Britain needs a national care service to heal divisions highlighted by the pandemic

Over the years, successive governments have talked about integrating health and social care services, but have failed to take action, says Arun Baksi

‘Nobody can tell when they might require support to live as independent a life as possible’ (Getty Images)

Britain urgently needs a national integrated care service that unites hospital care, primary care, community services and social care. This reformed structure would be administered by local care authorities that are democratically accountable and responsive to the needs of their communities – and supported by regional hubs.

In 1948, the NHS was established to provide comprehensive health care, free at the point of delivery for all who needed it and funded through general taxation. But social care remained the responsibility of local authorities, funded through local taxation but heavily means tested and subject to eligibility criteria.

The coronavirus pandemic has sharply highlighted that contrast and the damage caused by the continued division between the health systems and social care.

Over the years, successive governments have talked about integrated services. The paradox is that they have created divisions rather than integration; the creation of the provider-purchaser concept, the internal market, the continued fragmentation of NHS and the 2012 NHS and Social Care Act are some examples.

This division has led to an increasing lack of co-ordination between hospital and primary care. Significantly, the changes have resulted in multiple bodies rather than one authority providing the services, leading to almost total disorganisation.

Currently, a patient who suffers a heart attack does not have to pay for any future attacks or residual effects. Cancer sufferers receive care, free at the point of need, often spread over many years. Yet, an individual sustaining a stroke resulting in residual impairment of mobility becomes the responsibility of social care, as do those who suffer from dementia.

Both are then means tested. Nobody can tell when they might require support to live as independent a life as possible and the cost of such support is unpredictable.

Progressive cuts in funds to local authorities have resulted in an increasingly disjointed provision of care that involves jumping through many hoops. There is heavy reliance on informal care, imposing costs on families and the wider economy. Privately funded service users are subsidising state-funded users. Suffice it to state that the social care is not fit for purpose.

Jacob Rees-Mogg, the Conservative MP, wrote recently: “Every member of parliament will be aware of the deep unfairness inherent in the country’s health and social care provision.” Given the significant strength of the current government, the time is right for it to implement this obvious change now. Failure to do so would be irresponsible and unacceptable.

Dr Arun Baksi is a former Emeritus consultant physician. He has worked for the NHS for nearly 60 years and since retiring has been campaigning for this change. He started an online petition.