Should "Care" be part of the NHS? If do how would you pay for it?

Continuing to pay NI, (graduated to fit income level) seems perfectly reasonable to me. Totally sensible, in fact.

Also a prescription payment of some kind.

Compulsory insurance, with a payback clause if not used.

Lathyrus3

Continuing to pay NI, (graduated to fit income level) seems perfectly reasonable to me. Totally sensible, in fact.

Also a prescription payment of some kind.

Yes it would have to be graduated Lathyrus3. That would also be an opportunity to look at NI overall, applying it to passive income (it isn't at the moment).

Could you just extend the current prescription charges?

Flippinheck

Compulsory insurance, with a payback clause if not used.

I don't know of insurance policies that work that way Flippinheck. It would make it a hybrid Health Insurance/Life (death) insurance. Is there an example of such a thing?

The prescription charge needs thinking about because nobody would want medication to be beyond the reach of anyone.

But Ive been quite horrified of the extent to which some of my contemporaries rely on medication to ameliorate conditions that could be dealt with by more attention to life style. Things like diabetes, high blood pressure, digestion etc.

As one of them said to me about her conditions whilst sitting in her chair all day, eating a take away “Oh I don’t have to worry, the tablets sort all that out”. I can’t help feeling that if prescriptions had to be paid for people might think twice. I’m pretty sure she would. 😬

Anyway that’s a bit of a diversion and I know there’ll be posts saying “Ive tried to get my weight down etc” but I don’t think people realise how much medication costs. The feeling is, it’s free.

And the medical profession dish it out like it’s free too!

Social care should definitely be funded centrally.
I saw an infographic from Newcastle City Council yesterday that showed that 55% of council expenditure went on social care.
18% went on education. I think this is shocking.

No wonder younger generations complain about the boomers getting more than their fair share.

I’d be happy to pay into some contributory scheme if at least part of it was refunded to my estate.

I wish there was some way f ensuring care if it becomes necessary in old age.

Ive been holding on to a pot of money as insurance against needing care and I know most of my friends are doing the same.

Now I don’t think I have to worry about that Ive been spending happily. Think of all the money that would be released into the economy if that worry for the future was removed.

😁

I completely understand your point of view Lathyrus 3. I’d just like to say that I’ve struggled for a long time with blood pressure and cholesterol issues. Despite my best efforts I haven’t been able to achieve the right levels without the help of medication. I’m not at all overweight, don’t smoke, have 1 alcoholic drink a week, get exercise and eat sensibly. My GP says this isn’t uncommon and that the medication is essential for me.

Yes of course “care” should be part of the NHS. It’s shouldn’t be called “care” either! So many illnesses and conditions are wrapped up in this word and hidden!

How we pay for it is way above my pay grade but Id think NI contributions is a start and yes should be a life long tax on everyone eligible to pay.

Some kind of policy is an idea but difficult as insurance company’s are all about making money. Perhaps something linked in some way to the NHS.

More power to those in public office who are truly concerned and are willing to listen and try to help the system and ultimately the people of this country.

It frustrates me when I hear politicians from different parties unwilling to listen to all the people.

The interface between care and health has always been chaos - I know - I worked as an LA funded social worker in hospitals and clinics for years.

Trying to separate it all out is a minefield as they overlap.

We now have an expensive and wasteful system to try and unpick these in the form of Continuing Care assessments/reviews/appeals where LAs and the NHS battle it out as to who should be picking up the tab, and patients and their families have to try and work their way through the labyrinth of rules and regs (and often professional ignorance of the rules) and often finish up having to get legal advice - there are whole legal firms set up to deal with this and making loads-a-dosh from it. It is totally mad!

Ages ago a local initiative tried to coordinate this and it fell at the first hurdle as they were bound by national legislation at every turn.

I am hoping that a government one day will have the courage to grasp the nettle and do something radical. I think we need a system that is funded by a combination of state funding and compulsory insurance (with the option of private top-up insurance) as operates in many countries.

So much money is wasted on unpicking the two when the reality is that they are inextricably intertwined in ways which cannot be separated without leading to the sort of mess we have now.

Patients "block" beds for weeks while care is sorted by a different authority. It is quite crazy!

aonk

I completely understand your point of view Lathyrus 3. I’d just like to say that I’ve struggled for a long time with blood pressure and cholesterol issues. Despite my best efforts I haven’t been able to achieve the right levels without the help of medication. I’m not at all overweight, don’t smoke, have 1 alcoholic drink a week, get exercise and eat sensibly. My GP says this isn’t uncommon and that the medication is essential for me.

Yes, I take some stuff myself now so I do know sometimes your body won’t do as it’s told!😬

I don’t have an easy solution to prescription charges but except a feeling that those who can pay, at least something towards the cost, should. I can afford to pay a charge more easily than that one of my neighbours who is in her forties. But because I’m old I don’t 🤔

I've always thought those of pension age should pay NI over a certain level of income even if it was at a reduced rate.

Some people do receive funded care but the conditions are very specific.

I’m not sure the question fully defines what you mean DaisyAnneReturns? Are you talking about all the provision which is arranged by Social Services departments, for people of all ages, including children and disabled younger people, as well as elderly care services? Are you including those elements of care for older people which are purely social? Where is the link with residential, supported and extra care housing that you envisage? Sorry to be persnickety, but it’s a very big issue, and it needs parameters to understand what you’re suggesting.

Granniesunite

Yes of course “care” should be part of the NHS. It’s shouldn’t be called “care” either! So many illnesses and conditions are wrapped up in this word and hidden!

How we pay for it is way above my pay grade but Id think NI contributions is a start and yes should be a life long tax on everyone eligible to pay.

Some kind of policy is an idea but difficult as insurance company’s are all about making money. Perhaps something linked in some way to the NHS.

More power to those in public office who are truly concerned and are willing to listen and try to help the system and ultimately the people of this country.

It frustrates me when I hear politicians from different parties unwilling to listen to all the people.

I can only agree with It’s shouldn’t be called “care” either! Granniesunite. Even more it shouldn't be called "social care". If you can't do something because of your health it's a health issue. I would add teeth into the mix but I don't want to go off topic. Just to say that not having functioning teeth is a disability.

I would really suggest we DONT outsource this. Outsourcing has stripped the government of enough assetts.

That's my thinking as it happens, Casdon I am thinking all health related care ... I think.

I think things such a fostering would remain under the council auspices. But tell me anything more I need to know - I come to learn.

I’ve got very mixed views. I don’t think the function of the NHS is to provide any form of social care myself, because it will be prioritised against healthcare to its detriment. In my opinion people with additional learning needs, and children, whose personal and social needs are both better served by being part of communities should be Local Authority responsibilities. Mental health services are similar, but the interface for the severely mentally ill is much greater than for the other two groups.
For older people, there are millions more in need of social care than NHS led care. I think I’d lean towards Local Authorities taking the lead rather than Health because that will keep more people independent for longer. The issue with Health leading (speaking as a health professional) is that care becomes medicalised, and the system always wants to look after, rather than allow independence with risk. That’s no doubt a controversial view, sorry.

The problem with it being the responsibility of Local Authorities is that the need is equal across the country. Some Authorities buy social housing in cheaper parts of the country and rehouse there. Thus offloading any ongoing expense of provision for other services. These areas are, of course, those whose inhabitants are on low income anyway.

Other Authorities just by their location have a greater call on their social provision.

isn’t equal

No, it shouldn't be part of the the NHS but I agree there is a lot of wastage around people thinking medication is the answer when people just need to make the right lifestyle choices. It is important to given them the right support in this though, and support for mental health is part of it.

Lathyrus3

The problem with it being the responsibility of Local Authorities is that the need is equal across the country. Some Authorities buy social housing in cheaper parts of the country and rehouse there. Thus offloading any ongoing expense of provision for other services. These areas are, of course, those whose inhabitants are on low income anyway.

Other Authorities just by their location have a greater call on their social provision.

I know. That doesn’t preclude a Local Authority based model though, because it can be weighted - and the same issues would still arise if Health was the lead, people would still be moved to cheaper areas.

I'm not sure that NI is the way forward, as that seems to be a tax on work, which is not fair. Too much is expected of those who go to work and make compulsory contributions to the treasury, when those who don't get the benefits of living in a welfare state at no cost. Or no income tax cost, anyway.

As it stands, people who have worked, saved and bought houses pay for things that those who have not get free, which is a cause of a lot of resentment. I don't know how to make it fair but also humane, though. Nobody decent wants to see workhouses or paupers' hospitals coming back, but too many people seem to feel entitled to a free ride through life, and IMO one of the reasons for Reform's popularity is that people have had enough of being forced to provide for that. I understand their frustration, but find the thought of a Reform government terrifying.

We need a radical shake up of taxation, and a proper social contract, IMO*. I am very much in favour of a welfare state and of the strong protecting the weak, but that should be on the assumption that if people are capable of contributing then they should do so, and nobody should feel that they are being exploited.

* By this I mean things like a pension system that entitles people to a return on their contributions, rather than one where they are told that they have not contributed to a 'pot' and should be grateful for the 'benefit' of a pension that is often lower than the pension credit they may have got if they hadn't contributed at all. Basically, we need to know that if we do (a), will will get (b) when we need it, with no reneging when the time comes. If people choose to opt out, and there is no good reason for doing so, then everyone needs to know what (c) is likely to involve. I'm not suggesting that it should be punitive, but it should not put people in a better position than if they had done (a) in return for (b).

I think I've made that more complicated than necessary, but I hope it makes sense

I have an adult child who has a severe disability and lives in a residential care home. It's partly paid out of the social care budget and a percentage is paid by health services (the NHS) The residential home is ran not for profit by a charity and they pay for certain services and there is an element of other charities funding things such as days out, holidays etc. We are lucky.

I suppose we have to question whether the NHS can meet the needs of people with complex disabilities, especially learning disabilities with the resources they have? the answer is no.

There is just a lack of planning by central and local governments who seem to ignore the fact that all these children in special school requiring respite so their families can function and they are able to receive enrichment, are going to need respite or residential care in the future.

Casdon

I’m not sure the question fully defines what you mean DaisyAnneReturns? Are you talking about all the provision which is arranged by Social Services departments, for people of all ages, including children and disabled younger people, as well as elderly care services? Are you including those elements of care for older people which are purely social? Where is the link with residential, supported and extra care housing that you envisage? Sorry to be persnickety, but it’s a very big issue, and it needs parameters to understand what you’re suggesting.

Good post, Casdon.
I don't think it should be part of the NHS as the NHS is such a big organisation already & that does bring problems as well as benefits.It already deals with mental health provision as well as cradle to grave physical health.
Maybe a centrally funded service for care provision would be workable, and there is a clear crossover with nursing care in residential homes, and community care where the practice nursing team are part of the day-to-day care as well as carers for personal care & meals.But the NHS is big enough!
Residential care & insurance is difficult because some elderly people are happy to go into residential care & not have the responsibilities, even though their mobility / cognition isn't too bad. Others want to stay at home with extra help & others again won't even accept that, until they end up in hospital through self-neglect. The costs are very different for a different person with the same functional capacity, depending on their attitude / preference (& what unpaid support they have); insurance would have to enable the right solution, not impose one.

I agree Casdin that it wouldn’t make any difference if health was the lead but there is no “weighting” to to enable poorer areas to provide for people moved out by other authorities. Indeed thise authorities make it worse because they pay a bit over the odds to purchase houses thus making homelessness greater in the area and therefore a greater call on the Authorities resources.

Social needs should attract attached central funding, I think, based on numbers and needs as they are present.