I KNOW that voluntary services are working across the country in tandem with the NHS to provide excellent care to our constituents, but they are under pressure as never before.
There is a devastating impact on those affected – those who are not getting the care services they need. Not only working-age adults but older adults, and their families.
There is also an impact on the NHS. If people cannot access care services, there is not only an impact on their dignity, mobility and wellbeing but they are much more likely to end up in hospital – a place they do not want to be and at much higher cost – sometimes with serious illnesses or injuries that could have been avoided by better prevention and early intervention.
We need to deal with this issue, and the House of Commons needs to appreciate the scale of the challenge.
Let us look at the demographics. We know from the Office for National Statistics that, last year, 18 per cent of our population nationally was aged over 65, but that in 14 years’ time 23 per cent of our population nationally will be over 65.
Of course it is a good thing that people are living longer, but they are living longer with multiple disabilities and we need to be prepared for that. We need to be prepared not only for the scale of the shortfall we face right now but for what is coming in the future.
When we talk about social care funding, we need not only to acknowledge the impact of the shortfall we have here and now, and how we are going to deal with it, but to plan seriously for what is coming down the track.
I am afraid that one of the features of such debates is that the blame bounces backwards and forwards when, in fact, cross-party working and consensus building is what is really needed.
The funding choices we face are difficult. I agree with those who say this cannot all be funded at a local level. Doing so just widens inequality because the areas that are least able to pay have the greatest need. It is unrealistic for everything to come from a local level, so we need to work towards a national solution to the problem.
We can move forward, but if we have learned anything from the Brexit process, surely it has to be that we cannot build consensus at the end of a process; we have to build it in right from the start.
I hope that the Green Paper will be designed to achieve that, and that it will set out the principle of fairness in the funding of social care.
One statistic that we should all be aware of is that in the next 14 years there will be 4.4 million more citizens aged over 65 but only 1.5 million extra citizens aged under 65.
It is simply not sustainable to allow all the extra cost to fall on working-age, employed adults, so we must look at how to spread it fairly across the generations and between the employed and the self-employed.
If we are truly to move towards a system that expands not only eligibility but quality, we need to bring more funding into the total system; the funding cannot just come from local sources.
The wrong lesson to learn from the last general election campaign would be “Don’t ever set out who has to pay more”. We all need to do that now, between elections. We must be realistic with our constituents about the fact that everybody needs to pay more, and we must build their trust in the idea that the increase will be delivered fairly.
The consequences of doing nothing will be that more and more of our constituents will be left in desperate conditions, without carers to look after them; more and more of our care providers will go to the wall; and there will be no increase in the quality of care delivered on the ground, because there will not be the funding to support the workforce. We have to grasp the nettle with these difficult choices.
Before I close, I want to say something about Brexit. There is no version of Brexit that will deliver anything positive for health and social care, especially if we look at the impact on the workforce. Social care is very heavily dependent on access to a workforce from the European Union. That is also the case in my constituency.
Nationally, around seven per cent of the social care workforce are from the EU. If we cut off access to that workforce, not only will we miss out on an incredibly important and valued skilled workforce by making it more difficult for them to come here, but we will add costs.
We need a way to nurture our workforce and to make it easy for people to come here to work and to feel valued.
I do not want to meet any more people who work in the NHS and social care and tell me that after decades of dedicated service to this country, they no longer feel welcome.
Dr Sarah Wollaston chairs Parliament’s Health Select Committee. She is a Change UK MP and spoke in a Commons debate on local government and social care – this is an edited version.