Merging social care services with the NHS makes sense

And anyone who is really in the business of serving the public will agree

Councils have drastically raised the threshold for when they are prepared to help elderly people or those with disabilities (Corbis)

Maybe it’s the sort of conversation that you have when you reach a certain age. But I’ve lost count of those who tell me, often after losing an elderly relative, that there has to be something better than the desperate and humiliating mess that passes for our care system.

To those who have seen it at its worst, even Jeremy Paxman’s much-criticised euthanasia clinics on street corners don’t seem so bad. The number of those making living wills in the hope of ending their days with dignity has risen exponentially. Assisted dying may have been rejected by the courts and by the House of Lords, but popular pressure only grows. For some, a one-way trip to Zurich looks an ever more attractive option.

By and large, though, it is not the last days, even weeks, of utter dependency that concern us. With any luck, we’ll be high enough on morphine not to notice. It is the months and years before, when, with the right sort of accommodation and some help, we would have a good chance of coping, even enjoying life. But that housing and that help is just not there. Or if it is, it is so difficult to find and obtaining it so hedged about with restrictions that it is simpler just to soldier on. Those who do receive help from the state – real help, of the sort they need, when they need it – seem to the rest of us to have won life’s lottery.

This sense of trepidation about future care needs and the glaring contradiction, so it seems, between health care (free at the point of need) and social care (anything but) is addressed in two reports out this week. The timing is not coincidental. One aim is to catch the attention of politicians as they go into the last conference season before the election. But will they have any effect?

Dame Kate Barker’s commission, which reported yesterday at the King’s Fund, recommends – among other things – fusing the health (NHS) and social care (local authority) systems, so that people are not passed eternally between the two as each tries to avoid paying. It suggests an extra penny on national insurance for the over-40s to help pay for this joined-up service, plus means-testing of such benefits as free TV licences and fuel allowances. It was the “cuts”, alas, not the benefits, that captured the headlines.

The previous day, the left-leaning think-tank Demos had published the findings of its Residential Care Commission. Chaired by the former care services minister, Paul Burstow, it suggested, among other things, that hospitals use spare land (yes, they do have some) to build sheltered housing and care homes. It also wants private companies to build more retirement developments so as to tempt people out of the houses that are so badly needed by families. What is on offer at present, the report said, is simply not good enough to persuade people to move. Indeed.

My own view is that pretty much all of this makes sense, and pretty much all of it should be feasible – except, perhaps, for the one change on which most of the rest depends: the fusion of health and social care.

As Health Secretary, Jeremy Hunt has made a start, by diverting a small sum from the NHS to a social care fund, but this is tinkering. The two services really have to be brought together, not primarily for the savings that might result, but for the sake of the confused and abysmally served public. It’s not easy, though: the two sectors have resisted such calls before, and they will fight tooth and nail to defend their separate hierarchies and separate budgets.

In the last Budget, George Osborne shocked the insurance world by summarily abolishing their nice little earner, the compulsory annuity people had to buy with their private pension pot. I was amazed he had the authority, let alone the guts, to do something that would so obviously affect their bottom line.

Something similarly bold will be needed here. Of course, NHS staff will say the service can bear no more reorganisation; the social care establishment will warn of destitute 90-year-olds wandering the streets. But if these people are really in the business of serving the public, rather than themselves, they will knuckle down and get on with it.

Trierweiler should tell a little less

Granted that Paris Match, like any magazine buying book rights, will have chosen the most salacious morsels, and granted that Valérie Trierweiler had a difficult time of it as the first unmarried partner of a French president to reside at the Elysée – still, I feel that she has not done either herself or womankind many favours with her angry and self-pitying account of their break-up.

Thank You for the Moment, as her book is called, may be a novelty for the French, whose privacy laws protect public figures from prying eyes. But I doubt it will damage her ex any more than he has already been. After all, he left the mother of his four children to join Trierweiler, and the tales of his nocturnal motorcycling antics made him a national (and international) joke. “Discretion” used to be considered a virtue in France. I rather hope that, after Trierweiler’s outpourings, it might stage a speedy comeback.

Not fit for a king... or anyone else

Even if he never does anything else, Prince Charles has already left an honourable legacy in his description of a projected new wing for the National Gallery as a “monstrous carbuncle on the face of a much-loved friend”. The Carbuncle Cup, awarded in an online competition run by Building Design magazine, identified a true horror this year in Woolwich Central – a massive outcrop that combines the worst of 1960s council estates with clumsy, faux-modernist adornment. The judges described it as “oppressive, defensive, arrogant and inept”.

I was also gratified that Broadway Malyan’s Vauxhall Tower – which dominates the view from our kitchen window and resembles an out-of-proportion glass candle with a clichéd wedding-cake top – was the runner-up. It has only two saving graces: it’s so tall that it’s periodically lost in fog and it makes the still uglier (and already ageing) riverside ensemble beside it look a bit smaller than it is.

It turns out, though, that one of this year’s most-nominated buildings was eliminated as it’s not quite finished. The so-called “Walkie Talkie”, in the City of London, is an absolute shocker that eclipses both Woolwich Central and the Vauxhall Tower in its leering awfulness. “Carbuncle” would be letting it off lightly.