The vital fabric of civil society that supports people’s health and wellbeing is withering and, especially in poorer communities, resembles a wheel with the rubber worn away (Cuts are hurting people and politics. But who will break the impasse?, Editorial, 2 July).
Too many useful services, such as children’s centres, have been lost – despite recent confirmation of how Sure Start improved the health of families, and thus benefited the NHS.
People need decent homes; opportunities to build their skills and confidence, so as to find work or other meaningful activity; places to meet their neighbours; arts and culture; support to learn how to manage their health; outdoor spaces and managed facilities to exercise and relax.
More vulnerable groups need support such as youth services, dementia cafes, parenting support, carer respite, as well as advice and information.
These services and activities are (or were once) paid for by local councils, and often led and provided by the local voluntary, community and social enterprise (VCSE) sector.
The NHS may have had its funding protected, but many of its 10-year plan goals cannot be met in these circumstances. Indeed, for the first time since the second world war the rise in life expectancy has stalled; and the gap between healthy life expectancy for rich and poor has widened.
The government has reduced funding to all local authorities – but disproportionately to the poorest areas – cut the public health grant, and failed to decide on the future for social care. This summer’s prevention green paper is an opportunity to put some of this right.
We, as leaders of England’s VCSE sector, call on national political leaders to reverse the cuts to councils’ public health grants; focus the prevention green paper on the need to rebuild communities and places; and create a wellbeing fund to rebuild and sustain vital services and support in communities, in line with the growing national evidence base for their effectiveness.
Dr Charlotte Augst Chief executive, National Voices
Vicky Browning Chief executive, Association of Chief Executives of Voluntary Organisations (ACEVO)
Tom Watson Business manager, National Association for Voluntary and Community Action
Chris Askew Chair, the Richmond Group of Charities
Alex Fox OBE Chair, Joint VCSE Review
Dr Rhidian Hughes Chief executive, Voluntary Organisations Disability Group (VODG)
Caroline Abrahams Co-chair, Care and Support Alliance
Paul Bristow Acting chief executive, Kidney Care UK
Anna Dixon Chief executive, Centre for Ageing Better
Sandra Gidley Chair, English Pharmacy Board, Royal Pharmaceutical Society
Sarah Hughes Chief executive, Centre for Mental Health
Sally Light Chief executive, Motor Neurone Disease Association
Sarah Mann Director, Friends, Families and Travellers
Paul Martin OBE Chief executive, LGBT Foundation
Prof Tahir Masud President, British Geriatric Society
Alison Taylor Chief executive, Children’s Liver Disease Foundation
Dr Dale Webb Chief executive, National Ankylosing Spondylitis Society
Kevin Weston Chair, Lupus UK
Donna Wicks Chief executive, Hypermobility Syndromes Association
Sarah Wootton Chief executive, Compassion in Dying
Lord Victor Adebowale Chief executive, Turning Point
• Your editorial highlights “the problem” of social care – ie funding – but it is not the only one. In reality, there are several others as important.
First, social care is almost wholly located in the private sector (for profit), often of poor quality and usually distributed in geographical areas wealthy enough to generate it – if not, private providers move off to other more lucrative settings, leaving councils holding the baby with the financial burden on them and the NHS, increasing year by year.
Second, as long as local authorities are responsible for its funding (for those meeting the means test), councils will fall prey to the depredations of unfriendly governments bent on shrinking the state – forcing councils to deny support to needy citizens. It means that, currently, integrating social care with NHS services (with consequent savings and other efficiencies) is impossible because the two funding streams are different, with each system defending its own territory in hard times.
Finally, the issue of who pays then comes into play. Means-testing council services has always been permissible while the NHS has always been free at the point of use. Bringing social care services themselves (not just their commissioning and purchasing) into the public sector would mean that there was no such difference. Funding would come from a common source (from central funding via general taxation) and wholescale planning to meet demand, fairly distributed across the country, becomes feasible. Put simply – bring social care into the public sector and “the impasse” you describe will be broken.
• The criticism in your editorial about “both main parties disgracefully playing politics” over social care in the 2010 and 2017 elections asserts a false equivalence. Labour’s 2010 so-called death tax would have pooled risk among the asset-rich elderly, just as you advocate; the Conservatives’ 2017 “dementia tax”, in contrast, would have taxed only the assets of those randomly affected by such chronic conditions. Although you have regularly criticised the party for doing so, Labour was absolutely right to reject the latter approach.
Huddersfield, West Yorkshire
• What an indictment of government social policy. Having effective multi-agency safeguarding measures to identify and refer maltreated children, young people and vulnerable adults (Met flags up 700 welfare and abuse cases a day, 2 July) but failing, first, to adequately fund councils to continue to provide preventative services and, second, to lift families and children out of poverty, both of which contribute directly to increased demands on out-of-home care and its attendant costs (Councils warn of fresh cuts in fight to avoid bankruptcy, 2 July).
Prof Mike Stein
University of York