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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
Report
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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