The future of health care and support

The fourth Care Conversation event heard the views of Shadow Minister for Health, Stephen O’Brien.

Policy makers were facing an ‘exploding demographic challenge’ when it came to social care, Shadow Minister for Health, Stephen O’Brien MP, told delegates. The key question was how to move to a revitalised public health agenda against the background of an elderly and aging population.

The NHS model was a good one, he said, but the sense of motivation within the organisation was ‘at times sky high and at others rock bottom’ – and at the moment it was undoubtedly facing a crisis of morale. ‘One of the biggest crises we’ve had is that our health professionals have become dislocated from what we want them to produce – improved health outcomes,’ he said, and a key challenge facing any government would be to make that motivation grow again.

This challenge was coupled with a ‘remarkably atomised care sector that needs to predict and provide what’s coming down the line,’ he said. It was difficult to predict where future funding flows would come from in a sector that was means tested and largely dependent on ‘what happens when an emergency hits.’

So from a policy maker’s point of view, what could be done? An aging population meant it was important to plan for things such as Alzheimer’s and dementia, as at the moment it was very much on a ‘wing and a prayer approach’, with most people making little or no provision for their long-term care. The situation could be moving towards one based on the decumulation of a proportion of people’s assets to pay for care, he said.

‘If we are going to have a genuine attempt to improve health care outcomes, then we need to focus on the care part as much as the health part,’ he stated. ‘At the moment people really only confront this in the event of an emergency.’ Governments could only provide the context in which health and care took place, and the ‘public health architecture’ had largely disappeared, he said. ‘There is not going to be the money there, as there is in the health sector, for the care sector,’ he said, stressing that the Conservatives were committed to individual budgets that straddled both sectors – however that then raised the question of the point at which something moved from being an episodic illness to a long-term condition.

There needed to be much greater joining up, he said, which could come partly through effective joint commissioning. The Conservatives were committed to the ‘any willing supplier’ principle, he said, and totally committed to the NHS. Care, however, had always been a mixed market. One obvious area of improvement was that the National Institute for Health and Clinical Excellence (NICE) approval process for drugs was currently not allowed to take into account wider societal costs – ‘for example drugs that obviate the need to put into place a very expensive care package at the earlier stages of long term decline,’ he said. ‘We say that’s a massive no brainer.’

There also needed to be a greater sense of competitiveness in areas of the care home sector, ‘spiralling up the quality of care’, he told delegates. The forthcoming Green Paper would set some of the terms of debate about future funding of social care, and the challenge in a recession would be to do this without a huge burden to the taxpayer, he said. ‘I don’t think there’s going to be new money, but there is a debate about whether money could be re-allocated from the health side.’

His party wanted to make people feel confident that their care was ‘not just part of the lottery of life’, he stressed. ‘As we go forward we have to make that seamless join of health and social care so that long-term care, when it comes, is not something to be feared and people and their relatives can be confident that they are getting care of the highest quality.’