Now, 72 years on, is the time for a refresh – and it is time to recognise that you can’t achieve a sustainable solution for the NHS unless you also sort out the funding of social care. What’s more, you can’t achieve effective support for people unless we join up our fragmented system so that care is based around the needs of the person, rather than focussing on organisational boundaries and demarcation disputes about who should pay.

As we seek to learn lessons from this crisis, we should also look at how other countries coped. The truth is that we spend less on health and social care than many other leading European countries. And look at Japan and Germany, which have confronted the failures of their social care system and implemented more sustainable funding arrangements.

We will have to ask ourselves the uncomfortable question about why it is that healthcare systems around Europe based on social insurance tend to be better resourced and have, for example, more intensive care capacity.

So now is the time to confront these questions. For the sake of those who rely on health and care services, this cannot wait. And it cannot just become another political football smashed back and forth whilst people suffer.

This COVID crisis has led to much soul-searching. It has helped many of us reorder our priorities. My dream is that we grasp this moment; that we involve the people of this country in a national discussion and that we commit to building a modern, joined up health and care system.

Here are some basic principles to guide us. It must aspire to be, genuinely, the best in the world in terms of outcomes for people. It must have equitable access – whatever your wealth or income, you must have the same right of access to great care. We must focus much more on prevention of ill health. We must seek to empower people and families. There has to be equality between mental and physical health. It should not matter whether you have cancer or dementia – your right to outstanding support should not cause catastrophic financial loss. Finally, we should learn another important lesson from this pandemic. Command and control from the centre has not worked. More decentralised systems seemed to have fared better. By joining up our health and care services in each locality and by pooling recourses, we are likely to achieve better results for people.

 

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