In his 1942 report William Beveridge said: “A revolutionary moment in the world’s history is a time for revolutions, not patching”. The challenges presented by our ageing population require as great a revolution in our health and care system today as Beveridge called for 70 years ago.
The NHS remains one of our best loved institutions, an organisation that binds us together, whatever our background, income or needs; the embodiment of ‘one nation’ Britain. However, the health and care challenges we now face are very different from those in Beveridge’s day.
When the NHS was created, average life expectancy was 66 years for men and 71 for women. It is now over 78 years for men and 82 for women. The period between cradle and grave will continue to expand in future, with one in four babies born this year set to live to 100 years old.
70 years ago, the main causes of death and illness were infectious diseases and accidents and many disabled children died at a very young age. Now, the major diseases are long-term conditions like diabetes, heart disease and obesity, which are strongly influenced by people’s own health behaviour, and life expectancy for disabled people has increased.
Some health conditions that are now common amongst very old people, like dementia, were virtually unknown in the immediate post-war period. Mental health problems are also more prevalent and widely acknowledged.
Social attitudes have changed too. People are far less deferential, it can no longer automatically be assumed that women will stay at home to look after their families, and disabled people have more rights.
Despite the many reforms and real improvements in the NHS over the last 70 years, our health and care system still hasn’t kept pace with the scale and nature of demographic and social change. But it must if it is to retain support in future.
There are four key challenges ahead.
First, health and care services must address people’s physical, mental and social care needs together, rather than treating them in separate silos as is still too often the case. Delivering ‘whole person’ care is vital to improving health, helping people work, and reducing waste and inefficiency.
Second, the focus of care and support must shift out of hospitals, into the community and more towards prevention. Beveridge himself talked about the importance of domiciliary care and rehabilitation services, but these have historically been neglected compared to institutional or hospital based care. Tackling this issue is crucial to reducing health inequalities and ensuring the extra years of life people live are spent in good health.
Third, the contributory principle that was so central Beveridge’s original report needs to evolve beyond people’s financial contribution alone. An effective 21st century care system would see individuals and their families as genuine partners, giving them more say, greater control and greater responsibility for their health and care, and better support to look after their elderly or disabled loved ones.
Fourth, achieving security in the ageing society means finally tackling the crisis in social care. Social care was excluded from the initial creation of the NHS. Yet three quarters of us will now need some form of social care when we get older and one in 10 of us will face care costs of over £100,000.
The failure to grasp the nettle of reforming social care is hurting us all. As councils face increasing demand with ever tighter budgets, fewer people are getting their care for free, quality is suffering, and care charges are soaring, affecting those on low and middle incomes alike.
Beveridge believed genuine social security could only be achieved through co-operation between individuals and the state. This partnership must now be at the heart of a new settlement for funding social care, so people can effectively plan for their future and be confident of security in their old age.