Whenever I think of the question of providing social care, I think back to a story told to me by an ICU nurse, about an elderly couple coming into the unit on a cold night in January. The wife was seriously ill, the husband was physically fine but was suffering from dementia. His wife was his primary carer. ‘Sending him home on his home would have been essentially killing him,’ the nurse told me. ‘So I admitted him as well.’
That story frequently resonates with me: the limits of what we provide in care as a society; and how often our interventions are delayed to the point of catastrophe. I thought about it this week, when the Prime Minister announced his long-promised plan to ‘fix social care, once and for all’.
At the time – like many of Mr Johnson's promises – it had felt like a big cheque, which his account would struggle to honour. And so it was. In the end, what we got was a cap on care costs, financed by a rise in national insurance contributions. Nothing was said of the structural issues thrown up by an ageing population, and an undervalued workforce of careers voting with their feet. There was something peculiarly British about how it essentially turned into a row about tax, rather than a proper conversation about what sort of care system we actually need. Like a couple arguing about the minutiae of competing mortgage rates, before they’ve agreed on what house they actually want to move to.
There are big ideas around: in a country as rich as the UK, we should at least discuss universal personal care. It will come with a price tag and its own drawbacks, but without such a discussion, I fear we’ll trundle on through many more January nights, and many more old folks taking up acute beds they don’t need. Because there is nowhere else for them to go.