Stop arguing about who pays for care and figure out why it costs so much
Part of the problem with Britain’s care system is that we are paying crisis prices for problems that cost much less to prevent, writes Dr Ben Maruthappu
At the end of July, I sat a metre from the Prime Minister at a care home in Golders Green as he set out his plans to fix social care at last. By breakfast the next day, Westminster was already having the wrong arguments about income tax or inheritance tax, levy or estate charge, £6.5bn or £18bn, “care tax” or “death tax”. This row has hampered reform for 30 years and it’s one I’ve heard since my nights as an A&E doctor.
The problem is that we keep starting with who pays rather than asking why care costs so much in the first place. Whether free care is affordable won’t be settled in the Treasury, the answer lies firmly in the delivery model which we know, right now, is broken.
Surgery did not become affordable because we taxed people more to fund week-long hospital stays. Keyhole techniques turned people into day cases and the costs came down. Care is overdue the same shift to stop Britain paying crisis prices for problems that cost much less to prevent.
A case study for free care in Hammersmith & Fulham
A hospital bed costs around £562 a night but four daily home care visits cost about 10 times less. In June, 13,600 hospital beds were occupied by people well enough to leave but with no care to go home to. That means we’re paying 10 times over to keep people in the one place they least want to be.
However, one London borough has managed to break the pattern by offering free home care. 1,500 people a year benefit from this in Hammersmith & Fulham whose council has put up £19m funded, its leaders say, by ruthless efficiency rather than new taxes. And since charges were scrapped in 2014, the number of older residents in care homes has almost halved. This is because when care is free, people accept it before the crisis rather than after, and a carer who visits daily catches the infection on Monday that would be Friday’s ambulance.
In Hammersmith last year, Cera’s AI that spots deterioration days before it becomes an emergency prevented an estimated 296 hospital admissions. These AI tools are already in use across the UK, halving avoidable hospital admissions and cutting falls which, in turn, saves £2m daily for the NHS and government.
A place for AI
AI-enabled care robots already sit in the homes of older people across 14 local authorities. These are able to remind users to take their medication which is now done on time in 96 per cent of cases and alerts the care team if a check in is missed. Councils deploying these robots report savings of up to £11,500 per person per year.
The fair objection is that councils with weaker tax bases could never copy Hammersmith. But the £6.5bn the Health Foundation says free home care would cost assumes we keep delivering it the old way. In many ways, Hammersmith’s care delivery model and its focus on prevention are actually much more impressive than its balance sheet.
It goes without saying that technology must never replace the human heart of care because while a robot can prompt and report, only a person can comfort and notice. But with an estimated 96,000 vacancies right now in social care, technology can help to take away some of the administrative burden so carers can do the caring.
Baroness Casey’s review, commissioned by the PM to set out how England can build a more affordable, preventative social care system, is an opportunity to change this. It should ensure that each new pound buys reformed delivery by commissioning outcomes like fewer falls and admissions or more independent days at home. It should make preventative technology as routine in a care package as a stairlift.
22 attempts at reform have died on the hill of who pays. After 30 years of arguing, it’s time we fixed what we’re paying for.
Dr Ben Maruthappu is an A&E doctor turned founder and chief executive of Cera, a UK home care provider