There is no magic fix for our social care crisis | Letters


The fundamental problems of social care are not structural, but derive from deficiencies in funding and provision. These will not be solved by dumping social care on the NHS (Revealed: NHS could take over social care, swelling budget to £150bn, 27 July).

Its problems would be resolved in part by providing local authorities with enough money to fund a decent level of service. The problem of provision is more difficult. Ideally, there should be a combination of private, voluntary and local authority services. The big business model for residential care is plainly unsatisfactory. Social care needs owners and managers who are committed to the welfare of their clientele. Voluntary bodies and local authorities can provide this, as can small businesses, whether freestanding or linked into franchises.

The NHS is a remarkable institution, but neither history nor recent experience during the pandemic suggests that it is the right home for social care. Social care is a personal service involving family, friends and community resources. It should remain a local responsibility under local democratic control.
Bill Utting
London

• The search is on, once again, for the perfect solution to the problem of social care. One flawed proposal is for a merger with the NHS. The NHS already has huge post-Covid-19 challenges in meeting the care deficit and promoting healthy lifestyles. Social care is very different from healthcare, and the NHS doesn’t have the organisation to manage it. An NHS takeover would throw away the very considerable expertise of social services built up over 50 years since the farsighted Seebohm reforms.

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The second magic solution would be a free service. This would be a massive subsidy to the longer lived, mainly the more affluent in the south-east – ie an end to levelling up before it had started.

The better approach would be through smaller-scale pragmatic changes that could include encouraging innovation in home care and extra care housing, improving staff pay and training opportunities, as well as collaboration with the NHS and continuity of care. It is also vital to phase out the cross-subsidy that is unfair to self-payers. All this would mean extra funding, but in more modest and predictable amounts with clear planned outcomes.

Sweeping statements are made about the “breakdown” in social care. In fact, Care Quality Commission data shows that 80% of care homes and home care give good or excellent service. The search for the holy grail should be called off in favour of pragmatic reforms that would be feasible and fundable quickly, and would use the initiative of dedicated staff.
Nick Bosanquet Professor of health policy, Imperial College London Andrew Haldenby Director, Haldenby Woodford

• It shouldn’t have been difficult for Camilla Cavendish to start the process of “finalising government plans for social care” (Camilla Cavendish: the woman charged with shaking up social care, 27 July). On his first day as prime minister, Boris Johnson stated that he had a fully costed plan for social care. He repeated this during the ITV election debate in December, adding that the details would be in the Conservative party manifesto.

Sadly, Cavendish would be wasting her time looking for these details – there was no plan, hence the latest review to look for a solution. Covid-19 has laid bare this neglect, as well as the stunning realisation that Johnson started making things up before he went into No 10, then repeated the same line to a voter, to her face, on live TV months later. Not exactly the most effective way to build trust, but Cavendish hopefully can avoid the long grass.
Andy Sellers
Stockport, Greater Manchester

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