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The complex relationship between health and social care has been thrown into stark relief in Birmingham over the pa...
The complex relationship between health and social care has been thrown into stark relief in Birmingham over the past week, where the number of elderly people stuck in NHS hospital beds because there are not enough council-funded nursing and residential care home places has caused a crisis across the city's public services.
By the weekend, the NHS was funding nearly 400 beds and had cancelled around 700 operations in total as it struggled to cope with the consequences of a decision by the city council in April to reduce the number of placements for patients admitted into long-term care from hospital from 200 to just 93.
Thankfully, the problem has now been resolved - at least for now. Between them, the health authority and city council have found a further£7m for social care. But at what cost? The council will now have to ditch or delay nearly£6m of other projects planned for this year, including the refurbishment of a children's home, and raid the reserves of its schools to come up with the cash. And that's just to resolve the immediate crisis.
Come the winter, when pressures start to build on health and social care providers once again, both partners will be searching for more money - perhaps even more than this year if it is a cold winter or we experience a flu epidemic. And in the longer term still, there is little prospect of a structural solution within existing cash resources.
The truth of the matter - as notable organisations ranging from Age Concern to the King's Fund health charity noted shortly after the general election - is that social care is desperately under-resourced across the country. Indeed, the King's Fund warned that care and support for older and disabled people could collapse unless the government found at least£700m this year.
Prime minister Tony Blair may have promised to spend the next five years labouring night and day to put the NHS right, and the health service is already reaping the benefits of his pledge last year to raise spending to something approaching the European average.
But while social care remains the poor relation, social care staff an under-trained, under-regulated and under-valued resource, and social services directors go in fear that the creation of care trusts may see their concerns lost amid the more immediate demands of hospital waiting lists and waiting times, he will not succeed.
Where Scotland has led the way, England and Wales must surely now follow. The time has come for Mr Blair to revisit the conclusions of the Royal Commission on Long-Term Care that he set up in the last Parliament, to acknowledge that there are high costs to the adequate provision of decent care for elderly people, and to find that money.
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