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Views And Reviews

We need a social care system that is as much a source of national pride as the NHS

BMJ 2019; 365 doi: (Published 24 June 2019) Cite this as: BMJ 2019;365:l4349
  1. Anita Charlesworth, director of research and economics
  1. Health Foundation, UK
  1. Anita.Charlesworth{at}

The social care system is at breaking point and reform is long overdue, says Anita Charlesworth

History casts a long shadow and often it’s the choices that seem less important in the moment that have the biggest long term impact. In 1948, older and disabled people were divided into the “sick,” who were placed in hospitals, and those needing “care and attention,” who were placed in residential homes. Hospitals were integrated into the new National Health Service while those providing “care and attention” formed the social care system run by local authorities. Whereas NHS services were free at the point of use, local authorities could levy means tested charges for residential and community social services. The die was cast.

Fast forward over 70 years and we see that this divide has had profound implications. For all its faults, the NHS has grown and prospered. Since it was established, UK spending on the NHS has increased 12-fold when you adjust for inflation. In recent years, social care has become the poor relation; while NHS funding …

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