Queen's speech: social care reforms are doomed from the start

The real solution for the failings of the current system would be to reunite the founding principles of the welfare state
Queen's speech
The government trailed its social care reforms in the Queen's speech. Photograph: Pool/REUTERS

It seems highly unlikely that the government's proposed social care reforms, trailed in the Queen's speech, will get social care out of the mess it is now in. To just stop starving social care of money is also unlikely to be enough on its own. As David Brindle reminds us, we may have to go back to the creation of the welfare state in 1948 to make sense of what's gone wrong. What we also perhaps need to do, instead of just rehearsing again the inherent failings of the current social care system, is to look more closely at what may have gone wrong with the NHS after its creation.

What's interesting when hearing from pioneers who worked in the NHS from its earliest days, is that it didn't seem to draw the same hard and fast lines between medical and social that we have grown used to. There was no suggestion then that people living with dementia or who were very frail were the responsibility of the local authority and social services. GPs and other healthcare staff seemed to have a great sense of their social, as well as medical responsibilities. There was no automatic and crude reframing of conditions such as Alzheimer's from being a medical to a social responsibility, as sadly came later, so that people affected were pushed from the NHS pillar to the social care post.

The increasing preoccupation of the NHS with acute medical issues, rather than longer term social conditions, wasn't necessary and automatic. It wasn't the only route that could have been taken. It could be said that the less thought through role of the local authority as caregiver in relation to elderly and disabled people in 1948, with the abolition of the poor law left this door open. But we must also remember that before Margaret Thatcher came to power, a growing number of local authorities were providing free social care services, and means-testing did not feature in social care in the way it does now.

What really cemented the divide between health and social care that is so antagonistic to our changed social and demographic conditions, were the reforms initiated by Thatcher. These reforms reinforced distinctions between health and social care, and resulted in the divided and damaging system we have now. With the 1990 NHS and Community Care Act, the NHS retained its essential principles of being a universalist service free at the point of delivery. Social care became an increasingly residual needs- and means-tested service for which people had to pay – even at the risk of losing the homes that Thatcher had encouraged them to buy.

That is why this government's proposals for social care reform, like its predecessor's, seem doomed from the start. They retain the essentially separate and different underlying principles of the two systems and their vastly different bases for funding. It is only when we return social care to the fundamental principles of the NHS; a service funded out of general taxation, that there is likely to be a possibility of reintegrating these two incompatible systems.

Only then are we likely to see the sustainable, fair and inclusive system of support for disabled and older people that all political parties sign up for rhetorically, but run from for reasons of political and electoral expediency. This is also only likely to happen when they stop seeing social care as a policy framed in terms of people as burdensome and dependent. Instead they must open their eyes and see it as providing the basis for a creative, life-enhancing social and economic enterprise that can be a pillar of economic development for society. In other words, a source of worthwhile and valued employment for citizens, and a route to greater independence for service users – young and old– and their families.
