Britain’s National Health Service still delivers decent care for those who can access a doctor or hospital. Far too many can’t. The NHS is buckling under an acute shortage of staffers and beds. A Covid backlog has ballooned to 7.2 million patients. Long-festering problems have combined to create a crisis in emergency care — with up to 500 people dying each week amid worsening delays and regular strikes.
There are no easy fixes. But there is one major bottleneck that must be resolved urgently: Britain’s system of long-term care, known as social care, is so underfunded and fragmented that it has compounded pressures on the NHS and exacerbated the crisis.
A patient with brain cancer is entitled to treatment at the NHS, which is taxpayer-funded; one with Alzheimer’s or long-term complications from a stroke, however, will be left in most cases to the social-care sector, where funding is means-tested. Although local authorities are largely responsible for funding such care, their budgets were eroded by a decade of Conservative austerity. As a result, the system has been overwhelmed and staffing has reached crisis levels, with more than 160,000 vacancies and turnover rates often exceeding 30%.
The failure of this system has had enormous knock-on effects. With social-care beds in short supply, only 4 in 10 eligible patients were able to be discharged from hospitals in July. Blocked beds mean emergency departments can’t pass patients to hospital wards for surgery or treatment. Overcrowded ERs mean ambulances are parked at hospitals for hours, unable to unload their charges and respond to new emergencies.
In addition to the human toll, this breakdown is imposing colossal budgetary costs. Simple elements of long-term care provision — such as balance and strength training for the elderly, which has been shown to reduce the incidence of falls and fractures — have been neglected, leading to added costs for the NHS of about £1 billion a year.
Prime Minister Rishi Sunak has pledged increased funding for health care and promised to address workforce problems. The government plans to block-book beds in residential homes so that thousands of hospital beds can be freed. Such fixes may get Britain through this winter, but they won’t create a system the country can rely on over time.
As one royal commission after another has noted in recent years, the UK needs to think bigger. As a start, it needs to improve coordination between the health-care, social-care and social-housing sectors. It has to collect better data to identify capacity and keep track of needs. In particular, it needs proper training and better career opportunities for social-care professionals.
It could also learn from models elsewhere. Successful long-term care systems — in the Netherlands, Germany, Japan — tend to focus on keeping patients independent for longer and reducing demand. They offer a continuum of care, from prevention to rehabilitation, as well as community-based services. They also have funding models that are transparent, sustainable and regarded as fair. A combination of general taxation, user fees and social insurance (paid into from age 40, for example) can help stabilize such systems and shield them to some extent from politics.
Of course, such reforms will only be the start of a broader — and more contentious — discussion on the future of the NHS. For now, Britain needs to tackle one crisis at a time.
More From Other Writers at Bloomberg Opinion:
• Strikes Are Bad for the UK Economy? Go Figure: Marcus Ashworth
• All I Want for Christmas Is No Emergencies: Therese Raphael
• What Does Sunak Stand For? His Party Needs to Know: Martin Ivens
The Editors are members of the Bloomberg Opinion editorial board.
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