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We have invested in increased longevity, now we must invest in its implications

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We cannot continue to rely on laudable but piecemeal initiatives, says the president of the Association of Directors of Adult Social Services

The careful consideration of the issues by the expert panel in the Barker Commission is an important contribution to the debate about the future of health and social care and is to be welcomed.

This is the most important discussion that will take place in the first part of this century. Our modern, wealthy society has to decide how much it is going to set aside from national income to meet health and care needs; what contribution the state will make; and what we expect from our citizens in terms of a contribution.

We are living longer – and that is fantastic. But to the extent that we have invested in research and interventions to increase our longevity, we must invest in ways of dealing with all the implications that arise.

The reason why it is such a big issue is simple: it’s the numbers. The number of people who need care is set to rise dramatically as the number of people over the age of 85 is set to double in the next two decades. This is a major worldwide issue. As need increases the requirements on the system become more complex and we cannot continue to rely on laudable but piecemeal initiatives.

The concerns about meeting need in a way that is appropriate as the money available decreases was emphasised by the Adass budget survey published in July. This showed that savings of 26% have been required of adult social care in four years, taking account of the cash reduction and increase in need over this period.

The Barker Commission rightly points out that the country does need to recognise that expenditure will need to increase as a proportion of gross domestic product (as opposed to the dramatic decrease we are currently experiencing in social care funding).

The commission has explored ways of bringing in money and the connections with the welfare system. There are attempts to design a system that is graduated according to need and simplified. We will all want to consider the proposals and test them over the coming weeks.

We are less wedded to the idea of a single budget than the need to ensure that plans for individuals are centred around their needs and co-ordinated. Services are delivered locally by health and social care professionals and should be accountable to local people through local democracy. Of course it remains for Parliament and ministers to ensure that national requirements are set and that the means exist to deliver the health and care we expect.

Commissioners make the far-reaching proposal that social care should be free; and they provide some clear priorities – for example that this should start with the funding of critical care. There is no doubt that creating a more coherent payment structure would serve to remove some of the barriers to a more integrated approach.

We do, however, have to make sure that there is sufficient quantum of funding – a free system that is poorly funded may well serve to create an illusion of progress.

This report lands at a crossroads for public services and expenditure. Rising needs, falling resources and a desire to see a more integrated, personalised system. Thank you to the Barker Commission for highlighting the issues and prompting the debate.

In the lead up to a general election whatever the merits of the specific proposals, there is no doubt of the need to seek coherent and clear solutions.

David Pearson, president, Association of Directors of Adult Social Services

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