Simon Stevens says key to tackling the challenge of paying for care of ageing population is ‘intergenerational fairness’

Britain urgently needs a new political consensus on paying for elderly and social care, and the funding debate should consider the value of pensions and homes, the boss of the NHS has said.

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Simon Stevens argued that one of the main questions in tackling the challenge of how to pay for and look after an ageing population was whether some of the money spent on increasing state pensions should instead be allocated for social care.

In an interview with the Guardian, the NHS chief executive said that David Cameron’s administration should look at all the options for finding the billions of pounds needed, including revisiting the “triple lock”, which guarantees Britain’s pensioners generous annual increases in their state pension until 2020.

“What are the pros and cons of dedicating some of the proceeds of the triple lock to older people’s social care?” he asked. The triple lock promises to raises the state pension every year by the higher of inflation, the increase in average earnings or 2.5%.



Facebook Twitter Pinterest Simon Stevens at an art therapy session for teenagers at Maudsley hospital. Photograph: Felix Clay/The Guardian

Stevens also suggested ministers should also be prepared to risk upsetting Britain’s growing army of senior citizens by looking at whether the benefits they receive are fair to working-age and younger people.

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“Would intergenerational fairness support a further increase in the share of public funding on retirees, at the expense of children and working-age people? Does there need to be more flexibility between current disconnected funding streams for older people, so that at times of need everyone is guaranteed high quality social care?” Stevens said.

He floated the idea that it could become “easier for families to flexibly fund social care by drawing down resources tied up in housing, pension pots, and other benefits and entitlements”.

The comments raise questions about whether he thinks it is time to stop giving all pensioners regardless of income benefits – such as free TV licences, prescriptions and bus passes and the winter fuel allowance – to free up money for social care.

Social care is funded by cash-strapped local councils, who have had their budgets cut by 40% over the past five years. It includes services such as help for people at home with basic tasks such as washing and eating as well as adjustments to homes to reduce the risk of a frail, elderly person falling, such as grab-rails.

NHS England’s chief executive fears the service will be unable to cope if the recent decline in help received by older people from social care services, especially in their own homes, continues to increase demand for medical care and problems of hospitals becoming overcrowded.



He wants the government to rescue social care services from their downward spiral of funding cuts and increasing unmet need by reaching an agreement on how such care will be paid for by 2018, to coincide with the NHS turning 70.

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“2018 will be the 70th birthday of the NHS. That will be a fitting moment to seek, as the NHS turns 70, a new national consensus on properly resourced and functioning social care services,” he said.

Without urgent attention being given to the “pressing” issue of social care, the inadequacy of local provision would keep having a big impact on hospitals, GP surgeries and other health services, he said.

Even more older people would become trapped in hospital despite being fit to leave – a key reason hospitals run out of beds – and more operations would be cancelled unless ministers started seeing social care as a top priority, he said.

Stevens said he wanted the Westminster parties to start talking to each other now, well ahead of the 2020 general election, and find “a settled and durable new political consensus” on social care funding.

However, the parties’ responses suggested that Stevens’s appeal for a constructive debate between them had, initially at least, fallen on deaf ears.

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A government spokesman declined to commit it to seeking cross-party agreement and simply reiterated its existing plans for social care in England, which many – including Stevens – believe do not address the scale of the problem.

“Simon Stevens is right to highlight social care funding in the context of our ageing population. That is why in the spending review we gave local authorities access to up to £3.5bn extra a year by the end of the parliament with the social care precept and additional investment,” the spokesman said.

Organisations including the Local Government Association, King’s Fund health thinktank and Age UK have criticised the 2% levy on council tax as unlikely to raise anywhere near the sums ministers claim and no substitute for proper funding from central government for such key care.

Labour claimed that “Simon Stevens’s comments are further evidence that the government’s plans for funding social care are completely inadequate.”

Heidi Alexander, the shadow health secretary, said cuts to social care over the past five years had left “hundreds of thousands of elderly people without the care and support they need to live independently and with dignity”.



She added: “There is an important debate to be had about how we reform and fund health and care services for the future. However, this debate cannot be left to politicians alone. We need to have a national conversation, with the public, about how we can guarantee the future of health and care services for generations to come.”

She declined to speculate on where the money might come from and said that Labour would soon launch its own review of the subject.

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Norman Lamb, the Liberal Democrats’ health spokesman, said a consensus was vital “The NHS and social care face an existential crisis,” he said. “Demand for services continues to rise year on year but funding is failing to keep up”.

Lamb, a health minister until last May, said the approach by Stevens endorsed the call he had been making for more than a year for a cross-party commission to investigate how much money health and social care would together need in the future and agree where the money should come from. Alan Milburn, the ex-Labour health secretary, and Stephen Dorrell, health secretary in John Major’s Tory government, are backing Lamb’s initiative.

“The government cannot avoid this issue any longer. These issues transcend narrow party politics and that we should be prepared to work together,” Lamb said.

The NHS boss told MPs on Monday that English hospitals’ fast-ballooning deficits were largely down to the exorbitant fees for temporary staff charged by employment agencies who are “ripping off” the taxpayer.



Hospitals could spend as much as £4bn on temporary and agency staff this year, Stevens said while giving evidence to the Commons public accounts committee. That is much more than the £2.6bn spent in 2013-14 and last year’s £3.4bn and reflects hospitals’ increasing reliance on temporary staff, including locums, because of serious personnel shortages.

Stevens said the soaring bill for temporary workers lay behind “the vast majority if not all” of the record £2bn-plus deficit that trusts are forecast to run up.

Some MPs said that rising costs were inevitable, given the extra staffing needed to maintain quality of care. But Stevens voiced frustration that indebted hospitals swallowing up £1.8bn of the extra £3.8bn the NHS will receive in 2016-17 meant that less money was available to spend on primary care, including GP services.