Chris Rose: 5 minute read

The NHS is free and therefore, why is Social Care not?

We assume that social care will, much like the NHS be free throughout our lives and with this precedence that the NHS creates, it is an understandable assumption. We have this illusion shattered at a point in our lives. In this moment, we find out that in reality, social care is not free and it is a bone of contention that continues to follow successive governments.

The public believes that social care should be free and so we ask the question, why can’t it be free? Is this possible? Is it feasible? Where would the money come from?

We are not the only ones that are asking this question

According to The Progressive Policy Think Tank (IPPR), the introduction of free personal care for the elderly could save the NHS nearly £5bn per year. This reform would have the additional benefit of increasing the number of people who have access to state-funded care from 185,000 to 440,000. This would reduce unmet need and relieve pressure on unpaid carers.

This sounds like a great idea but then as the thought percolates in your mind, you are reminded of the key question and that is cost. The money for a change such as this would need to come from somewhere. IPPR has worked through the costs and suggests that this would mean spending on adult social care would rise from £17bn to £36bn by 2030. A big increase and one that would be a hard sell for the government, to a public that has lived in austerity Britain for the last ten years.

IPPR suggests that the money could be raised through a 2% income tax increase. This would be hard to sell to families already struggling to even put food on the table. However, as IPPR points out, £11bn of this £19bn increase is set to happen anyway. This, for the eagle-eyed out there would still leave a gap of £8bn, with savings referenced being for the NHS and not social care.

The author of the report, Harry Quilter-Pinner and his team calculate that the savings for the NHS would reach up to £4.5bn per year. The change in approach would lead to an additional 70,000 jobs being created and shift hospital patients back to the community. This would go a long way towards negating avoidable costs, such as the near £1bn that is lost through Delayed Transfers of Care each year.

Is it morally right to make this change?

Moving beyond the simple cash calculations, would making social care for the over 65s lead to a better quality of life and a more person-centred approach? Harry Quilter-Pinner (Senior research fellow at IPPR and lead author of the report) believes so and commented:

“‘By investing in personal care so it is free at the point of need for everyone over 65, we can provide a better and more integrated care system, one that’s fairer to us all and saves the NHS £4.5bn a year.”

As an organisation, we (OLM) have spent nearly 30 years developing ways and means in which health and care organisations can better communicate and therefore, deliver care to a higher standard. It is for this reason that we applaud Mr Quilter-Pinner for his efforts in coming up with a possible solution to provide free care to the over 65s.

Anything that moves the narrative along and makes a difference, leading to person-centred care being realised is something that we can get behind. Whilst the wording and manner in which this should be conveyed to the public will be up for debate, you cannot argue with the vision. For too long health and social care have lived separate lives, yet interact with the same people and so why wouldn’t you investigate making social care free for everyone over the age of 65?

Social care is expensive

You could arguably take the social part away from this subheading as care, in general, is expensive. It is a fact that is emphasised through the near £1bn in debt that the NHS ended with at the end of 2018. Despite having a budget in excess of £100bn, the NHS is in debt and this is increasing each year.

Short term boosts in finance are consistently promised and delivered but in recent years, end up being spent on clearing debt. By thinking about this plan from IPPR, you do have to wonder where the money is coming from and would a plan be in place? To fund a scheme like this would require a massive political consensus, with buy-in from health and social care leaders. They would need a direction and they would need a long-term plan.

We would wholeheartedly back a debate that would discuss the benefits of health and care to work together. It is the direction required and we need to embrace this mentality if we are to get through Brexit still placing people first. Yes, the outlay to any scheme such as this would be eye-watering but it would be worth it for the moral applications living behind the scenes. The current split between health and care being discussed in the IPPR report:

‘If you develop cancer in England you are cared for by the NHS, free at the point of need for as long as it takes, but if you develop dementia you’re likely to have to pay for all your own social care – running up potentially catastrophic costs in the last years of your life. This makes no sense,’ said Harry Quilter-Pinner.

Do we believe that making personal care free would lead to savings?

That is a difficult one to answer without established, quantifiable data. What we do know is that health and social care are two sides of the coin and need to be kept as close together as possible to ensure that person-centred care is realised. People will inevitably need both in life, health and social care.

The NHS will take care of your ailment’s and then when you are ready to be released, you need to ensure that the appropriate, ongoing care has been provided via social care. Without which the process stalls. The individual is kept in the hospital, which can lead to further ailments when they should be in a more suitable environment. The two organisations being separate leads to delays and issues occurring such as those seen with Delayed Transfers of Care.

By combing the two into one, ensuring that they share funding, we believe you would be able to make savings through shared operational priorities and procedures. This above everything else would result in person-centred care being prioritised, with efficiencies emerging. These efficiencies providing the ability for staff members to get patients to where they truly need to be, quicker. By working as one this dream can be realised.


The NHS is free and social care is not. We believe that by combining the two of them under one funding source and one shared organisation, you would be able to create efficiencies and enable person-centred care. The needs of the patient would be mapped out easier, with each stage of care being carefully thought through.

This level of shared thinking and responsibility would enable person-centred care but before these dreams can be realised, the question of funding would need to be answered. Cross-party support would need to be directed towards health and care. Other considerations such as Brexit would need to be parked and attention directed here, arguably where it is needed most. The way in which we treat the most vulnerable members of society is the true measuring stick of society.

A true long-term funding plan that combines the ambition of the NHS Plan and the promise of the Green Paper can help to create a system in which patients are placed first. The system by this token then becomes self-sustaining and would be around for generations to come. Its time that we flipped the view on care, became proud once more of our health and care services, rather than running in the other direction.

Let’s campaign for the true combining of health and social care. Let’s invest in technology to create a system that is as efficient as possible and will underpin developments for years to come. Let’s work together to ensure that the system, whether free or not, is made fairer and something that we are proud of rather than a building without concrete foundations. Whether we like it or not, the future is here and we need to act.