NHS Confederation calls for compulsory insurance to fund care of elderly people

BMJ 2008; 336 doi: (Published 01 May 2008) Cite this as: BMJ 2008;336:983
  1. Jacqui Wise
  1. 1London

    The United Kingdom should bring in compulsory insurance to cope with the care needs of the growing elderly population, argues the NHS Confederation, the body that represents the managers and directors of NHS trusts across the UK.

    Its debate paper Funding Tomorrow Today says that the current social care system is unable to deliver targeted social care to all those who could benefit from it, let alone universal provision.

    And things are only going to get worse, it says. The number of UK people aged over 65 years will rise by 400 000 over the next three years, the paper estimates, with a particularly steep rise occurring in the number of people aged over 85. Currently a quarter of people aged over 85 have some degree of mental impairment, it says, and in 30 years’ time one million people will have dementia and more than 480 000 people will be caring for elderly people, of whom a substantial number will themselves be elderly.

    The confederation’s chief executive, Gill Morgan, said, “It cannot be right that many people who have saved or invested money wisely feel penalised through, for example, having to sell their homes to pay for care in their old age or if they get sick.”

    The paper says that it is not realistic to rely on children to fund the care of the rising number of elderly people and people with long term health problems. “Tweaking around the edges” will not produce a solution, it says, and instead a radical rethink is needed. It says that the solution is a hybrid model combining a minimum level of government funded care with individual top-ups and compulsory insurance.

    Dame Gill said, “A system of social insurance that guarantees a level of care to the elderly and sick in keeping with the NHS’s values of fairness and social justice, with top-ups for those who can afford it and support for those that can’t, offers a fairer way forward.”

    The paper’s author, Nigel Edwards, director of policy at the confederation, calls for a greater focus on prevention rather than continuing to rely on rescue based approaches. He said, “Because of the need to make rapid decisions [and] the lack of availability of a 24 hour rapid response, people have been forced into choosing residential solutions, whereas home based alternatives might have been better.”

    The UK needs to look to other European countries where the benefits and income support systems are better connected, the paper says. In the Netherlands, for example, employees contribute 12% of their salary to social care insurance to cover the costs of long term care. Despite this personal insurance model, central and local government still exert high levels of control on the system.

    The paper suggests that bringing together commissioning of health and social care into a unified budget would bring advantages. Mo Girach, chief executive of the St Albans and Harpenden practice based commissioning group, argues that such commissioning of social care could improve coordination and management of care, particularly for people who are heavy users of both health and social care.

    The debate paper will be discussed at the NHS Confederation conference in July. Three further papers will be published in the lead up to the conference, on compassionate care, globalism, and disruptive innovation.

    Helena McKeown, chairwoman of the BMA’s community care committee, agrees that a new model to pay for a better standard of care should be created. “Current BMA policy still supports free personal care, but many of us within the organisation doubt this is sustainable for the quality we want for our vulnerable and elderly people in a civilised 21st century society.”


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