IT is over 20 years since Tony Blair asked the late Lord Sutherland to head the Royal commission on long-term care. Since the Sutherland report, we have had endless inquiries, commissions and reports, but we are still no further forward on defining a long-term solution for the care and support of adults.
There have been recent announcements of significant extra funding for the NHS, but nobody in the Government or the Department of Health seems to be able to understand the interdependence between health and care.
When you see hospitals that are in crisis, it is often because there are not enough social care services to discharge people to when they have finished their medical treatment.
One of our major problems is that the notion of separate health and social care services is not fit for purpose in the 21st century. The challenge for 2018 is how to support people with long-term conditions, and by its very nature, much of that needs to be done within communities.
Yet we have a totally inappropriate approach to community care. We separate out community medicine from domiciliary care, and the older you are the less likely you are to receive the services you need at the required time.
What I want to see in the new Green Paper is a complete overhaul of community support services and a new way to join up medical and social needs. We need to see the staff in domiciliary care recognised as professionals, who do an incredibly difficult and complex job. We need to see integrated career pathways, so that staff in the NHS and social care receive the same training, conditions and reward, which will enable staff to move seamlessly between health and social care, just as citizens do.
I am also anxious to see a new definition of integration. All too often talk of integration focuses on the NHS, the local authority or the care provider. In my view this misses the point; real integration is about the experience of the person who uses the service.
When I am on a plane, I do not know when I leave Austrian airspace and enter German airspace, despite there being a lot of administrative processes all I experience is a flight from A to B. This must be the way in which we look at integration in health and social care, we should measure its success by the experience of the person who uses the service.
There are a range of practical things that could be delivered by the Green Paper. We need to start paying people who work in domiciliary care for their travel time, because this is an essential part of their job.
I would like to see the Government extend the agricultural diesel scheme to social care, so that social care staff are not paying huge amounts of tax on their fuel. I would also like to see local authorities doing simple things, such as issuing parking permits for domiciliary staff, so that they can easily and freely park near to the people they support.
There has also got to be a different approach to allocating community support, and it should be done before people go into crisis, rather than after the event. If we support people who are becoming frailer and more vulnerable to be as independent as possible, this will be better for them, and cheaper for the system.
Residential care is also a vital part of delivering care for people who need constant support because of frailty or conditions, such as dementia. Residential care can also develop a range of re-enablement services that help people to get more independent after a hospital stay, and eventually go home. All too often residential care is only given to people at the very end stages of their life, but it could be used more creatively for respite, re-enablement and convalescence.
The other issue I want this Green Paper to address is the one of ageism, which is rife throughout the system. Why do older people find themselves paying for services which they need because of a health condition, and yet we see a range of services to younger people free at the point of need?
There is a vast difference in how older people services are commissioned compared to those for younger people. In a country where there is an Equality and Human Rights Act, which supposedly protects you against ageism, I am at a loss to understand why our health and social care service has not been called to account for its ageist approach.
I also want the Government to use the tax system in a positive way when it comes to social care. I would like to see tax disregarded on inheritance tax for anything that a person has contributed towards their care. The current system sees people paying for their care, and then having a tax bill when they die, which takes no account of their contribution to society.
There is much that needs to be done, and the Green Paper is a real opportunity to get some innovation and creativity into our system, and we will not forgive politicians if they fail us again.
Professor Martin Green OBE is chief executive of Care England.