Alzheimer's Society CEO Jeremy Hughes has called on the government to make personal social care free in England, as in Scotland. He was responding to figures showing a 35% leap in hospital admissions for people with dementia in the past 5 years. Hughes attributed the rise to England's ‘scarce, inadequate and costly’ social care system (Campbell, 2020).
For many with dementia, entering hospital means a prolonged stay because of a lack of social care to support their return home. Hospitals cannot provide the individualised care someone with dementia needs. In an unfamiliar, stressful environment, these individuals are vulnerable to confusion, delirium, as well as other health risks of hospitalisation, including hospital-acquired infection, loss of muscle mass, falls and pressure ulcers (Andrews et al, 2017).
Scotland has provided free basic personal care to people over 65 years since 2002, and recently extended cover to all working-age adults. Scotland's system is not comprehensive; people with expensive care needs must fund additional services themselves, such as accommodation. Setting up a basic free social care system in England similar to Scotland's is estimated to cost £4.4 billion a year; more comprehensive coverage might cost £6–11 billion a year (Alderwick et al, 2019).
It may sound like a lot, but consider that, since June 2016, the gross domestic product (GDP) lost to Brexit is about £130 billion (Bloomberg, 2020), averaging £37 billion a year. Only a portion of that might have come back in tax, but even the higher figure of £11 billion is less than 1.8% of UK tax revenue in 2019 (£623 billion). Among the nine funding options considered by Independent Age, increasing National Insurance by 0.5% would raise almost £5 billion in 2020/21, which would be adequate for a basic system (Mitchell et al, 2018). Perhaps people should be asked how they want their taxes spent.
The Scottish experience over two decades has shown that free social care saves money by improving the health of those who receive it. There has been a considerable reduction in occupied long-stay hospital beds for older people, and an even greater fall in delayed discharges from hospital (Bell et al, 2013). One estimate put the single cost of delayed discharge in England at £3 billion (Andrews et al, 2017). Free social care enables older people to remain in their homes longer, living healthier, more independent lives (Mitchell et al, 2018). It is a preventive health measure.
If the world's sixth largest economy can fritter £37 billion a year for no tangible gain at all, it should be able to afford a fraction of that for free social care that will improve the lives of its older people. Scotland has shown that such a system is affordable, deliverable and popular, and the returns have been high, in terms of better health and reduced costs. It is a matter of political will.
We will all grow old and infirm at the end of life. Visit any nursing home and you meet people from all walks of life. Any one of us might need to call on state support in old age. Politicians need to be asked, what kind of social care do you want for your family and yourself?