Polly Toynbee is right to underline concerns over how the government’s immigration proposals are likely to significantly worsen existing serious staffing problems within social care (Social care is crumbling, and Johnson has no idea how to fix it, Journal, 21 February). I was, however, surprised that she did not argue the point that, while additional care funding might alleviate some of the current difficulties, any long-term solution to what is not unreasonably termed the current “crisis” has to involve addressing its relationship with the NHS.
She makes the point that NHS staff doing similar work to those in social care get paid more. But, as the needs they are dealing with and the skills they require are similar, in addressing the very real problems in social care, shouldn’t we be asking the fairly obvious question as to why on earth we have separate health and care systems in the first place? Having spent my entire working life in social services and the NHS – meeting many of the great and good of both sectors along the way – I have yet to meet anyone who can offer a clear definition of the dividing line between the two when, for example, addressing the complexities of something like dementia.
But the lack of a unified approach to health and care leads to a scandalous waste of scarce public resources, especially as a consequence of the longstanding issue of delayed transfers of care from free NHS hospitals into means-tested provision within the community. Formally integrating the two systems would lead to a far more humane approach to dealing with the needs of individuals and, logically, to the gradual alignment of staff terms and conditions, which would be of particular benefit of care staff.
A long-term political goal should undoubtedly be universal free social care, as well as free NHS provision. Of course it will cost money but if, alongside ending the gross inefficiencies of two separate structures, the privatised care system is gradually returned to public ownership, I suspect there may be far more public resources released than most people realise.
David Hinchliffe
Chair, House of Commons health committee, 1987-2005
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