Let’s care about the future of care

Back in 2024, I was invited to a 200-year anniversary dinner at the University of Manchester. The pre-dinner speaker was Sir Chris Whitty, currently the Chief Medical Officer for England. He spoke about how the population’s health has changed over those 200 years. Chris is a great speaker, and uses data very effectively in getting his point across. One of my take aways from that evening was the notion that if we live long enough, we will all get cataracts and some form of dementia. It was a sobering thought.

The last couple of weeks have seen much discussion about UK social care, much of which has been focused on the financial and emotional costs of caring for someone living with dementia. The Prime Minister’s father lives with dementia. My mum lived with dementia in the last decade of her life.  Despite the very best efforts of my dad, my brothers and sisters, eventually mum’s needs meant that she could no longer be cared for at home, and she was admitted to a residential care home. She died aged 91.

Hers is a familiar tale. In March this year, there were nearly 800,000 people aged over 65 who were said to have dementia in the UK. Nearly 500,000 had been formally diagnosed with dementia. It estimated that by 2040, there will be 1.4 million people living with dementia. Currently the cost of dementia across the UK is £45 billion. By 2040 it is estimated this will increase to £90 billion. These are State borne costs, and account for almost 78% of local councils funding across most of England.

Individual families are often faced with meeting the costs of their loved one’s care. Residential care averages at around £1000 a week. Where nursing care is also required, such as that my mum received, the cost rises to an average of £1300 a week. My mother’s care was funded through the NHS due to her primarily having health-based needs. The dementia just added to her overall complex care needs. While help with such costs is available there are strict criteria that often make accessing such financial help difficult. For example, if you have savings of more than £23,400 you are not eligible for any financial help. People can require residential nursing care for many years, and the overall costs of such care can run into £100’s of thousands. Many families have to sell off their parents’ house in order to pay for the costs of care.

Surprisingly, a survey undertaken by the Kings Fund last year revealed that 33% of those asked believed such care was free at the point of use, with a further 18% stating they didn’t know. Despite what Chris Whitty had to say about if we all live long enough, we will all get dementia, currently 1 in 3 people alive today will be diagnosed with dementia.

Last week saw Baroness Louise Casey announce the start of her ‘Big Conversation’ as part of her review of adult social care in the UK. The review is said to provide the evidence required to create a National Care Service. The ‘Big Conversation’ is aimed at both gathering people’s experiences of the current system, and educating people about the realities of social care. Against such a background it is perhaps not surprising that our new Prime Minister has set solving the problems of creating a National Care Service as one of his high priorities. Last week he bluntly observed that the NHS is likely to collapse without the effective reform of the current social care system. The delivery of the outcomes of the Casey review has now been brought forward by 12 months.

However, Burnham has a tough task. Securing cross political party support is but just one issue, persuading people to pay (in one way of another) for social care services, is also likely to be difficult. Finding people with the skills and knowledge to provide such care will require a different way of thinking (maybe a unified national health and care workforce) as much as it will require future investment. I don’t know what the solutions might be, but I feel that none of these challenges should be seen as insurmountable problems.  

I’m on the waning side of the Chris Whitty life trajectory. That said, I am an early baby boomer. Over my lifetime I have benefited from greater economic opportunities, had the best the NHS has been able to provide, and continue to benefit from the triple locked UK pension system. I’m living a life far removed from poverty, (although of course there are many folk my age who are not so fortunate), and touch wood, I enjoy good health. However, for the sake of us all, I sincerely hope this time around we can achieve a breakthrough in what has so often been seen as intractable issues in delivering a national care service.