Listening to Yuval Noah Harari speak about his new book to the RSA recently, I heard him answer a question about climate change. He pointed out that with national governments we are trying to solve global problems and so far, it hasn’t been very successful. He also suggests that the 21st century might see entirely new forms of government emerge that are more fit for purpose in the new environment than the democracies of the late 20th century.
There are many whole problems we face today that we as a race are trying to solve in bit parts. Not all of them are global, like climate change.
Take one chunk of a larger problem: the health and social care of an ageing population. Some rough-and-ready maths based on this data from The Guardian suggests that by the late 2030s, people over 65 will consume more than half of the NHS budget. What the NHS looks like by this point is a different question. Assuming it still exists in something like its current form, it will require significantly more funding to support our ageing population.
Speak to anyone in the NHS and they will tell you that a lot of the cost of older people is not really down to medical care. Lots of the people who visit hospitals and end up staying a long time have conditions that aren’t acute and can’t be treated in hospital. But there is nowhere else for them to go. People turn up at doctors surgeries because they are lonely or have no-one to meet even their most basic needs.
The solution is not to pour more money into the NHS. It’s to address the problem as a whole: social care, independence, loneliness. There’s a political argument to be made about the funding for services that historically addressed these issues. But that argument is desperately difficult to make in a national context. Since putting the various services that would need to co-operate to solve it into a single coherent organisation and budget would produce a terrifying, unwieldy and likely, politically-unpopular beast.
Instead the problem has to be addressed at a manageable scale. The first experiment in this in the UK will be Manchester, with the devolution of health and social care budgets, and a plan to integrate their operations detailed a year ago in this document. The ideas are sound, encompassing a whole-life view designed to tackle the reasons people end up needing extended health care, not just the costs when it finally happens. It is hoped this will help the combined authority save the approximately two billion shortfall against the projected budget requirement in 2020/21 under the current system.
Unless you’re engaged in this programme there’s little evidence of it beyond the walls of the NHS so far. But the implementation phase is due to begin in October.
I will be watching with interest.