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Chapter 1 - Introduction

The need for greater integration between health and social care services has

long been acknowledged and accepted, yet very limited progress has been

made in transforming the system. After decades of health modernisation and

reform, the Labour Government of Tony Blair acknowledged the 'Berlin Wall'

between health and social care, calling for its demolition in 1997.1

Yet, more than a decade and a half on from this declaration, it's clear that our

current system is still not working as it should. In recent months NHS England

A&E performance has been under extreme pressure, resulting in a deluge of

national coverage describing a health and social care system in crisis.

These headlines are indicative of intense pressure across the whole health and

social care system. The system is plagued by numerous problems including

delayed transfers of care, unnecessary hospital admissions and enormous cost

pressures. All of which, we argue, can be traced back to the fact that we do not

have a system that considers the full range of an individual's needs. Rather we

are stuck with a system that is built upon a stark, disruptive and, in the minds of

many, arbitrary distinction between health and social care.

A radical rethinking of services is required in order to provide person-centred,

co-ordinated care. However, despite there being widespread recognition of

the need for such change, there still exists huge cultural, financial and structural

barriers preventing greater integration. And the biggest impact of this impasse

is on our ageing population.

1.1 An ageing population

Demand for both health and social care in England is rising significantly.

This is partly as a result of an increasing population, but in particular due

to the inexorable ageing of that population. Significant and very welcome

improvements in standards of living and medical care over the last century have

resulted in a higher number of people surviving into old age. In 1948, when

the NHS was founded, 48 per cent of people died before the age of 65. Today

that figure is down to 14 per cent.2 By 2030 it has been estimated there will

be 51 per cent more people aged 65 and over in England compared to 20103

and that by 2037 the number of those over 80 will have doubled to 6 million.4

Having an ageing population is a huge asset for the country. It expands the

available workforce, and offers a wealth of experience. And while many

older people enjoy a well-earned retirement, that often includes other forms

of contributing to society, for example through volunteering. Millions of active

grandparents also provide hugely valuable support for working families, which

also has knock-on benefits of supporting the family and hence wider social

cohesion. In 2013 it was estimated that the value of grandparental childcare in

the UK was £7.3 billion-up from £3.9 billion in 20045 with one in four working

families depending on grandparental care.6 Informal childcare provided by

grandparents is particularly important for lower and middle income women

who may struggle to afford formal care and are less likely to return to work

after maternity leave. A report for the Department for Work and Pensions found

that 54 per cent of families received regular help from grandparents to provide

childcare after the mother returned to work.7

1 Department Department of

Health Press Release 97/274.

Select Committee on Health, First


2 The King's Fund, Making our

health and care systems fit for an

ageing population (2014)

3 Select Committee on Public

Service and Demographic

Change, Ready for Ageing?

4 The King's Fund, A new

settlement for health and social

care (2014)

5 Grandparents Plus, Policy

Briefing 04, (May 2013)

6 Department for Education,

Childcare and early years survey

of parents 2011 (January 2011)

7 Department for Work and

Pensions, Maternity and

paternity rights survey and

women returners survey

2009/2010 (2011)



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